Adverse childhood experiences with physical, depressive, and cognitive multimorbidity among Chinese adults and the mediating role of loneliness

Little is known about the associations between adverse childhood experiences (ACE_S) and physical, depressive, and cognitive (PDC) disorders and their multimorbidity. Moreover, no study has assessed whether loneliness mediates any such associations. Using a nationally population-based study in China, we aimed to investigate the associations between ACE_S and PDC disorders and their multimorbidity among 11,124 middle-aged and older adults. Eight categories of outcomes including no disorders, physical disorder, depressive symptoms, cognitive disorder, and their four combinations were assessed. Twelve ACE_S indicators were measured using a validated questionnaire. Multivariate logistic regression and stratification analyses were performed to explore the association between ACE_S and PDC disorders and their multimorbidity, as well as potential modifiers. Mediate analyses were applied to examine the potential pathways via loneliness. Of the 11,124 individuals (45.8 % women, mean [SD] age: 60.1 [8.9] years), 79.3 % had at least one ACE. Compared with individuals without ACE_S, those who had four or more ACE_S had elevated risks of PDC disorders and their multimorbidity. The estimated odds ratios (OR) were 2.95 (95 % CI: 2.46-3.54) for physical-depressive multimorbidity, 1.59 (1.28-1.98) for physical-cognitive multimorbidity, 2.58 (2.01-3.31) for depressive-cognitive multimorbidity, and 2.91 (2.15-3.96) for PDC multimorbidity, respectively. There is an exposure-response relationship between cumulative ACE_S with different outcomes. These associations were mediated by loneliness, with a mediation proportion varying from 8.7 % to 32.5 %. However, no significant modification was observed by sex, age, educational level, and childhood economic status. Our findings provided important insights for reducing childhood adversity to prevent chronic multimorbidity.