Examining the Contribution of Childhood Maltreatment to the Sex Gap in Depression: Insights from the German National Cohort (NAKO).

Abstract

Childhood maltreatment is a major risk factor for depression and may contribute to sex differences in depression prevalence. We examined sex-specific associations between childhood maltreatment and depression and estimated the proportion of depression cases attributable to maltreatment subtypes. We analyzed baseline data from 159,045 participants (49.4% female; aged 19-72) in the German National Cohort (NAKO). Childhood maltreatment was assessed via the Childhood Trauma Screener; depression via self-reported physician's diagnosis and MINI classification (lifetime) and the PHQ-9 (current). Associations, including sex interactions, were modeled using binary logistic regressions. Disparity decomposition and sex-stratified population attributable fractions quantified the contribution of childhood maltreatment to depression. Childhood maltreatment was associated with increased odds of lifetime (ORphysician's diagnosis=2.45 [2.38,2.53]; ORMINI=2.30 [2.18,2.43]) and current depression (OR=2.90 [2.79,3.02], all padj<0.001). Sex interactions were observed for physician's diagnosis: physical abuse (padj=0.024) and neglect (padj<0.001) had stronger associations in females (ORphysical abuse=2.74 [2.59,2.90]; ORphysical neglect=1.36 [1.28,1.44]) than males (ORphysical abuse=2.36 [2.21,2.52]; ORphysical neglect=1.08 [1.00,1.16]), whereas sexual abuse (padj=0.003) showed stronger associations in males (OR=3.23 [2.91,3.57]) than females (OR=2.61 [2.48,2.75]). Overall, childhood maltreatment accounted for 21.2-26.2% of lifetime and 33.4% of current depression. Population attributable fractions were higher in females than males for lifetime (24.5-28.5% vs. 16.0-20.9%) and current depression (36.1% vs. 28.4%). Emotional subtypes contributed the highest population attributable fractions (up to 10.2%). Childhood maltreatment contributed 19.2-22.4% to the association between sex and depression. Childhood maltreatment accounts for a substantial proportion of depression in both sexes, with stronger overall associations in females. Sex-specific prevention may help reduce depression prevalence.