Examining the Contribution of Childhood Maltreatment to the Gender Gap in Depression: Insights from the German National Cohort (NAKO)

Abstract Background Childhood maltreatment is a major risk factor for depression and may contribute to sex differences in depression prevalence. We examined sex-specific associations between childhood maltreatment and depression and estimated the proportion of depression cases attributable to specific maltreatment subtypes. Methods We analyzed baseline data from 159,045 participants (49.4% women; aged 19–72) in the German National Cohort (NAKO). Childhood maltreatment was assessed via the Childhood Trauma Screener; depression via self-reported physician’s diagnosis and MINI classification (lifetime) and the PHQ-9 (current). Associations, including sex interactions, were modeled using binary logistic regressions. Mediation analyses and sex-stratified population attributable fractions (PAFs) quantified the contribution of maltreatment to depression. Results Maltreatment was associated with increased odds of lifetime (OR physician’s diagnosis =2.45 [2.38,2.53]; OR MINI =2.30 [2.18,2.43]) and current depression (OR=2.90 [2.79,3.02]). Sex interactions were observed for the physician’s diagnosis: physical abuse and neglect had stronger associations in women (OR physical abuse =2.74 [2.59,2.90]; OR physical neglect =1.36 [1.28,1.44]) than men ( ORphysical abuse =2.36 [2.21,2.52]; OR physical neglect =1.08 [1.00,1.16]), whereas sexual abuse showed stronger associations in men (OR=3.23 [2.91,3.57]) than women (OR=2.61 [2.48,2.75]). Overall, childhood maltreatment accounted for 21.2-26.2% of lifetime and 33.4% of current depression. PAFs were higher in women than men for lifetime (24.5-28.5% vs. 16.0-20.9%) and current depression (36.1% vs. 28.2%). Emotional abuse and neglect contributed the highest PAFs (up to 10.2%). Maltreatment mediated 18.9-30.0% of the association between sex and depression. Conclusion Maltreatment, especially emotional subtypes, account for a substantial proportion of depression in both sexes, with stronger overall associations in women. Sex-specific prevention may help reduce depression prevalence.