Childhood stress and midlife depression in women: the influence of diet quality

ABSTRACT

Objective

How does diet quality (DQ) moderate associations between serious childhood stress exposures and adult depression?

Methods

We analyzed a cohort of Californian women at midlife (N=382; age 36-42). Serious childhood stress was defined as high perceived stress during childhood or adverse childhood experiences (ACEs) of physical abuse, sexual abuse, and/or household substance abuse. Women were dichotomized by current depression risk (high/low). The Healthy Eating Index (HEI)-2015 and Alternate Healthy Eating Index (AHEI)-2010 measured current DQ from 3-day food records. Interactions between childhood stress exposures and DQ indices were tested one-by-one in multivariable Poisson regression models.

Results

Depression risks associated with endorsing all 3 ACEs differed by HEI and AHEI scores, as did risks associated with endorsing high perceived stress, physical abuse, and sexual abuse by AHEI. Where DQ moderated stress-depression associations, predicted prevalences of high depression risk did not vary with DQ among women endorsing the particular childhood stressors. However, among non-endorsing women, predicted high depression risk prevalences were significantly lower with higher DQ compared to in their stress-exposed counterparts – e.g. at the 90th AHEI percentile, depression prevalences were ∼20% among ‘non-childhood-stressed’ women versus 48.8% (high perceived stress, sexual abuse), 52.0% (physical abuse), and 73.0% (3 ACEs) in ‘childhood-stressed’ women.

Conclusions

Higher current DQ, particularly as aligned with chronic disease prevention guidelines, predicts lower depression risk in women with low childhood adversity. DQ did not buffer depression risk in women with high childhood stress. Further research is warranted to examine persistent pathways of depression risk and diet's role within.

KEYWORDS:

• adverse childhood experiences
• diet quality
• depression
• childhood stress
• nutritional psychiatry
• moderation
• high perceived stress
• Healthy Eating Index (HEI)-2015
• Alternate Healthy Eating Index (AHEI)-2010
• psychosomatic health

Acknowledgements

We recognize NGHS staff past and present, especially Michael Coccia, MS, Kristy Brownell, BS, and Tashara Leak, PhD, MS, RD, for their talents and dedication without which the study and these analyses would not be possible. We also thank the Nutrition Policy Institute who provided consultation and support with historical study data. Most of all, we thank the incredible NGHS participants for their time and efforts over the years.

Data availability statement

The authors confirm that the data supporting the findings of this study are available by contacting corresponding author DTC and shareable upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant Race, stress and dysregulated eating: Maternal to child transmission of obesity [R01HD073568], the National Heart, Lung, and Blood Institute grant Neighborhood Environments and Intergenerational Transmission of Cardiovascular Health [R56HL141878], and the National Institute on Aging grants Early Life Adversity, Cumulative Life Stress, Race, and Cellular Ageing in Midlife Women and Offspring [R56AG059677 & R01AG059677].

Notes on contributors

Dorothy T. Chiu

DTC is a postdoctoral scholar/affiliate in the Division of Community Health Sciences at the University of California, Berkeley, and public health researcher interested in the intersection of diet and stress on mental and physical health outcomes.

Elissa J. Hamlat

EJH is a licensed clinical psychologist and postdoctoral fellow at the University of California, San Francisco. Her research focuses on the pubertal transition as a developmental period of risk for physical and mental health problems, particularly with depression.

Cindy W. Leung

CWL is Assistant Professor in the Department of Nutritional Sciences at the University of Michigan, Ann Arbor, and a nutritional epidemiologist whose research focuses on diet and health disparities in vulnerable populations.

Elissa S. Epel

ESE is Professor, and Vice Chair, in the Department of Psychiatry, at University of California, San Francisco, as well as Associate Director of the Center for Health and Community. Her research aims to elucidate mechanisms of healthy aging, and to apply this basic science to scalable interventions that can reach vulnerable populations.

Barbara A. Laraia

BAL is Professor in the Division of Community Health Sciences at the University of California, Berkeley, whose research focuses on the influence of contextual level effects on dietary intake, cardiometabolic risk factors, and pregnancy outcomes, especially among vulnerable populations.