Childhood Interpersonal Trauma and Depression of Middle-Aged and Older Adults in China: The Mediation Effect of Social Integration

Abstract

Objectives: This study investigates the associations between five types of childhood interpersonal trauma (CIT) and depression in mid-later life, as well as the mediation roles of social integration in the associations. Methods: Two waves of data from a nationally representative survey in China were used, with participants aged 45 years and older (N = 14,180). Measures of CIT included physical abuse, physical neglect, emotional neglect, bullying victimization, and exposure to interparental violence. Binary logistic regression and Karlson–Holm–Breen mediation analysis were used as statistical methods. Results: People who were bullied, physically abused, and witnessed interparental violence during childhood were more likely to develop depression in mid-later years. The associations between CIT and depression were mediated by satisfaction with marriage, satisfaction with children, and perceived social support. Discussion: Although CIT elevates the risk of depression in later life, effective interventions that strengthen integration across family and social domains could benefit mental health.

Keywords

childhood interpersonal trauma depression family relationships perceived social support social integration

Introduction

Depression is a leading public health concern worldwide. Approximately 5% of adults and 5.7% of older adults aged over 60 years were affected by depressive disorders globally (World Health Organization [WHO], 2021). In China, the overall prevalence of depressive symptoms among older people has been estimated at around 20% (Tang et al., 2021). Therefore, it is vitally important to mitigate and prevent depression by identifying its risk factors. From a life course perspective (Kuh et al., 2003), late-life depression could be attributed to adverse experiences in early life. Previous studies have primarily focused on the health consequences of childhood socioeconomic disadvantage (Cui et al., 2020; Torres & Wong, 2013), household dysfunction (e.g., parental psychiatric disorders) (Angelini et al., 2016), individual health conditions (Yao, 2021), and neighborhood problems (Baranyi et al., 2019) on mental health in old age.

However, the chronic influence of childhood interpersonal trauma (CIT) has not been fully recognized among a variety of adverse exposures. Relative to non-relational experiences, the detection of interpersonal stressors was more challenging due to the hidden and invisible features embedded in relational contexts. Nevertheless, interpersonal trauma was most commonly experienced, with 30% of youth living in welfare institutions self-reported to be interpersonal victimization (Fischer et al., 2016). Moreover, interpersonal adversity may cause more detrimental consequences for mental health as interpersonal stressors were revealed to be the strongest predictors of emotional distress and depression (Epel et al., 2018). Given the fundamental motivations for humans to establish and sustain social bonds, it is crucial to diagnose interpersonal victimization and to disentangle the long-reaching influences of CIT on depression in later life. Thus, this study aims to examine the associations between multiple forms of CIT and depression, as well as its underlying mechanisms from the perspective of social integration.

Childhood Interpersonal Trauma and Depression

Conceptually, interpersonal trauma is related to another person or a social group who jeopardizes the victim by violating the basic ethics of social relationships and social norms (Finkelhor, 2008; Lilly & Valdez, 2012). In this way, these interpersonal traumas are harmful to children because of the malevolence, betrayal, and injustice enacted by other human actors (Finkelhor, 2008). Centered on adverse relational contexts, CIT may undermine an individual’s sense of agency, identity, and self-worth (Brown et al., 2012). These negative perceptions of self and social environments further develop into chronic psychosocial stressors in one’s daily life, leading to a series of post-traumatic stress symptoms and misbehaviors (Garami et al., 2019; Ramos et al., 2022). Particularly, exposure to interpersonal adversities at a critical developmental phase (e.g., childhood) could exert long-lasting influences on mental health throughout life. Numerous studies have consistently found that people with a history of childhood maltreatment, such as physical/emotional neglect or physical/emotional/sexual abuse, exhibited more severe depressive symptoms in old age (Dugal et al., 2016; Humphreys et al., 2020; Wang et al., 2022; Yang et al., 2020).

Notably, the sources of interpersonal trauma and relational adversities are complex. D’Andrea et al. (2012) suggested that interpersonal trauma should encompass a wide range of experiences of maltreatment and interpersonal violence that took place in relational contexts from family to community and school. Although childhood maltreatment was found to affect depression, limited studies have examined whether the CIT caused by peers (e.g., being bullied) or through indirect manner (e.g., witnessing parental violence) was related to the life-long mental disorders. It has been suggested that the associations and mechanisms between CIT and mental health may vary with different forms of interpersonal trauma. The biological hypothesis proposed that some traumatic experiences in early life directly trigger a series of stress responses and physiological activations in the body (De Bellis & Zisk, 2014). For instance, Cicchetti et al. (2010) found that children who experienced physical abuse were more likely to suffer limbic–hypothalamic–pituitary–adrenal axis dysregulation than those who reported emotional abuse or neglect. Alternatively, the cumulative disadvantage hypothesis postulated that childhood traumatic events may indirectly affect mental health in adulthood by changing the life-course pathways, such as risk, resource, and behavioral selection (Dannefer, 2003). Wu et al. (2018) revealed that the association of adulthood depression with childhood neglect, but not with childhood physical abuse, was partially mediated by individual personality traits (e.g., gratitude). To reach a more nuanced understanding of diverse traumatic experiences in childhood, therefore, it necessitates a deeper examination of the associations between different types of CIT with depression in mid-later life and potential pathways that may explain such relationships.

In addition, some scholars (Nelson et al., 2020) argued that the effects of specific childhood trauma on mental health were conditional on social and cultural contexts as the interpretation of interpersonal adversity may differ in various contexts. Unlike the dominant values of individualism and equality in Western societies, the Confucian culture in China advocates children’s obedience to parents and hierarchical relationships within family. For example, parental corporal punishment of children is deemed acceptable in traditional Chinese society because it is perceived as an expression of involvement, concern, and love for children (Liu & Wang, 2018). Hence, it might be plausible that physical abuse in childhood may affect mental health of Chinese adults differently compared to Western counterparts. Considering that the majority of empirical studies on interpersonal trauma are based on Western settings (Fischer et al., 2016; Garami et al., 2019; Humphreys et al., 2020; Ramos et al., 2022), a study of aging Chinese adults is warranted to provide new evidence that how specific CIT may be relevant for depression in mid-later life from a non-Western perspective.

Mediation Effect of Social Integration

The underlying mechanisms linking early traumatic interpersonal experiences to depression in later life have not been fully investigated by extant literature. In this study, we examined the role of social integration in mediating the associations between different types of CIT and depression in mid-later life. Social integration refers to the degree to which an individual is integrated into social groups (e.g., family, community, and society), and it plays a pivotal role in shaping well-being outcomes (Berkman et al., 2000; Nakagawa & Hulur, 2020). Family is the fundamental source of social integration, and integrating through family relationships (e.g., marriage and intergenerational relationships) provides individuals with a sense of connection to wider society (Knoester & Haynie, 2005). The relationships with spouse and adult children are the “bonded, connected, and close feelings people have toward each other” (Barnes & Sternberg, 1997). It reflects the integration process where individuals foster emotional closeness, develop intergenerational solidarity, and reinforce family cohesion with core family members (Bengtson & Robert, 1991). Beyond the family setting, this study also examined additional two indicators of social integration, namely, social engagement and social support, to present the extent to which people were integrated into broader social environments (Cohen et al., 2000). Social engagement denotes the participation in social activities through which the interactions with environments and in-group members can integrate people together based on the practice of shared resources and meanings (Aroogh & Shahboulaghi, 2020). Social support is the functional aspect of social integration, referring to a person’s perception of available assistance or support derived from social networks (Cohen et al., 2000).

It has been established that close relationships with spouses and adult children are beneficial for mental health among older adults (Liu & Upenieks, 2021; Zhou & Bai, 2022). However, people with a history of CIT may report poor family relationships in adulthood compared with those who did not. According to attachment theory, humans naturally have the need to seek a secure attachment with others in childhood, which is the basis for developing a lasting and loving relationship in adult life (Bowlby, 1969). Yet interpersonal traumas in childhood disrupted the formation and maintenance of intimate relationships in family contexts (Colman & Widom, 2004). Victims of CIT tend to report more abandonment anxiety and avoidance of intimacy (Dugal et al., 2016). Consequently, people experiencing CIT may be less likely to sustain high-quality close relationships with their spouse and children, which in turn impaired their well-being in later life.

Beyond the family setting, exposure to CIT might have repercussions on broader social relationships. It has been found that people who experienced CIT encountered more difficulties in building interpersonal effectiveness, providing positive responses, or establishing boundaries in social interactions (D’Andrea et al., 2012). Evidence has also shown that early life interpersonal adversities were associated with the lack of social resources (Ferraro et al., 2016), eroding the opportunities for social engagement and acquiring social support (Nishio et al., 2022; Sperry & Widom, 2013; Su et al., 2022). Hence, it is projected a chain of risk that older adults with CIT may be more likely to withdraw from social activities and lack social support, which could further increase the risk of depression in mid-later life (Gariépy et al., 2016; Tengku Mohd et al., 2019).

The Present Study

As shown in Figure 1, this study aims to (1) examine the associations of multiple forms of CIT (i.e., physical neglect, emotional neglect, physical abuse, being bullied, and exposure to interparental violence) and depression of middle-aged and older Chinese adults; and (2) investigate the mediation roles of social integration in the family (i.e., satisfaction with marriage and children) and in broader social contexts (i.e., social engagement and perceived social support) in the associations between CIT and late-life depression. We first hypothesize that CIT is positively associated with depression (Hypothesis 1). Further, we propose another set of hypotheses that the associations between CIT and depression could be mediated by satisfaction with marriage and children (Hypothesis 2) and social engagement and perceived social support (Hypothesis 3). The results of this study will disentangle the effects of diverse forms of CIT on mental health in mid-later years. It will enrich the current understanding of different interpersonal experiences and their implications for depression in a non-Western social and cultural context. More importantly, the exploration of social mechanisms could shed new light on the chain of risk in bridging CIT and late-life depression over time since no prior research has extensively examined social integration in spheres of both family and broader society.

Method

Data and Participants

Data for this study were derived from the China Health and Retirement Longitudinal Study (CHARLS). CHARLS is a nationally representative cohort survey of adults aged 45 years or above in mainland China (Zhao et al., 2014). Using a multistage probability sampling strategy, the CHARLS conducted the baseline survey with 17,708 non-institutionalized respondents from 28 provinces in 2011. Interviewers were trained by the survey team and conducted data collection in their home counties through computer-assisted face-to-face interviews, yielding a response rate of 80.5% at the baseline survey (Zhao et al., 2014). The follow-up surveys were conducted biennially in 2013, 2015, and 2018. The CHARLS implemented a life history survey in 2014, which collected a rich body of information about the respondents’ childhood conditions, residence, employment, health, and family history.

We used the data from the CHARLS life history survey in 2014 and the follow-up wave in 2015. We restricted the sample to the respondents who participated in the life history survey’s family and health modules (N = 20,419). We excluded participants who (a) were not followed up in CHARLS 2015 survey (n = 1757); (b) did not have sampling weights (n = 728); and (c) were younger than 45 years (n = 628). Participants with missing data in depressive symptoms (n = 1039), childhood interpersonal trauma (n = 1250), and covariates (n = 837) were excluded. The final sample consisted of 14,180 Chinese adults aged 45 years and older.

Measures

Dependent Variable

Mental health was measured by the ten-item Center for Epidemiologic Studies Depression (CES-D) scale, which has been validated in older populations in China (Chen & Mui, 2014). The respondents were asked to report their frequencies of eight negative (e.g., “I felt depressed”) and two positive (e.g., “I was happy”) feelings or behaviors during the past week. These ten items were rated on a four-point scale from 0 (rarely or none of the time) to 3 (most or all of the time). After reverse-scoring of two positive items, the total score was calculated to assess the level of depressive symptoms, ranging from 0 to 30. Observations with no more than three missing items in the CES-D scale were imputed with individual mean scores. The scale had a satisfactory internal consistency (Cronbach’s α = .799). Because CES-D is an effective screening instrument for detecting major depression, and using a dichotomized outcome variable could identify the proportion of suffering severe depressive symptoms, thus rendering the estimation of potential risks of CIT on depression. This study adopted the cutoff score of 10 (Fu et al., 2022) to indicate whether the respondents were severely depressed.

Independent Variables

Five types of CIT were assessed in this study. Following previous studies (Fischer et al., 2016; Yang et al., 2020), we used dichotomized variables of interpersonal trauma to imply the presence of different types of CIT. (1) Physical neglect was measured by asking, “How much effort did your female guardian put into watching over you?”. We dichotomized this variable into two categories (1 = not at all, 0 = a lot, some, a little). (2) Emotional neglect was measured by asking, “How much love and affection did your female guardian give you while you were growing up?” Emotional neglect was identified if respondents answered that they never received love or affection expression from their female guardian. (3) Physical abuse was measured by asking two questions “When you were growing up, did your female/male guardian ever hit you?”. Physical abuse was defined as being frequently hit by at least one parent (1 = often; 0 = sometimes, rarely, or never). (4) Bullying victimization refers to being frequently bullied by siblings or other kids in the neighborhood or school. Questions included “When you were growing up, how often did your brother or sister ever hit you?” and “When you were a child, how often were you picked on or bullied by kids in your neighborhood or school?”. For each question, the answers were dichotomized to identify bullying behaviors (1 = often, 0 = sometimes, rarely, or never). Then a new binary variable was created by combining bullying behaviors from different perpetrators, with 1 indicating being often bullied by siblings or other kids and 0 otherwise. (5) Exposure to interparental violence was measured by asking, “Have your father ever beat up your mother?” and “Have your mother ever beat up your father?”. The variable was coded as 1 if the respondents had witnessed physical violence between parents (often, sometimes, or not very often) and 0 (never) otherwise.

Mediators

As suggested by previous research (Yang et al., 2016), social integration was assessed by the structural and functional components of social ties across relationship domains, including romantic partners, children, social engagement, and perceived social support. Satisfaction with marriage was measured by asking: “How satisfied are you with your marriage (relationship with your spouse)?” Similarly, the respondents were asked about their satisfaction with children, “How satisfied are you with your relationship with children?” The two questions were responded on a five-point scale from 1 (completely satisfied) to 5 (not at all satisfied). We reverse-coded the two variables, with a larger score indicating a higher level of relationship satisfaction with their partner or children.

Social engagement and perceived social support measured the degree of social integration in broader social contexts. Social engagement was assessed by the number of activities that respondents participated in during the past month (e.g., interacted with friends, played mahjong/chess/cards, went to community club, or did voluntary or charity work). The variable was dichotomized (1 = participated in at least two activities; 0 = none or one activity) because the number of social activities was highly skewed. Perceived social support was measured by asking the respondents, “If you need help with basic daily activities, do you have relatives or friends who would be willing and able to help you over a long period of time?” Responses included 1 (yes) and 0 (no).

Control Variables

Social and demographic characteristics of respondents that may confound the associations between CIT and depression were controlled in this study. Demographic information included age, gender (male vs. female), marital status (married vs. unmarried), educational level (illiterate, primary school, middle school, high school, or above), and area of residence (rural vs. urban). As suggested by previous research (Ye et al., 2022), we also included the respondents’ early life socioeconomic status (i.e., education of parents and family economic status) and parental mental health problem. A dummy variable of childhood family financial status before age 17 was created, with 1 indicating average or above and 0 for being below average. Parental mental illness was assessed by asking the respondents whether their female and male dependents had been depressed for two or more weeks during their childhood. The responses were clustered into a dummy variable indicating the presence of depression in at least one parent (yes vs. no).

Analytic Strategy

Descriptive analysis was performed to show the characteristics of the total sample and subsamples stratified by depression. Group differences were assessed using Pearson Chi-squared tests and adjusted Wald tests. The associations of childhood interpersonal risk factors with depression were examined using logistic regression (Models 1–4). Model 1 included five types of CIT and control variables. Indicators of social integration at family and societal levels were then added to Models 2 and 3, respectively. Model 4 included childhood interpersonal trauma, all mediators, and control variables. The mean score of variance inflation factors of the full model was 1.23, indicating no evidence of the multi-collinearity issue. Given that group comparison of coefficients across nested logistic models may be misled due to the rescaling issue (Williams & Jorgensen, 2023), the unbiased average marginal effects (AMEs) were reported (odds ratios can be found in Supplementary Table A1).

Mediation analysis was conducted using the Karlson–Holm–Breen (KHB) decomposition method (Karlson & Holm, 2011). The KHB estimates the indirect effect by comparing two models: (a) the reduced model that includes independent variables and residualized mediators; and (b) the full model that includes independent variables and mediators. We employed the KHB method to estimate the indirect effects of various types of CIT on depression through satisfaction with marriage, satisfaction with children, social engagement, and perceived social support. Individual sampling weights were used to adjust for sampling design and nonresponse error. Sensitivity analyses were conducted to check the robustness of our main findings to statistical control, household-level omitted variable bias, sample selection bias, and alternative coding of outcome variable. All analyses were conducted in Stata/MP version 17.0 (StataCorp).

Results

Sample Characteristics

Table 1 presents the descriptive characteristics of the sample. The sample had an average age of 59.78 (SD = 9.59) and 51.48% of females. In the sample, 4056 (31.31%) respondents had severe depressive symptoms. Regarding childhood interpersonal trauma, 6.67% were exposed to physical neglect; 9.60% reported emotional neglect; 5.76% experienced physical abuse; 5.30% were often bullied by siblings or other kids in community or school; 20.29% witnessed interparental violence. The Pearson Chi-squared tests showed that depressed respondents were more likely to have experienced all types of CIT than those without severe depressive symptoms.

Table 1.

Weighted Descriptive Statistics of the Total Sample and Subsamples Stratified by Depression.

Variable	Total sample	Not depressed	Depressed	p-Value
	(N = 14,180)	(68.69%)	(31.31%)
	Mean/percent	Mean/percent	Mean/percent
Childhood interpersonal trauma
Physical neglect	6.67%	6.26%	7.57%	F = 4.16 p = .042
Emotional neglect	9.60%	9.04%	10.83%	F = 6.58, p = .011
Physical abuse	5.76%	4.64%	8.23%	F = 27.78, p < .001
Being bullied	5.30%	4.05%	8.03%	F = 66.73, p < .001
Exposure to interparental violence	20.29%	18.35%	24.57%	F = 29.22, p < .001
Social integration
Satisfaction with marriage^a	3.47 (.80)	3.57 (.74)	3.22 (.88)	F = 324.54, p < .001
Satisfaction with children^b	3.65 (.73)	3.72 (.70)	3.51 (.79)	F = 170.18, p < .001
Social engagement (≥ 2 activities)^c	28.13%	30.89%	22.08%	F = 77.60, p < .001
Perceived social support (≥ 1 person)^d	67.95%	72.45%	57.98%	F = 144.53, p < .001
Demographic characteristics
Age	59.78 (9.59)	59.43 (9.68)	60.53 (9.36)	F = 22.46, p < .001
Female	51.48%	46.11%	63.27%	F = 308.30, p < .001
Married	87.47%	89.66%	82.68%	F = 74.22, p < .001
Urban residence	32.20%	36.48%	22.80%	F = 76.69, p < .001
Education
Illiterate	21.29%	17.29%	30.08%	F = 88.84, p < .001
Primary school	45.09%	44.41%	46.58%
Middle school	20.64%	22.51%	16.54%
High school or above	12.98%	15.80%	6.80%
Childhood SES and parental health
Father was literate	47.16%	49.60%	41.80%	F = 36.09, p < .001
Mother was literate	16.83%	18.53%	13.10%	F = 33.49, p < .001
Average or above family economy	62.91%	66.39%	55.27%	F = 98.92, p < .001
Parental mental problem	21.31%	16.95%	30.88%	F = 206.27, p < .001

Note. Standard deviations are in parentheses

^amissing observations = 1801

^bmissing observations = 272

^cmissing observations = 1

^dmissing observations = 881.

The average level of satisfaction with marriage was 3.47 (SD = .80) and with children was 3.65 (SD = .73) out of 5. Depressed respondents had lower scores in satisfaction with marriage and with children than not depressed respondents (adjusted Wald test: p < .001). About 28.13% of respondents had participated in two or more social activities and 67.95% perceived that they could receive social support from at least one person. The Pearson Chi-squared tests revealed that those who were not depressed were more likely to participate in social activities and have perceived social support.

Regression Analysis

Logistic regression results of depression are presented in Table 2. The results showed that three types of CIT were associated with a greater probability of depression (Model 1). Specifically, the probability of depression would increase by 8.5% (95%CI [.044, .126]) if the respondents experienced physical abuse in childhood. Being bullied could increase the probability of being depressed by 7.8% (95%CI [.033, .124]). Exposure to interparental violence was associated with a 5.7% (95%CI [.031, .083]) increase in the probability of depression. The effects of the abovementioned CIT persisted after the introduction of social integration in the family (Model 2) and broader social relationships (Model 3). In Model 2, satisfaction with marriage (AME = −.074, 95%CI [−.087, −.061]) and satisfaction with children (AME = −.040, 95%CI [−.054, −.026]) were associated with lower probability of depression. Results in Model 3 showed that social engagement (AME = −.036, 95%CI [−.058, −.014]) and, particularly, perceived social support (AME = −.113, 95%CI [−.133, −.093]) were related to a lower probability of depression. The effects of physical abuse and exposure to interparental violence on depression maintained in the full model (Model 4), whereas the effect of being bullied was totally attenuated.

Table 2.

Logistic Models of Depression on Childhood Interpersonal Trauma.

	Model 1		Model 2		Model 3		Model 4
	AME	95% CI	AME	95% CI	AME	95% CI	AME	95% CI
Childhood interpersonal trauma
Physical neglect	.019	[−.018,0.056]	.018	[−.022,0.058]	.003	[−.036,0.041]	.006	[−.033,0.045]
Emotional neglect	.017	[−.016,0.050]	.002	[−.033,0.037]	.012	[−.024,0.049]	.001	[−.040,0.040]
Physical abuse	.085***	[.044,0.126]	.061**	[.015,0.107]	.080***	[.039,0.122]	.056*	[.010,0.102]
Being bullied	.078***	[.033,0.124]	.030	[−.009,0.070]	.083**	[.031,0.134]	.039	[−.004,0.083]
Exposure to interparental violence	.057***	[.031,0.083]	.040**	[.014,0.065]	.054***	[.027,0.081]	.038**	[.012,0.064]
Social integration
Satisfaction with marriage			−.074***	[−.087,−.061]			−.072***	[−.085,−.058]
Satisfaction with children			−.040***	[−.054,−.026]			−.037***	[−.052,−.022]
Social engagement					−.036**	[−.058,−.014]	−.029**	[−.051,−.007]
Perceived social support					−.113***	[−.133,−.093]	−.087***	[−.110,−.064]
Control variables
Age	.001	[−.000,0.002]	.002**	[.000,0.003]	.001	[−.000,0.002]	.002**	[.000,0.003]
Female	.125***	[.108,0.143]	.103***	[.085,0.122]	.124***	[.105,0.142]	.100***	[.081,0.119]
Married	−.078***	[−.105,−.050]	.031	[−.188,0.250]	−.073***	[−.100,−.046]	.055	[−.177,0.287]
Urban residence	−.096***	[−.127,−.066]	−.085***	[−.116,−.054]	−.086***	[−.119,−.054]	−.073***	[−.107,−.039]
Education (ref. illiterate)
Primary school	−.028*	[−.053,−.002]	−.039**	[−.067,−.011]	−.022	[−.048,0.004]	−.035*	[−.065,−.005]
Middle school	−.066***	[−.096,−.035]	−.079***	[−.111,−.046]	−.056***	[−.087,−.025]	−.073***	[−.106,−.040]
High school or above	−.136***	[−.185,−.087]	−.150***	[−.203,−.097]	−.115***	[−.163,−.067]	−.133***	[−.182,−.084]
Father was literate	−.019	[−.040,0.002]	−.018	[−.037,0.002]	−.018	[−.040,0.005]	−.016	[−.039,0.006]
Mother was literate	−.004	[−.034,0.025]	−.007	[−.035,0.022]	−.008	[−.038,0.022]	−.012	[−.043,0.018]
Average or above family economy	−.052***	[−.071,−.034]	−.042***	[−.062,−.023]	−.046***	[−.065,−.027]	−.036***	[−.057,−.016]
Parental mental problem	.116***	[.094,0.138]	.112***	[.089,0.135]	.113***	[.091,0.135]	.111***	[.088,0.134]
N	14,180		12,272		13,298		11,547

Notes. AME = average marginal effect; CI = confidence intervals. Data are weighted

* p < .05, ** p < .01, and *** p < .001.

We adopted the KHB decomposition method to examine whether social integration mediated the effects of CIT on depression (Table 3). Given that all the CIT indicators were associated with social integration (Supplementary Table A2), the evidence and magnitude of an indirect effect were of primary interest when conducting mediation analysis (Rucker et al., 2011). Although the direct association between emotional neglect and depression was absent, an indirect association via social integration was observed (B_indirect = .118, p < .001). The indirect effects of CIT on depression via social integration could be explained by satisfaction with marriage, satisfaction with children, and perceived social support. Notably, satisfaction with marriage appeared to be the most salient mediator, accounting for 14.89% [ = .077/0.517] to 35.29% [ = .060/0.170] of the total effects of five CIT domains on depression. Perceived social support contributed to about 3.13%–27.45% of the total effects of CIT subdomains, except for being bullied. Approximately 3.86%–11.76% of the associations between CIT subdomains and depression could be attributed to satisfaction with children. No meaningful mediational roles were found for social engagement in the associations between CIT and depression.

Table 3.

KHB Mediation Analysis Results of Social Integration.

	Physical neglect	Emotional neglect	Physical abuse	Being bullied	Exposure to interparental violence
Total effect	.204*	.170	.517***	.363*	.319***
Direct effect	.074	.052	.384**	.290*	.236**
Indirect effect	.130*** (63.72%)	.118*** (69.41%)	.133*** (25.73%)	.073* (20.11%)	.084** (26.33%)
Satisfaction with marriage	.047 (23.04%)	.060 (35.29%)	.077 (14.89%)	.064 (17.63%)	.059 (18.5%)
Satisfaction with children	.018 (8.82%)	.020 (11.76%)	.028 (5.42%)	.014 (3.86%)	.017 (5.33%)
Social engagement	.009 (4.41%)	.001 (.59%)	−.013 (−2.51%)	−.009 (−2.48%)	−.002 (−.63%)
Perceived social support	.056 (27.45%)	.037 (21.76%)	.040 (7.74%)	.004 (1.10%)	.010 (3.13%)

Notes. KHB = Karlson–Holm–Breen. N = 11,547. Coefficients are reported (log odds). Data are weighted. Percentages in parentheses denote the proportion of the total effect of different types of CIT that were mediated by social integration indicators

*p < 0.05, **p < 0.01, and ***p < 0.001.

Sensitivity Analysis

To check the sensitivity of the results, we conducted several supplementary analyses. First, we further adjusted for current physical health and current economic status and found that current physical health may be a possible mediational mechanism in the associations between CIT and depression (Supplementary Tables A3-A4), whereas current economic status had no substantial influence on our results (Supplementary Table A5). Second, multilevel modeling was adopted to account for household-level confounders (Supplementary Table A6). Third, we used the Heckman selection model to handle potential sample selection bias (Supplementary Table A7). We also estimated the relationships between CIT with marital status (Supplementary Table A8) and the number of children (Supplementary Table A9). Moreover, we re-estimated the mediation roles of three social integration indicators among non-partnered adults and observed that mediating roles of social integration persist among older adults, regardless of their marital status (Supplementary Table A10). Lastly, we employed negative binomial regression to model the relationships between continuous CES-D total score and CIT (Supplementary Table A11). Overall, the results of sensitivity analyses remained consistent even when concerns about statistical control, household-level omitted variables, sample selection, and alternative coding of outcome variable were addressed.

Discussion

Based on a nationally representative sample of middle-aged and older Chinese, this study examined the long-term effects of childhood traumatic interpersonal experiences on depression in mid-later life. The results of the study enrich the existing knowledge about the associations between CIT and mental health in two aspects. First, this study highlights the interpersonal nature of traumatic experiences in childhood and their long-term influences on mental health from a non-Western perspective. In addition to childhood maltreatment by primary caregivers, which has been broadly discussed in previous research, this study further revealed the long-lasting effects of bullying victimization by siblings or peers and witnessing interparental violence on mental health throughout the lifespan. Second, to fully understand the mechanism linking CIT and late-life depression, this study shifts the research attention from individual pathways (e.g., personality traits) to the way that people integrate into social groups in adulthood. Results showed that satisfaction with marriage and children, and perceived social support, partially mediated the associations between CIT and depression. It indicates that CIT could disrupt the life-long social integration process in both family and broader social contexts, which in turn deteriorates mental health in mid-later years. Our findings provide important implications for policymakers and health professionals that building social integration for disadvantaged older people may help cure their hidden scars of traumatic childhood experiences and enhance healthy aging.

Three types of CIT, including physical abuse, bullying victimization, and interparental violence, were identified to have detrimental and direct effects on mental health among middle-aged and older Chinese adults. Consistent with previous research in other countries (Humphreys et al., 2020; Wang et al., 2022), this study reaffirmed that being physically abused by parents was associated with depression in later life. This result uncovers that the destructive effect of childhood physical abuse over the life course may be persistent across different cultures despite that (to some extent) corporal punishment over children is traditionally acceptable in Chinese culture (Liu & Wang, 2018). In addition, childhood bullying victimization increased the probability of depression in mid-later life, echoing previous research (Hu, 2021). This study innovatively adopted a broader conceptualization of bullying victimization and found that being bullied, either by siblings or peers from schools and neighbors, was associated with a higher risk of later-life depression. It sheds new insights on improving anti-bullying schemes by suggesting that preventative measures and interventions should be implemented not only in schools and communities but also in the family context to curtail sibling bullying.

This study found that individuals who were exposed to interparental violence during childhood had a higher risk of mid-later life depression. Notably, 20% of participants witnessed violence between parents in our study, which was exceptionally higher than other types of CIT. This high prevalence of interparental violence was consistent with another study conducted in the Chinese context (Xu et al., 2005), and it was explained by the long-standing patriarchal norms and power-based conflict resolutions in Confucian families. It adds to the literature by showing that the psychological influence of exposure to interparental violence may persist across the life span (Roland et al., 2021). Health and social service professionals should consider screening older people with a history of early exposure to family violence and delivering psychosocial support to enhance their well-being. More importantly, it is crucial to implement family-centered policies and interventions aimed at reducing exposure to interparental violence among younger generations, who will eventually comprise future cohorts of older adults, in order to break the cycle of violence (Carlson et al., 2019).

In contrast with previous research, childhood physical neglect and emotional neglect were not directly linked to late-life depression in this study. This result could be explained from a socio-cultural perspective. In Chinese families, childhood neglect might be viewed as pardonable and relevant to family and historical circumstances. The study cohorts of middle-aged and older Chinese were primarily born from the 1940s to 1960s, a period characterized by prevalent poverty, inadequate care provision, and poor parenting (Xia et al., 2013). Hence, the direct influences of childhood physical neglect and emotional neglect on mental health in mid-old age might be negligible. Particularly, emotional neglect (9.60%) was relatively prevalent among various types of CIT in our study sample because expressing outward affection to children was not a common practice in traditional Chinese families. Therefore, the lack of positive emotional interactions or physical neglect during childhood may not directly deteriorate mental health in mid-later years.

With respect to the social mechanisms, this study uncovered that social integration in family and broader social contexts partially explained the late-life mental consequences of various forms of CIT. Our research is the first endeavor to provide evidence that the relationship between traumatic experiences during childhood and depression in later life can be explained by the extent to which people are socially integrated. Among the mediators of social integration, the link between CIT and depression was largely attributed to satisfaction with marriage. Because of elevated emotional needs, older people tend to have more frequent and profound interactions with their spouses than with other social relationships. Yet, people who experienced interpersonal traumas in early life may find it difficult to maintain emotional closeness, feelings of affection, and personal disclosure in marital relationships (Bigras et al., 2015). Therefore, lower satisfaction with marriage increases the risk of late-life depression. In addition, this study found that traumatic interpersonal experiences during childhood also foreshadowed poor relationships with children in mid-later life, which further impeded mental health. Hence, our research expands previous literature (Kong, 2018) by revealing that not only the intergenerational relationship with abusive parents but also with their adult children in adulthood family mediated the associations between CIT and depression.

In the broader societal context, perceived social support mediated the associations between CIT and depression. Our finding was consistent with previous studies (Sperry & Widom, 2013; Su et al., 2022), indicating that victims of interpersonal trauma in childhood may receive less social support in later life. It is reasonable that traumatic interpersonal experiences in childhood may increase the risk of depression in later life by reducing older people’s ability to accumulate and mobilize social support resources. However, contrary to our hypothesis, social engagement did not mediate the link between CIT and depression. This might be explained by the fact that social engagement may be more relevant to older adults’ contemporary social needs and health conditions rather than their distant early life experiences. It is also understandable because our measurement assessed the number of a wide range of social activities and may downplay the role of CIT in older adults’ activity preference and frequency of participation.

The findings of our study suggest that health professionals and service providers should recognize the protective role of social integration in reducing the negative influences of CIT on mental health. Interventions aimed at promoting healthy aging are suggested to enhance family cohesion and social support for older adults. For example, family counselors may utilize a structural family therapy approach to provide strengths-based and resilience-building interventions to develop people’s sense of closeness and connection with family members (Daniels & Bryan, 2021). To maintain marital satisfaction in old age, family therapists may intervene in increasing mutual understanding as well as positive emotional expression among older couples. Besides, adult children are advised to provide sufficient emotional, instrumental, and financial support to their older parents to promote intergenerational solidarity. In addition, policymakers may consider incorporating community-based service programs with family support policies to build a more supportive and inclusive environment for aging adults.

Limitations

Several limitations should be noted in this study. First, the measurement of childhood interpersonal trauma in this study was based on retrospective information and hence may be affected by recall bias. Despite the subjective self-reported data, previous studies have proved that the memory of recalling childhood traumatic events remains consistent over time (Rivers, 2001; Yancura & Aldwin, 2009), suggesting the validity and reliability of using retrospective information to investigate childhood experiences. Future studies could utilize multiple data sources to improve the measurement and explore individual differences in CIT reports. Second, social integration was measured using single-item measures and did not fully explain the associations between CIT and depression. Future research could improve the measurement of social integration by assessing family cohesion, social support, and social engagement in a multidimensional manner. In addition to social mechanisms, future research is needed to explore and compare potential biological (e.g., telomere length), psychological (e.g., early maladaptive schemas), physical (e.g., chronic illness), and behavioral (e.g., alcohol use) chains linking CIT and late-life depression (Dugal et al., 2016; Liu, 2017). Third, this study cannot consider other key confounding factors, such as parenting style and childhood behavioral problems. Future research could improve the conceptual framework and adopt advanced methods to determine and compare the effects of CIT on social integration and mental health outcomes. Fourth, the cross-sectional design limited the causal explanatory power of the relationships in this study. Hence, longitudinal methods with repeated measures across time intervals should be considered in future research.

Conclusion

This study examined the associations between various types of interpersonal traumatic events during childhood and depression in middle-aged and older adults in China. It found that childhood bullying victimization, physical abuse, and exposure to interparental violence increased the risk of depression in mid-later years. The associations between CIT and depression were significantly mediated by satisfaction with marriage, satisfaction with children, and perceived social support. Our research suggested that the direct and indirect links between different forms of CIT and depression should be reconsidered from a non-Western social and cultural context. We also uncovered the underlying mechanisms of CIT and depression in later life from a perspective of social integration. Experiencing interpersonal trauma during childhood chronically undermined the process of integrating into family and wider social groups in adulthood, thus elevating the risk of suffering mental disorders in later life. As such, healthy aging policies and interventions may benefit from promoting multidomain social integration in mid-later adulthood.

Supplemental Material

Supplemental Material - Childhood Interpersonal Trauma and Depression of Middle-Aged and Older Adults in China: The Mediation Effect of Social Integration

Supplemental Material for Childhood Interpersonal Trauma and Depression of Middle-Aged and Older Adults in China: The Mediation Effect of Social Integration by Jia-Jia Zhou and Shuai Zhou in the Journal of Aging and Health.

Footnotes

Acknowledgments

The authors would like to thank all the participants in the China Health and Retirement Longitudinal Study.

Author Contributions

J.J.Z designed the study, performed the preliminary data analysis, and wrote and revised the manuscript of the paper. S.Z. performed the full data analysis and wrote and revised the manuscript of the paper.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Jia-Jia Zhou

Shuai Zhou

Supplemental Material

Supplemental material for this article is available online.

References

Angelini

Klijs

Smidt

Mierau

J. O.

(2016). Associations between childhood parental mental health difficulties and depressive symptoms in late adulthood: The influence of life-course socioeconomic, health and lifestyle factors. PloS One, 11(12), Article e0167703. https://doi.org/10.1371/journal.pone.0167703

Aroogh

M. D.

Shahboulaghi

F. M.

(2020). Social participation of older adults: A concept analysis. International Journal of Community Based Nursing and Midwifery, 8(1), 55–72. https://doi.org/10.30476/IJCBNM.2019.82222.1055

Baranyi

Sieber

Pearce

Cheval

Dibben

Kliegel

Cullati

(2019). A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors? Preventive Medicine, 126(9), 105764–105764. https://doi.org/10.1016/j.ypmed.2019.105764

Barnes

M. L.

Sternberg

R. J.

(1997). A hierarchical model of love and its prediction of satisfaction in close relationships. In Sternberg

R. J.

Hojjat

(Eds.), Satisfaction in close relationships (pp. 79–101). The Guilford Press.

Bengtson

V. L.

Robert

E. L.

(1991). Intergenerational solidarity in aging families: An example of formal theory construction. Journal of Marriage and Family, 53(4), 856–870. https://doi.org/10.2307/352993

Berkman

L. F.

Glass

Brissette

Seeman

T. E.

(2000). From social integration to health: Durkheim in the new millennium. Social Science and Medicine, 51(6), 843–857. https://doi.org/10.1016/S0277-9536(00)00065-4

Bigras

Godbout

Hébert

Runtz

Daspe

M.-È.

(2015). Identity and relatedness as mediators between child emotional abuse and adult couple adjustment in women. Child Abuse and Neglect, 50(12), 85–93. https://doi.org/10.1016/j.chiabu.2015.07.009

Bowlby

(1969). Attachment and loss. Penguin.

Brown

N. R.

Kallivayalil

Mendelsohn

Harvey

M. R.

(2012). Working the double edge: Unbraiding pathology and resiliency in the narratives of early-recovery trauma survivors. Psychological Trauma, 4(1), 102–111. https://doi.org/10.1037/a0024969

10.

Carlson

Voith

Brown

J. C.

Holmes

(2019). Viewing children’s exposure to intimate partner violence through a developmental, social-ecological, and survivor lens: The current state of the field, challenges, and future directions. Violence Against Women, 25(1), 6–28. https://doi.org/10.1177/1077801218816187

11.

Chen

Mui

A. C.

(2014). Factorial validity of the center for epidemiologic studies depression scale short form in older population in China. International Psychogeriatrics, 26(1), 49–57. https://doi.org/10.1017/S1041610213001701

12.

Cicchetti

Rogosch

F. A.

Gunnar

M. R.

Toth

S. L.

(2010). The differential impacts of early physical and sexual abuse and internalizing problems on daytime cortisol rhythm in school-aged children. Child Development, 81(1), 252–269. https://doi.org/10.1111/j.1467-8624.2009.01393.x

13.

Cohen

Underwood

Gottlieb

B. H.

(2000). Social support measurement and intervention: A guide for health and social scientists. Oxford University Press.

14.

Colman

R. A.

Widom

C. S.

(2004). Childhood abuse and neglect and adult intimate relationships: A prospective study. Child Abuse and Neglect, 28(11), 1133–1151. https://doi.org/10.1016/j.chiabu.2004.02.005

15.

Cui

Smith

J. P.

Zhao

(2020). Early-life deprivation and health outcomes in adulthood: Evidence from childhood hunger episodes of middle-aged and elderly Chinese. Journal of Development Economics, 143(2), 102417. https://doi.org/10.1016/j.jdeveco.2019.102417

16.

D’Andrea

Ford

Stolbach

Spinazzola

van der Kolk

B. A.

(2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200. https://doi.org/10.1111/j.1939-0025.2012.01154.x

17.

Daniels

A. D.

Bryan

(2021). Resilience despite complex trauma: Family environment and family cohesion as protective factors. The Family Journal (Alexandria, Va.), 29(3), 336–345. https://doi.org/10.1177/10664807211000719

18.

Dannefer

(2003). Cumulative advantage/disadvantage and the life course: Cross-fertilizing age and social science theory. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58(6), S327–S337. https://doi.org/10.1093/geronb/58.6.S327

19.

De Bellis

M. D.

Zisk

(2014). The biological effects of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 23(2), 185–222. https://doi.org/10.1016/j.chc.2014.01.002

20.

Dugal

Bigras

Godbout

Claude Bélanger

(2016). Childhood interpersonal trauma and its repercussions in adulthood: An analysis of psychological and interpersonal sequelae. In El-Baalbaki

Fortin

(Eds.), A multidimensional approach to post-traumatic stress disorder: From theory to practice. Intech. https://doi.org/10.5772/64476

21.

Epel

E. S.

Crosswell

A. D.

Mayer

S. E.

Prather

A. A.

Slavich

G. M.

Puterman

Mendes

W. B.

(2018). More than a feeling: A unified view of stress measurement for population science. Frontiers in Neuroendocrinology, 49(2), 146–169. https://doi.org/10.1016/j.yfrne.2018.03.001

22.

Ferraro

K. F.

Schafer

M. H.

Wilkinson

L. R.

(2016). Childhood disadvantage and health problems in middle and later life: Early imprints on physical health? American Sociological Review, 81(1), 107–133. https://doi.org/10.1177/0003122415619617

23.

Finkelhor

(2008). Childhood victimization. Oxford University Press.

24.

Fischer

Dölitzsch

Schmeck

Fegert

J. M.

Schmid

(2016). Interpersonal trauma and associated psychopathology in girls and boys living in residential care. Children and Youth Services Review, 67(8), 203–211. https://doi.org/10.1016/j.childyouth.2016.06.013

25.

Guo

(2022). What is the optimal cut-off point of the 10-item center for epidemiologic studies depression scale for screening depression among Chinese individuals aged 45 and over? An exploration using latent profile analysis. Frontiers in Psychiatry, 13, 820777. https://doi.org/10.3389/fpsyt.2022.820777

26.

Garami

Valikhani

Parkes

Haber

Mahlberg

Misiak

Frydecka

Moustafa

A. A.

(2019). Examining perceived stress, childhood trauma and interpersonal trauma in individuals with drug addiction. Psychological Reports, 122(2), 433–450. https://doi.org/10.1177/0033294118764918

27.

Gariépy

Honkaniemi

Quesnel-Vallée

(2016). Social support and protection from depression: Systematic review of current findings in Western countries. British Journal of Psychiatry, 209(4), 284–293. https://doi.org/10.1192/bjp.bp.115.169094

28.

(2021). Is bullying victimization in childhood associated with mental health in old age. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(1), 161–172. https://doi.org/10.1093/GERONB/GBZ115

29.

Humphreys

K. L.

LeMoult

Wear

J. G.

Piersiak

H. A.

Lee

Gotlib

I. H.

(2020). Child maltreatment and depression: A meta-analysis of studies using the childhood trauma questionnaire. Child Abuse and Neglect, 102(4), 104361–104420. https://doi.org/10.1016/j.chiabu.2020.104361

30.

Karlson

K. B.

Holm

(2011). Decomposing primary and secondary effects: A new decomposition method. Research in Social Stratification and Mobility, 29(2), 221–237. https://doi.org/10.1016/j.rssm.2010.12.005

31.

Knoester

Haynie

D. L.

(2005). Community context, social integration into family, and youth violence. Journal of Marriage and Family, 67(3), 767–780. https://doi.org/10.1111/j.1741-3737.2005.00168.x

32.

Kong

(2018). Childhood maltreatment and psychological well-being in later life: The mediating effect of contemporary relationships with the abusive parent. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 73(5), e39–e48. https://doi.org/10.1093/geronb/gbx039

33.

Kuh

Ben-Shlomo

Lynch

Hallqvist

Power

(2003). Life course epidemiology. Journal of Epidemiology and Community Health, 57(10), 778–783. https://doi.org/10.1136/jech.57.10.778

34.

Lilly

M. M.

Valdez

C. E.

(2012). Interpersonal trauma and PTSD: The roles of gender and a lifespan perspective in predicting risk. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 140–144.

35.

Liu

Wang

(2018). Parental harsh discipline and adolescent problem behavior in China: Perceived normativeness as a moderator. Child Abuse and Neglect, 86(12), 1–9. https://doi.org/10.1016/j.chiabu.2018.09.009

36.

Liu

R. T.

(2017). Childhood adversities and depression in adulthood: Current findings and future directions. Clinical Psychology, 24(2), 140–153. https://doi.org/10.1111/cpsp.12190

37.

Liu

Upenieks

(2021). Marital quality and well-being among older adults: A typology of supportive, aversive, indifferent, and ambivalent marriages. Research on Aging, 43(9–10), 428–439. https://doi.org/10.1177/0164027520969149

38.

Nakagawa

Hulur

(2020). Social integration and terminal decline in life satisfaction among older Japanese. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 75(10), 2122–2131. https://doi.org/10.1093/geronb/gbz059

39.

Nelson

C. A.

Bhutta

Z. A.

Burke Harris

Danese

Samara

(2020). Adversity in childhood is linked to mental and physical health throughout life. BMJ (Online), 371, m3048. https://doi.org/10.1136/bmj.m3048

40.

Nishio

Green

Kondo

(2022). Roles of participation in social activities in the association between adverse childhood experiences and health among older Japanese adults. SSM - Population Health, 17(1), 101000–101000. https://doi.org/10.1016/j.ssmph.2021.101000

41.

Ramos

Dion

Bőthe

Girouard

Hébert

Wong

Bergeron

(2022). Cumulative interpersonal childhood adversity and post-traumatic stress symptoms across heterosexual, cisgender and gender and sexually diverse adolescents: The mediating role of emotion regulation. Child Abuse and Neglect, 124(2), 105454–105454. https://doi.org/10.1016/j.chiabu.2021.105454

42.

Rivers

(2001). Retrospective reports of school bullying: Stability of recall and its implications for research. British Journal of Developmental Psychology, 19(1), 129–141. https://doi.org/10.1348/026151001166001

43.

Roland

Leon

du Roscoat

Panjo

Saurel-Cubizolles

M. J.

Ringa

(2021). Witnessing interparental violence in childhood and symptoms of depression in adulthood: Data from the 2017 French Health Barometer. Family Practice, 38(3), 306–312.

44.

Rucker

D. D.

Preacher

K. J.

Tormala

Z. L.

Petty

R. E.

(2011). Mediation analysis in social psychology: Current practices and new recommendations: Mediation analysis in social psychology. Social and Personality Psychology Compass, 5(6), 359–371. https://doi.org/10.1111/j.1751-9004.2011.00355.x

45.

Sperry

D. M.

Widom

C. S.

(2013). Child abuse and neglect, social support, and psychopathology in adulthood: A prospective investigation. Child Abuse and Neglect, 37(6), 415–425. https://doi.org/10.1016/j.chiabu.2013.02.006

46.

Meng

Yang

D’Arcy

(2022). The relationship between childhood maltreatment and mental health problems: Coping strategies and social support act as mediators. BMC Psychiatry, 22(1), 359–359. https://doi.org/10.1186/s12888-022-04001-2

47.

Tang

Jiang

Tang

(2021). Prevalence of depressive symptoms among older adults in mainland China: A systematic review and meta-analysis. Journal of Affective Disorders, 293(17), 379–390. https://doi.org/10.1016/j.jad.2021.06.050

48.

Tengku Mohd

T. A. M.

Yunus

R. M.

Hairi

N. N.

Choo

W. Y.

(2019). Social support and depression among community dwelling older adults in asia: A systematic review. BMJ Open, 9(7), e026667. https://doi.org/10.1136/bmjopen-2018-026667

49.

Torres

J. M.

Wong

(2013). Childhood poverty and depressive symptoms for older adults in Mexico: A life-course analysis. Journal of Cross-Cultural Gerontology, 28(3), 317–337. https://doi.org/10.1007/s10823-013-9198-1

50.

Wang

Chen

Zhou

Zhang

(2022). A meta-analysis of the effects of childhood maltreatment on elderly depression. Trauma, Violence and Abuse. https://doi.org/10.1177/15248380211073838

51.

Williams

Jorgensen

(2023). Comparing logit and probit coefficients between nested models. Social Science Research, 109(1), 102802. https://doi.org/10.1016/j.ssresearch.2022.102802

52.

World Health Organization . (2021). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression (Accessed 28 December 2022).

53.

Chi

Lin

(2018). Child maltreatment and adult depressive symptoms: Roles of self-compassion and gratitude. Child Abuse and Neglect, 80(6), 62–69. https://doi.org/10.1016/j.chiabu.2018.03.013

54.

Xia

Y. R.

Wang

Qin

(2013). Family policy in China: A snapshot of 1950–2010. In Handbook of family policies across the globe (pp. 257–272). Springer. https://doi.org/10.1007/978-1-4614-6771-7_17

55.

Zhu

O’Campo

Koenig

M. A.

Mock

Campbell

(2005). Prevalence of and risk factors for intimate partner violence in China. American Journal of Public Health, 95(1), 78–85. https://doi.org/10.2105/AJPH.2003.023978

56.

Yancura

L. A.

Aldwin

C. M.

(2009). Stability and change in retrospective reports of childhood experiences over a 5-year period: Findings from the Davis Longitudinal Study. Psychology and Aging, 24(3), 715–721. https://doi.org/10.1037/a0016203

57.

Yang

Silventoinen

Martikainen

(2020). Childhood adversity and depressive symptoms among middle-aged and older Chinese: Results from China Health and Retirement Longitudinal Study. Aging and Mental Health, 24(6), 923–931. https://doi.org/10.1080/13607863.2019.1569589

58.

Yang

Y. C.

Boen

Gerken

Schorpp

Harris

K. M.

(2016). Social relationships and physiological determinants of longevity across the human life span. Proceedings of the National Academy of Sciences - PNAS, 113(3), 578–583. https://doi.org/10.1073/pnas.1511085112

59.

Yao

(2021). Relationships between childhood health experience and depression among older people: Evidence from China. Frontiers in Psychology, 12, 744865–744865. https://doi.org/10.3389/fpsyg.2021.744865

60.

Zhu

(2022). Direct and indirect associations between childhood socioeconomic status and cognitive function in the middle-aged and older adults in China. Aging and Mental Health, 26(9), 1730–1737. https://doi.org/10.1080/13607863.2021.1935459

61.

Zhao

Smith

J. P.

Strauss

Yang

(2014). Cohort profile: The China health and retirement longitudinal study (CHARLS). International Journal of Epidemiology, 43(1), Article 1. https://doi.org/10.1093/ije/dys203

62.

Zhou

J.-J.

Bai

(2022). Influence of intergenerational relationships on depressive symptoms in ageing Chinese adults in Hong Kong: Mediating effects of sense of loneliness. BMC Geriatrics, 22(1), 1–587. https://doi.org/10.1186/s12877-022-03269-z

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.44 MB