The intersection between race/ethnicity and adverse childhood experiences and its association with depression

We assessed the association between number of adverse childhood experiences (ACEs) and depression among adults and explored the association by race/ethnicity.

We used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) among 127,577 adult respondents (≥ 18 years old). The exposure was the number of ACEs classified as zero, one, two-three, and ≥ four. The outcome was a self-reported history of depression diagnosis (yes/no). Weighted multivariable logistic regression models examined the association between ACEs and depression stratified by race/ethnicity. Each model was adjusted for age, gender, smoking status, income, education, marital status, and body mass index.

In this sample, 36%, 23%, 21%, and 20% reported having experienced zero, one, two-three, and ≥ four ACEs, respectively. Depression was reported by 19% of survey respondents. There was a significant interaction between the number of ACEs and race/ethnicity, and depression (p = 0.0003), thus, analyses were stratified by race/ethnicity. Respondents who experienced ≥ 4 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR = 4.07; 95% CI: 3.55, 4.65), non-Hispanic Blacks (aOR = 3.96, 95% CI: 2.68, 5.86), or Hispanics (aOR = 7.73; 95% CI: 4.48, 13.35). Respondents with 2-3 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR: 2.41, 95% CI. 2.11- 2.76), non-Hispanic Blacks (aOR: 1.94, 95% CI. 1.19- 3.17), and Hispanics (aOR: 2.86, 95% CI. 1.64- 4.98).

We found that individuals with two or more ACEs were more likely to report a depression diagnosis, irrespective of race/ethnicity. This finding highlights the need to monitor individuals with an increasing number of ACEs for depression.