Sex as a moderator of the relationship between childhood trauma and depression in adulthood: an analysis in a clinical sample of adult patients.

BACKGROUND

Childhood trauma is a well-established risk factor for depression in adulthood; however, not all individuals exposed to early adversity develop depressive disorders. Biological sex has been proposed as a potential moderator of this relationship, yet findings remain inconsistent, particularly in clinical samples. The present study aimed to examine whether biological sex moderates the association between childhood traumatic experiences and depression in a clinical sample of adults.

METHODS

The study included 308 adults (73 patients diagnosed with depression and 235 non-clinical participants), recruited from inpatient and day psychiatric units in north-western Poland. Childhood trauma was assessed retrospectively using the Polish adaptation of the Maltreatment and Abuse Chronology of Exposure questionnaire (MACE-58 [PL]), which measures multiple forms of abuse and neglect, as well as their severity, multiplicity, and duration. Moderation analyses were conducted using binary logistic regression models implemented in the PROCESS macro (Model 1), with biological sex tested as a moderator of the relationship between childhood trauma indicators and depression.

RESULTS

Biological sex significantly moderated the association between childhood trauma indicators and the presence of a depressive disorder diagnosis across all significant models. Parental physical abuse, peer physical bullying, cumulative trauma severity, multiplicity of peer violence, and duration of maltreatment were significantly associated with depression in women, whereas no significant associations were observed in men. The strongest effects were found for repeated peer physical bullying among women.

CONCLUSIONS

The findings indicate that biological sex plays a significant moderating role in the relationship between childhood trauma and depression in adulthood. Women demonstrated stronger associations between interpersonal and cumulative trauma exposure and the presence of a depressive disorder diagnosis.These results underscore the importance of sex-sensitive approaches in the assessment and treatment of depression in clinical populations.