Adverse Childhood Experiences, Depressive Symptoms, Functional Dependence, and Physical Activity: A Moderated Mediation Model

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $117.00

1 year online subscription

USD  $156.00

Student 2 year online subscription

USD  $222.00

2 year online subscription

USD  $296.00

Background: Adverse childhood experiences, depressive symptoms, and functional dependence are interrelated. However, the mechanisms underlying these associations remain unclear. The authors investigated the potential of depressive symptoms to mediate the effect of adverse childhood experiences on functional dependence in older age and whether physical activity moderated this mediation. Method: Data from 25,775 adults aged 62 (9) years from the Survey of Health Ageing and Retirement in Europe were used in adjusted linear mixed-effects models to test whether depressive symptoms mediated the associations between adverse childhood experiences and functional dependence in activities of daily living (ADL) and instrumental ADL (IADL) and whether physical activity moderated these mediations. Results: The results showed a graded association between the number of adverse childhood experiences (0 vs 1 and 0 vs ≥2) and the number of functional limitations in both ADL (bs = 0.040 and 0.067) and IADL (bs = 0.046 and 0.076). These associations were mediated by depressive symptoms. Physical activity reduced the effect of adverse childhood experiences on depressive symptoms (bs = −0.179 and −0.515) and tempered the effect of depressive symptoms on functional dependence both in ADL (b = −0.073) and IADL (b = −0.100). As a result of these reductions, the effect of adverse childhood experiences and depressive symptoms on functional dependence in ADL (Ps > .081) and IADL (Ps > .528) was nonsignificant in physically active participants. Conclusions: These findings suggest that, after age 50, engaging in physical activity more than once a week protects functional independence from the detrimental effects of adverse childhood experiences and depression. In inactive individuals, the detrimental effects of adverse childhood experiences on functional dependence are mediated by depressive symptoms.

Cullati and Cheval contributed equally to this work. Boisgontier is with the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. Orsholits, von Arx, Sieber, and Cullati are with the Swiss NCCR “LIVES—Overcoming Vulnerability: Life Course Perspectives,” University of Geneva, Geneva, Switzerland; and the Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland. Miller is with the School of Kinesiology, Auburn University, Auburn, AL, USA; and the Center for Neuroscience, Auburn University, Auburn, AL, USA. Courvoisier is with the Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland. Iversen is with the College of Health Professions, Sacred Heart University, Fairfield, CT, USA; the Department of Medicine, Section of Clinical Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; and the Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden. Cullati is also with the Population Health Laboratory, Department of Community Health, University of Fribourg, Fribourg, Switzerland. Cheval is with the Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland; and the Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland.

Boisgontier (matthieu.boisgontier@uottawa.ca) is corresponding author.

Supplementary Materials

    • Supplementary Material (PDF 127 KB)
  • 1.

    Hughes K, Bellis MA, Hardcastle KA, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356e366. PubMed ID: 29253477 doi:10.1016/S2468-2667(17)30118-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Laditka JN, Laditka SB. Adverse childhood circumstances and functional status throughout adult life. J Aging Health. 2017;30(9):13471368. PubMed ID: 28643582 doi:10.1177/0898264317715976

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185(12):914919. PubMed ID: 14044222 doi:10.1001/jama.1963.03060120024016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3, pt 1):179186. PubMed ID: 5349366 doi:10.1093/geront/9.3_Part_1.179

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Keeler E, Guralnik JM, Tian H, Wallace RB, Reuben DB. The impact of functional status on life expectancy in older persons. J Gerontol A Biol Sci Med Sci. 2010;65(7):727733. PubMed ID: 20363833 doi:10.1093/gerona/glq029

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Cummings SM. Predictors of psychological well-being among assisted-living residents. Health Soc Work. 2002;27(4):293302. PubMed ID: 12494721 doi:10.1093/hsw/27.4.293

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, Inc; 2013. doi:10.1176/appi.books.9780890425596

    • Search Google Scholar
    • Export Citation
  • 8.

    Cheong EV, Sinnott C, Dahly D, Kearney PM. Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor. BMJ Open. 2017;7(9):e013228. PubMed ID: 28864684 doi:10.1136/bmjopen-2016-013228

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Angelini V, Klijs B, Smidt N, Mierau JO. Associations between childhood parental mental health difficulties and depressive symptoms in late adulthood: the influence of life-course socioeconomic, health and lifestyle factors. PLoS One. 2016;11(12):e0167703. PubMed ID: 27936078 doi:10.1371/journal.pone.0167703

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004;82(2):217225. PubMed ID: 15488250 doi:10.1016/j.jad.2003.12.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    von Arx M, Cheval B, Sieber S, et al. The role of adult socioeconomic and relational reserves regarding the effect of childhood misfortune on late-life depressive symptoms. SSM Popul Health. 2019;8:100434. PubMed ID: 31294074 doi:10.1016/j.ssmph.2019.100434

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Braune BT, Berger K. The influence of depressive mood on activities of daily living and health care utilization in the elderly—the MEMO study on the KORA platform Augsburg. Gesundheitswesen. 2005;67(Suppl 1):176179. PubMed ID: 16032538 doi:10.1055/s-2005-858236

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO collaborative study on psychological problems in general health care. JAMA. 1994;272(22):17411748. PubMed ID: 7966922 doi:10.1001/jama.1994.03520220035028

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Shrira A, Litwin H. The effect of lifetime cumulative adversity and depressive symptoms on functional status. J Gerontol B Psychol Sci Soc Sci. 2014;69(6):953965. PubMed ID: 24898028 doi:10.1093/geronb/gbu056

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Wada T, Ishine M, Sakagami T, et al. Depression, activities of daily living, and quality of life of community-dwelling elderly in three Asian countries: Indonesia, Vietnam, and Japan. Arch Gerontol Geriatr. 2005;41(3):271280. PubMed ID: 15979739 doi:10.1016/j.archger.2005.03.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Rosenström T, Jokela M. Reconsidering the definition of major depression based on collaborative psychiatric epidemiology surveys. J Affect Disord. 2017;207:3846. doi:10.1016/j.jad.2016.09.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Boisgontier MP, Beets IAM, Duysens J, Nieuwboer A, Krampe RT, Swinnen SP. Age-related differences in attentional cost associated with postural dual tasks: increased recruitment of generic cognitive resources in older adults. Neurosci Biobehav Rev. 2013;37(8):18241837. PubMed ID: 23911924 doi:10.1016/j.neubiorev.2013.07.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Maes C, Gooijers J, Orban de Xivry JJ, Swinnen SP, Boisgontier MP. Two hands, one brain, and aging. Neurosci Biobehav Rev. 2017;75:234256. PubMed ID: 28188888 doi:10.1016/j.neubiorev.2017.01.052

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. Gerontologist. 2016;56 (Suppl 2):S268S280. PubMed ID: 26994266 doi:10.1093/geront/gnw031

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Chekroud SR, Gueorguieva R, Zheutlin AB, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5(9):739746. PubMed ID: 30099000 doi:10.1016/S2215-0366(18)30227-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Teychenne M, Ball K, Salmon J. Sedentary behavior and depression among adults: a review. Int J Behav Med. 2010;17(4):246254. PubMed ID: 20174982 doi:10.1007/s12529-010-9075-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Monnat SM, Chandler RF. Long term physical health consequences of adverse childhood experiences. Sociol Q. 2015;56(4):723752. PubMed ID: 26500379 doi:10.1111/tsq.12107

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Easterlin MC, Chung PJ, Leng M, Dudovitz R. Association of team sports participation with long-term mental health outcomes among individuals exposed to adverse childhood experiences. JAMA Pediatr. 2019;173(7):681688. PubMed ID: 31135890 doi:10.1001/jamapediatrics.2019.1212

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev. 2013;12(1):329338. PubMed ID: 23063488 doi:10.1016/j.arr.2012.10.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Börsch-Supan A, Brandt M, Hunkler C, et al. Data resource profile: the Survey of Health, Ageing and Retirement in Europe (SHARE). Int J Epidemiol. 2013;42(4):9921001. PubMed ID: 23778574 doi:10.1093/ije/dyt088

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Cheval B, Chabert C, Sieber S, et al. Association between adverse childhood experiences and muscle strength in older age. Gerontology. 2019;65(5):474484. PubMed ID: 30921803 doi:10.1159/000494972

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Landös A, von Arx M, Cheval B, et al. Childhood socioeconomic circumstances and disability trajectories in older men and women: a European cohort study. Eur J Public Health. 2019;29(1):5058. doi:10.1093/eurpub/cky166

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Copeland JRM, Beekman ATF, Braam AW, et al. Depression among older people in Europe: the EURODEP studies. World Psychiatry. 2004;3(1):4549. PubMed ID: 16633454

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Prince MJ, Reischies F, Beekman ATF, et al. Development of the EURO–D scale—a European, Union initiative to compare symptoms of depression in 14 European centres. Br J Psychiatry. 1999;174(4):330338. PubMed ID: 10533552 doi:10.1192/bjp.174.4.330

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Cheval B, Sieber S, Guessous I, et al. Effect of early- and adult-life socioeconomic circumstances on physical inactivity. Med Sci Sports Exerc. 2018;50(3):476485. PubMed ID: 29112624 doi:10.1249/MSS.0000000000001472

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Cheval B, Rebar AL, Miller MW, et al. Cognitive resources moderate the adverse impact of poor perceived neighborhood conditions on self-reported physical activity of older adults. Prev Med. 2019;126:105741. PubMed ID: 31153916 doi:10.1016/j.ypmed.2019.05.029

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Cheval B, Orsholits D, Sieber S, Courvoisier DS, Cullati S, Boisgontier MP. Relationship between decline in cognitive resources and physical activity. Health Psychol. 2020;39(6):519528. doi:10.1037/hea0000857

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Boisgontier MP, Cheval B. The anova to mixed model transition. Neurosci Biobehav Rev. 2016;68:10041005. PubMed ID: 27241200 doi:10.1016/j.neubiorev.2016.05.034

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Yzerbyt VY, Muller D, Batailler C, Judd CM. New recommendations for testing indirect effects in mediational models: the need to report and test component paths. J Pers Soc Psychol. 2019;115(6):929943. doi:10.1037/pspa0000132

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Muller D, Judd CM, Yzerbyt VY. When moderation is mediated and mediation is moderated. J Pers Soc Psychol. 2005;89(6):852863. PubMed ID: 16393020 doi:10.1037/0022-3514.89.6.852

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY: Guilford Press; 2013.

    • Search Google Scholar
    • Export Citation
  • 37.

    Amemiya A, Fujiwara T, Murayama H, Tani Y, Kondo K. Adverse childhood experiences and higher-level functional limitations among older Japanese people: results from the JAGES study. J Gerontol A Biol Sci Med Sci. 2018;73(2):261266. PubMed ID: 28525611 doi:10.1093/gerona/glx097

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull. 1991;110(3):406425. PubMed ID: 1758917 doi:10.1037/0033-2909.110.3.406

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5(1):56. PubMed ID: 18990237 doi:10.1186/1479-5868-5-56

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Hardt J, Rutter M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry. 2004;45(2):260273. PubMed ID: 14982240 doi:10.1111/j.1469-7610.2004.00218.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 264 264 60
Full Text Views 19 19 5
PDF Downloads 13 13 2