Subtypes of adverse childhood experiences and depression among adult cancer survivors: Evidence from a population-based study.
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Depression is highly prevalent among cancer survivors and is associated with poorer health outcomes and quality of life. Adverse childhood experiences (ACEs) are well-established risk factors for adult depression; however, limited research has examined the role of specific ACE subtypes in depression among cancer survivors. Data for this study were obtained from the 2019-2024 Behavioral Risk Factor Surveillance System survey. An analytic sample of 72,380 adult cancer survivors aged 18 and above (56.1% female) was analyzed. Nine ACE subtypes were assessed. Diagnosis of depression was the primary outcome measure. Multivariable binary logistic regression models were estimated to examine associations between ACE subtypes and depression, sequentially adjusting for sociodemographic characteristics, socioeconomic status, physical health, and health risk behaviors. Overall, 21.1% of cancer survivors reported a diagnosis of depression. All ACE subtypes were significantly associated with depression in bivariate analyses. In fully adjusted models, several ACE subtypes remained independently associated with higher odds of depression, including household mental illness (adjusted odds ratio [AOR] = 2.45; 95% CI = 2.24-2.81), sexual abuse (AOR = 1.70; 95% CI = 1.52-1.91), emotional abuse (AOR = 1.45; 95% CI = 1.32-1.59), and household alcohol use problems (AOR = 1.17; 95% CI = 1.06-1.29). Older age and engagement physical activity were protective factors against depression, while female sex, lower socioeconomic status, poor self-rated health, smoking, and obesity were associated with increased odds of depression. Specific subtypes of adverse childhood experiences, particularly household mental illness and abuse-related exposures, are associated with depression among adult cancer survivors. Findings highlight the importance of trauma-informed screening and mental health interventions in cancer survivorship care.