Associations of adverse childhood and adulthood experiences with depressive and anxiety symptoms among rural left-behind women: A cross-sectional study in China

Background: Life course adverse experiences are linked to an increased risk of mental health problems. However, these associations remain unclear among Chinese rural left-behind women. This study aimed to investigate the associations of adverse childhood and adulthood experiences with depressive and anxiety symptoms among rural left-behind women in China. Methods: This cross-sectional survey was conducted in Henan province, China in July 2023. Rural left-behind women were recruited using a multistage-stratified random sampling method. Data on adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) were collected through structured interviews. Depressive and anxiety symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale and Generalized Anxiety Disorder-7 assessment, respectively. Multivariable log-binomial models with stabilized inverse probability of treatment weights (IPTW) were applied to analyze the associations of ACEs and AAEs with depressive and anxiety symptoms. Restricted cubic splines (RCS) were used to investigate the doserisk associations of the ACEs score and AAEs score with depressive and anxiety symptoms. The additive and multiplicative interaction effects of ACEs and AAEs were also explored. A mediation analysis was conducted to examine the role of AAEs between ACEs and depressive and anxiety symptoms. Results: Among 1495 rural left-behind women, 60.2% had at least one ACE, and 48.0% were affected by both ACEs and AAEs. The median age of the total population was 53 years (interquartile range [IQR]: 44-58). Women with four or more ACEs had higher risks of depressive symptoms (risk ratio [RR]: 2.60, 95% confidence interval [CI]: 2.22, 3.05) and anxiety symptoms (RR: 1.87 95% CI: 1.69, 2.08). Women with four or more AAEs had an RR of 2.19 for depressive symptoms (95% CI: 1.90, 2.51), and an RR of 2.44 (95% CI: 1.90, 2.51) for anxiety symptoms. The presence of both ACEs and AAEs doubles the risks of depressive symptoms (RR: 2.33, 95% CI: 1.96, 2.78) and anxiety symptoms (RR: 1.89, 95% CI: 1.54, 2.32). Besides, AAEs exhibited significant indirect effects on depressive and anxiety symptoms, with mediation proportions of 7.50% and 38.76%, respectively. Conclusion: Our findings highlight the compounded impact of adverse experiences across the lifespan on mental health among Chinese rural left-behind women. Life-course strategies or policies aimed at preventing and mitigating the effects of such adverse experiences are crucial for this vulnerable population.