Abstract
OBJECTIVES: This study investigates the impact of adverse childhood experiences (ACEs) and depressive symptoms on incident arthritis in middle-aged and older Chinese adults, examining the mediating role of depressive symptoms in the ACEs-arthritis relationship to uncover psychological mechanisms underlying arthritis development. METHODS: We used 2011-2020 data from the China Health and Retirement Longitudinal Study (CHARLS) and included 4,184 participants aged ≥ 45 years who were free of arthritis at baseline (2011). ACEs were evaluated with 11 types of childhood adversity, classified into quartiles, while depressive symptoms were measured using the CES-D scale. Multivariable logistic regression and stratified analyses assessed associations between ACEs, depressive symptoms, and incident arthritis. Restricted cubic splines and mediation analysis were applied to explore dose-response relationships and the mediating role of depression. RESULTS: Among 4184 participants, 969 developed incident arthritis. Individuals in the highest ACEs quartile (Q4) had a significantly higher arthritis risk (OR 1.78, 95% CI 1.43-2.21, P < 0.001). This association was stronger in females and individuals aged 45-64. Depressive symptoms also increased arthritis risk, with a nonlinear dose-response relationship. Mediation analysis showed depressive symptoms partially mediated the ACEs-arthritis relationship, accounting for 12.4% of the effect. CONCLUSIONS: In this national cohort, higher ACEs burden and greater depressive symptom severity were significantly associated with incident arthritis, and depressive symptoms partially mediated by the ACEs-arthritis association. Targeting childhood adversity and later-life mental health may help reduce arthritis risk in aging populations.