The Differential Impact of Adverse Childhood Experiences on Trajectories of Depressive Symptomology Throughout the Life Course

Depression is the leading cause of disability and is associated with lower quality of life, substance use, and suicide. Adverse Childhood Experiences (ACEs) is a conceptual framework that consolidates different exposures to childhood adversity including child abuse, family challenges, and other exposures to violence within the first 18 years of life. While research has found greater exposures to ACEs increases depression risk, the underlying causal mechanism of this relationship is not well understood. This gap is largely due to the lack of study of how ACEs are specifically linked to depressive symptoms over the life course. The goal of this dissertation was to understand the multidimensionality of ACEs and understand how each ACEs domain was associated with depressive symptom trajectories using a nationally representative dataset of adolescents in school year 1994-1995 followed over two decades (Add Health). For Aim 1, I evaluated the measurement properties of a constructed ACEs measure via factor analysis. For Aim 2, I conducted growth mixture modeling using a 4-item CES-D scale to develop depressive symptom trajectories from ages 12 to 42 using a cohort sequential design (Sub Aim 2a) and to estimate the odds of trajectory class membership of each identified factor from Aim 1 and other covariates using multinomial logistic regression. Results from Aim 1 found the three-factor solution to be the best-fitting model. All achieved configural invariance, but two factors were non-invariant in the scalar model: Factor 1 (“Direct Experiences of Abuse”) by sex and Factor 2 (“Neglect/Family and Home Instability”) by race/ethnicity. Results from Aim 2 identified three trajectory classes: Low-increasing (7%), High-decreasing (9%), and Persistently-low (83%). In the full regression model, increased “Crime and Community Violence” exposure and being female increased odds of membership into Low-increasing and High-decreasing classes separately. “Neglect/Family and Home Instability” was not related to class membership. The findings from this study indicate ACEs are multi-dimensional and each dimension is differently associated with longitudinal depressive symptoms. These findings suggest the need for more nuanced understanding of the ACEs-depression causal mechanism, which can inform the need for ACEs-focused community-violence prevention and gender-specific interventions to reduce population-level depression.