Racial disparities in the association between adverse childhood experiences and history of self-reported depression among cancer survivors.

OBJECTIVE

This study aimed to assess the association between the number of adverse childhood experiences (ACEs) and the history of depression among cancer survivors by race.

METHODS

This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System among 22,292 cancer survivors. The number of ACE experienced (zero, one, two-three, ≥ four) included questions assessing exposure to physical, emotional, and sexual household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence before age 18 years. The outcome is self-reported history of depression (yes/no). Three weighted multivariable logistic regression models were used to examine the association between ACE and depression for each race group: non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanics.

RESULTS

In this sample of cancer survivors, 41%, 22%, 21%, and 16% reported having experienced zero, one, two-three, and ≥ 4 ACEs, respectively. In the adjusted models, among NHW survivors, those who experienced ≥ 4 ACEs (aOR 4.20; 95% CI 3.32-5.32) had higher odds of depression diagnosis compared with those with zero ACEs. Among NHB survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 2.98; 95% CI 1.45-6.14) compared with those with zero ACEs. Similarly, among Hispanic survivors, those who experienced ≥ 4 ACEs had higher odds of depression diagnosis (aOR 10.74; 95% CI 5.01-23.00) compared with those with zero ACEs.

CONCLUSION

Individuals with ACEs may constitute a key group for targeted prevention efforts to mitigate the risk of depression in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS: Development of personalized and targeted screening methods for patients diagnosed with cancer who have experienced adverse childhood experiences and depression is critical to improving their long-term well-being.