A Moderation Analysis of Sleep In the Relationship between Childhood Trauma Exposure and Depression Among Middle- and Older-Aged Adults

Background and Purpose: Consequences of exposure to childhood trauma extend across the lifespan, negatively impacting the physical health and mental health of middle- and older-aged adults. Depression is exacerbated by sleep disturbances, also a consequence of childhood trauma. Prior studies found that sleep moderates the relationship between depression and childhood trauma among young adults. Our study expands on previous research by analyzing the moderating influence of sleep on the relationship between depression and childhood trauma among middle- and older-aged adults, while controlling for the effects of health status.

Method: Using longitudinal data from the Health and Retirement Study, we analyzed a sample (N=15,777) of middle- and older-aged adults (Mean age=67; 59% female) using multilevel generalized linear model analyses to test relationships between the exposure of childhood traumatic events and depression symptoms (time-varying). Our analysis examined data collected from 2010, 2012, 2014, 2016, 2018, and 2020 HRS study waves. Model 1 partially adjusted for demographic and socioeconomic factors, Model 2 provided the fully adjusted model, including health status factors, while Model 3 tested the moderating effect of sleep disturbances against the fully adjusted model.

Results: Main Effects: Significant main effects of demographic characteristics were found in the relationship between childhood trauma and depression across all three models in our study. Depression symptoms were greater among people exposed to childhood trauma who were women, married, had lower educational attainment, less income, and who identified as Hispanic, non-Hispanic Black, or who identified as Non-Hispanic and endorsed racial and ethnic categories other than White or Black. Main effects of self-rated health and the presence of chronic health conditions were also significant in both models that analyzed them. Depressive symptoms increased in accordance with poorer subjective ratings of health and the number of reported chronic health conditions. Moderated Effects: We found associations between childhood traumatic events and depression remained significant, even after controlling for health status. Additionally, the impact on depressive symptoms is amplified when sleep disturbances are present among middle- and older-aged adults exposed to one (B=0.14; 95% CI: 0.04, 0.24) and multiple (B=0.30; 95% CI: 0.15, 0.45) childhood traumatic events. Our findings demonstrated a dose-response relationship between the main variables, as the moderating influence of sleep disturbance on depression increased in accordance with exposure to more experiences of childhood trauma.

Implications and Conclusions: Our study provides novel insights into the multifaceted relationships between childhood trauma exposure and physical and mental health consequences across the lifespan. We found that sleep disturbances can yield a unique influence on depression outcomes among middle- and older-aged adults exposed to trauma, above and beyond the influence of objective and subjective measures of health. While trauma-informed care approaches are generally recommended for people exposed to childhood adversity, middle- and older-aged adults may have unique treatment considerations related to historical stigma around mental health. Interventions addressing depressive symptoms that explicitly focus on treating sleep disturbances may be more desirable, and we encourage further studies examining the effectiveness of these treatment approaches among trauma-exposed middle- and older-aged adults.