Adverse childhood experiences, depression, and cardiometabolic disease in a nationally representative sample

Adverse childhood experiences (ACEs) and depression are both independently associated with increased risk of diabetes and cardiovascular disease (CVD). The objective was to determine if the association of ACEs, examined with Latent Class Analysis (LCA), with CVD and diabetes was stronger in patients with versus without depression.

Participants were 78,435 non-institutionalized adults in the United States completing the ACEs module in the 2011-2012 Behavioral Risk Factor Surveillance System. LCA grouped participants into ACE classes. Respondents self-reported ACEs and lifetime depression, diabetes and CVD. Complex survey weighted logistic regression models assessed the relationships between ACEs, diabetes, and CVD overall and in those with and without depression.

Half of participants were female (48.6%) and 82.3% White, non-Hispanic. LCA identified a four-class solution characterized as 'low adversity', 'verbal/physical abuse', 'sexual abuse', and 'high adversity'. The odds ratios for each ACE class and diabetes were similar in those with and without depression. An overall adjusted model showed that 'sexual abuse' versus 'low adversity' was significantly associated with diabetes (OR = 1.30; 95% CI: 1.05-1.61). Effect modification was present for CVD such that among those with depression, but not among those without, 'high adversity' had over two times the odds of CVD than 'low adversity' (OR = 2.17; 95% CI: 1.06-2.93).

'High adversity' in those with but not without depression is positively associated with CVD. 'Sexual abuse' is positively associated with diabetes independent of depression. The study is relevant to trauma-informed care and highlights the contribution of ACEs and depression to poor health outcomes.