Association between early-life food insecurity and depressive symptom trajectories in middle-aged and older adults: The mediating role of educational attainment.
BACKGROUND While the long-term impact of childhood adversity on mental health in middle and old age is receiving increasing attention, the association between food insecurity at different early-life stages and the dynamic trajectories of depressive symptoms remains unclear. The potential mediating role of educational attainment in this relationship also warrants investigation. METHODS Utilizing data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS), this study included 4546 participants aged 45 and above with complete information. Based on retrospective data, early-life food insecurity was categorized into distinct periods: Early Childhood (0-5 years), Middle Childhood (6-12 years), Adolescence (13-17 years), and Multiple periods. Group-based trajectory modeling was employed to identify developmental trajectories of depressive symptoms from 2011 to 2020. A counterfactual framework-based mediation model was used to analyze the mediating effect of educational attainment. Stratified analyses were conducted by gender and residence. RESULTS Five distinct depressive symptom trajectories were identified. Early-life food insecurity, particularly exposure during Middle Childhood (OR range: 1.34-2.03) and Multiple periods (OR range: 1.51-2.81), significantly increased the risk of belonging to non-stable, high-risk depressive trajectories. Mediation analysis revealed that educational attainment played a significant mediating role in the association between food insecurity during Middle Childhood, Adolescence, Multiple periods, and the risk of adverse depressive trajectories. The indirect effect values were 0.009, 0.007, and 0.010, accounting for 9.83%, 10.82%, and 7.14% of the total effect, respectively. Exploratory subgroup analyses suggested that these associations were more pronounced among females and rural residents. CONCLUSION Early-life food insecurity, especially during middle childhood or across multiple developmental periods, was associated with less favorable depressive symptom trajectories in later life. Education explained only a modest share of these associations, suggesting multiple life-course pathways linking childhood deprivation to later-life mental health.