Associations between childhood adversity and depressive symptoms in later life: parallel mediation through self-rated health, internet media use, and social adaptation among Chinese older adults

Abstract

Introduction Late-life depressive symptoms remain a major public health concern in aging China. Although childhood adversity is a recognized risk factor for later-life depression, the concurrent conditions that statistically account for the association between early disadvantage and current emotional distress, particularly those amenable to intervention, have not been systematically examined in a parallel mediation framework. Methods Using cross-sectional data from the 2023 wave of the China Longitudinal Aging Social Survey (N = 11,670), we examined associations between childhood adversity and depressive symptoms and tested whether self-rated health, internet media use, and social adaptation accounted for part of that association as parallel mediators. Childhood adversity was a composite of childhood hunger, childhood medical deprivation, and parental loss by age 10. Depressive symptoms were assessed with a nine-item Center for Epidemiologic Studies Depression Scale. Models adjusted for sociodemographic covariates and used survey weights. Results Childhood adversity was positively associated with depressive symptoms in the total-effect model (β = 0.439, p < 0.001; N = 10,476). In the complete-mediator sample (N = 10,093), the corresponding total association was β = 0.348. The three concurrent measures together accounted for about 92% of this latter association in the specified model. The largest specific indirect associations were through social adaptation (β = 0.147) and self-rated health (β = 0.125), followed by internet media use (β = 0.051). A bootstrap contrast did not show a statistically significant difference between the social-adaptation and health indirect associations. The remaining direct association was small and nonsignificant (β = 0.026, p = 0.464). Subgroup analyses showed marked heterogeneity by community activity participation, residence, and family structure. Discussion Because the data are cross-sectional, these results describe association decomposition rather than causal transmission. Adversity-linked depressive burden in later life is concentrated in present-day health, social adaptation, and digital participation, with implications for integrated community mental health policy in China.