The mediating role of pain and Activities of Daily Living in the relationship between childhood domestic physical violence and depression levels in Later Life: A propensity score matching and mediation analysis

Objectives: Amid global aging trends, the relationship between childhood domestic physical violence (CDPV) and depression levels in older adults, along with the underlying mechanisms, remains insufficiently explored. This study aims to analyze the relationship between CDPV and depression levels in older adults and to verify the mediating roles of pain and activities of daily living (ADL) in the relationship between CDPV and depression in later life. Methods: This study is based on data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2014 and 2020. Depression levels were assessed using the Center for Epidemiologic Studies Depression Scale (CESD-10), and ADL was measured using the ADL scale. A propensity score matching (PSM) method was used to match older adults exposed to CDPV with those in the non-exposed group. A bootstrap procedure was employed to assess the impact of CDPV on depression levels in older adults and to explore the mediating roles of pain and ADL in the relationship between CDPV and depression. Sensitivity analyses were performed by varying the dataset and classifications of depression variables. Results: A total of 2,288 individuals (30.53%) were exposed to CDPV. The mean scores for pain, ADL, and depression levels were 2.68±3.56, 33.98±4.17, and 9.40±6.47, respectively. Exposure to CDPV was significantly associated with higher depression levels in older adults ( β = 0.423, 95% CI [0.089–0.757]), with pain and ADL showing significant individual mediating effects between CDPV and depression ( β = 0.110, 95% CI [0.020–0.201]; β = 0.113, 95% CI [0.038–0.193]). Furthermore, pain and ADL together exhibited a significant chain mediating effect in the relationship between CDPV and depression ( β = 0.024, 95% CI [0.004–0.044]). Sensitivity analyses further validated the robustness of these findings. Conclusions: Reducing the prevalence of childhood domestic physical violence and addressing the pain and ADL status of older adults exposed to CDPV may serve as effective strategies to prevent depression in later life.