Same storm, different boats: Robust yet unequal links between adverse childhood experiences and depression in 12,638...

Early-life adversity is a well-established risk factor for depression, yet the extent to which this relationship varies across adverse childhood experiences (ACEs) subtypes and socially-defined groups remains unclear.

This study examines the robustness of ACE-depression links and model intersectional heterogeneity.

Data was collected annually from first-year undergraduate cohorts at Guangzhou, China, between 2017 and 2024 (N = 12,638).

Specification Curve Analysis (SCA) was employed to examine the robustness of ACE-depression associations across model specifications. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was then used to reveal how unique configurations of sex, single-child status, place of origin, and family socioeconomic status (SES) modify ACE-related depression risk.

Across 320 analytical specifications, exposure to ACEs exhibited a consistent, positive association with depressive symptoms (all p < .001). Among the ten ACE subtypes examined, emotional abuse displayed the strongest effect (median β = 9.77, median OR = 7.34), whereas parental divorce the weakest (median β = 2.62, median OR = 1.89). Within each of the 24 intersectional social-strata combinations, emotional abuse remained significantly linked to clinically significant depression. SES emerged as the most potent moderator: individuals from lower-SES families-especially those who were female, urban-born, or had siblings-displayed the highest depression levels following ACE exposure.

The ACE-depression link is robust yet highly heterogeneous across adversity types. Low SES amplifies vulnerability more than any other sociodemographic factor, underscoring the urgency of trauma-informed, equity-focused interventions during the high-risk university transition period-most critically for survivors of emotional abuse.