How Socioeconomic Status Mediates the Association Between Adverse Childhood Experiences and Depression: A Meta-Analytic Structural Equation Modelling Approach.
Adverse childhood experiences (ACEs) are well-established risk factors for adult depression. Indicators of socioeconomic status (SES, i.e. income, education, and employment) are likely mechanisms linking ACEs to depression. However, research has yet to meta-analytically test the mediating role of SES in the ACEs-depression association. We examined the associations between childhood ACEs and adult depression and SES indicators by synthesizing available literature into three random-effects meta-analytic structural equation models (MASEMs). From systematic searches in PsycINFO, Embase, CINHAL, and MEDLINE, we identified 105 samples representing 755,306 adults. Included studies reported effect sizes between ACEs, depression, and ≥1 SES indicator in adult populations. To test the mediating role of SES, separate MASEMs were tested for adult income (k = 56, n = 414,020), education (k = 87, n = 557,483), and employment (k = 21, n = 260,550). Adult income and education partially mediated the childhood ACEs-to-adult depression association. Higher ACE scores were associated with lower income and decreased educational attainment, which then predicted higher depression severity. Indirect effects were small but significant (income = 0.01 [0.006, 0.02]; education = 0.003 [0.0004, 0.007]). No variables moderated these indirect effects. Employment did not mediate the association between ACEs and depression. Our research provides context for understanding how SES indicators differentially mediate the pathway from ACEs to depression across populations. Although potentially limited by study reporting and assumptions in MASEM models, this research highlights the need to address socioeconomic disparities, particularly in income and education, within mental health strategies that target the lasting impacts of childhood adversity.