Respiratory Sinus Arrhythmia Moderates the Association Between Adverse Childhood Experiences and Depressive Symptoms via Stress Appraisals and Perseverative Thinking.
OBJECTIVE Adverse childhood experiences (ACEs) confer risk for depressive symptoms in adulthood, potentially through maladaptive cognitive-affective responses to stress. The neurovisceral integration model suggests that resting respiratory sinus arrhythmia (RSA), an index of parasympathetic regulation, shapes capacity to regulate cognitive-affective stress responses. The present study tested whether stress-related appraisals and perseverative thinking mediated the association between ACEs and depressive symptoms, whether RSA moderated these pathways, and whether effects varied under chronic caregiving stress. METHODS Participants were 222 middle-aged mothers (mean age=46.83, SD=6.03) experiencing higher (n=125) and lower (n=97) caregiving stress. ACEs and depressive symptoms were assessed with the Childhood Trauma Questionnaire and CES-D. Perceived threat, perceived control, and perseverative thinking were measured via daily diaries. Resting RSA, CES-D, and daily measures were collected at three timepoints across 30 months. RESULTS Lower RSA strengthened the association between ACEs and depressive symptoms (b=0.269, SE=0.060, P<.001). Lower perceived control (b=0.022, 95% CI [0.001, 0.049]) and greater perseverative thinking (b=0.072, 95% CI [0.020, 0.128]) mediated the association between ACEs and depressive symptoms; lower RSA strengthened associations between ACEs and these mediators. Higher ACEs were associated with greater perceived threat among mothers with higher caregiving stress and lower RSA (b=0.014, SE=0.004, P<.001). CONCLUSIONS Early adversity is associated with depressive symptoms through stress-related cognitive-affective pathways. Lower RSA may reflect diminished regulatory capacity that strengthens associations between ACEs and maladaptive cognitive-affective stress responses.