Association between adverse childhood experiences and self-reported physician-diagnosed depression: The moderating effect of race/ethnicity

Objectives: Although research indicates that individuals with a history of adverse childhood experiences (ACEs) are at greater risk of experiencing chronic conditions, including depression, less is known about the association between ACEs and depression and how this association is dependent on race/ethnicity. This study examined the moderating effects of race/ethnicity on the association between ACEs and self-reported physician-diagnosed depression among adults. Study design: Cross-sectional study. Methods: Data for this study came from the 2021 Behavioral Risk Factor Surveillance System. An analytic sample of 26,877 adults 18-64 years old (50.4% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was self-reported physician-diagnosed depression, the main explanatory variable was ACE score, and the moderating variable was race/ethnicity. Results: Of the 26,877 respondents, 28.1% had no ACEs, 47.2% had one to three ACEs, and 24.7% had four or more ACEs. About one in four respondents had physician-diagnosed depression. In the multivariable logistic regression, we found that the effect of ACEs on self-reported physician-diagnosed depression depends on race/ ethnicity. Specifically, the effect of four or more ACEs is significantly stronger when the respondent identifies as Hispanic compared to those who identify as non-Hispanic Black or another race (AOR = 2.80, 95% CI = 1.42, 5.53). Conclusion: The findings of this study demonstrate that experiencing four or more ACEs is associated with self- reported physician-diagnosed depression during adulthood, and this association is moderated by race/ethnicity.