Does accumulative childhood trauma affect adult depression? Exploring the mediating effects of substance misuse experience and gender differences

Background: There is a growing global concern of depression, especially notable in South Korea, where childhood trauma significantly elevates the risk of depression and substance misuse in adulthood. This study aims to explore the mediating role of substance misuse within this relationship, emphasizing gender differences. The insights gained from this research aim to inform the development of effective intervention strategies and public health policies. Methods: This study utilizes data from the 2021 Life Events and Trauma Experience Survey conducted in South Korea to explore gender differences in the mediating effects substance misuse on the relationship between childhood trauma and adult depression. The sample comprises 1331 adults who experienced childhood trauma, and depression is assessed using the Patient Health Questionnaire-9 (PHQ-9). Childhood trauma is categorized into 23 life events. Results: The findings indicated that both childhood trauma and substance misuse were significantly associated with increased levels of adult depression, with substance misuse intensifying this effect. Gender differences were observed, as females reported higher levels of both depression and experiences of childhood trauma. However, gender did not influence the mediating effect of substance misuse on depression. Furthermore, factors such as having a spouse, chronic illness, and economic status influenced levels of depression and substance misuse. Conclusions: The findings suggest the need for preventive efforts for childhood trauma and substance misuse interventions, emphasizing a comprehensive approach rather than a gender-specific one in mental health programs.

Childhood trauma; Adult depression; Substance misuse; Gender differences

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th edn. American Psychiatric Association: Arlington, VA, USA. 2013.

[2] Lee NI. The effects of the person-centered art therapy on depression and stress of woman [master’s thesis]. Dongguk University. 2021.

[3] World Health Organization. Depressive disorder (depression). 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/depression?form=MG0AV3 (Accessed: 19 December 2024).

[4] Korea Ministry of Health and Welfare & National Center for Mental Health. 2024 National survey on knowledge and attitudes toward mental health. 2024. Available at: https://www.ncmh.go.kr/ncmh/board/boardView.do?no=9742&fno=106&gubun\_no=6&menu\_cd=04\_03\_00\_02&bn=newsView&search\_item=&search\_content=&pageIndex=1 (Accessed: 31 May 2025).

[5] Lee SM, Park JH, Yun YD, Kim JY. Impact analysis and management study of mental health problems—mainly depression. (Report No. 2013-02). Wonju, Republic of Korea; 30 Nov. 2013.

[6] Kwon MJ, Song YS, Kim SA. Factors influencing depression by causes of stress in individuals. Journal of the Korean Convergence Society. 2021; 12: 453–465. (In Korean)

[7] Song RR, Lee MA. The relationship between childhood trauma experiences and adult depression: the moderating effect of social relationships. Korean Journal of Population Studies. 2016; 39: 1–24. (In Korean)

[8] He J, Yan X, Wang R, Zhao J, Liu J, Zhou C, et al. Does childhood adversity lead to drug addiction in adulthood? A study of serial mediators based on resilience and depression. Frontiers in Psychiatry. 2022; 13: 871459.

[9] Park AR. The effect of negative childhood experiences on adult depression and suicidal thoughts. Journal of the Korean Wellness Association. 2021; 16: 277–283. (In Korean)

[10] Lee HN, Jeong IJ. The relationship between negative childhood experiences and adult health: an exploration of gender differences. Journal of Child Studies. 2021; 42: 343–357. (In Korean)

[11] Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, Grogan-Kaylor A. Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse & Neglect. 2017; 69: 10–19.

[12] World Health Organization (WHO). Adverse childhood experiences international questionnaire (ACE-IQ). 2020. Available at: https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq) (Accessed: 31 May 2025).

[13] Center for Disease Control and Prevention. About child abuse and neglect. 2024. Available at: https://www.cdc.gov/child-abuse-neglect/about/index.html?CDC_AAref_Val=https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html (Accessed: 31 May 2025).

[14] Yehuda R. Post-traumatic stress disorder. The New England Journal of Medicine. 2002; 346: 108–114.

[15] Chae S. The reality of trauma among young adults in Korea. Health and Welfare ISSUE & FOCUS. 2022; 417: 1–8.

[16] Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, et al. Childhood adversities and adult psychopathology in the WHO world mental health surveys. British Journal of Psychiatry. 2010; 197: 378–385.

[17] Choi JH, Chae SM. Childhood trauma experience and adult depression: the moderating effect of resilience. Health and Social Welfare Review. 2024; 44: 407.

[18] Choi SS, Hwang BR. Adverse childhood experiences and depression in young adults: mediating effects of perceived isolation. Journal of Social Science. 2024; 35: 197–219.

[19] Anda RF, Brown DW, Dube SR, Bremner JD, Felitti VJ, Giles WH. Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine. 2008; 34: 396–403.

[20] Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health. 2017; 2: e356–e366.

[21] Shonkoff JP, Garner AS. Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012; 129: e232–e246.

[22] O’Rand AM. The precious and the precocious: understanding cumulative disadvantage and cumulative advantage over the life course. Gerontologist. 1996; 36: 230–238.

[23] Choi SS, Kim AR. The impact of adverse childhood experiences on depression in young adults: mediating effects of adverse young adulthood experiences. Journal of Social Science Research. 2025; 18: 392–414. (In Korean)

[24] Nurius PS, Green S, Logan-Greene P, Borja S. Life course pathways of adverse childhood experiences toward adult psychological well-being: a stress process analysis. Child Abuse & Neglect. 2015; 45: 143–153.

[25] McLaughlin KA, Greif Green J, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC. Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Archives of General Psychiatry. 2012; 69: 1151–1160.

[26] Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders. 2004; 82: 217–225.

[27] Schulenberg JE, Maggs JL. A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol and Drugs. 2002; 54–70.

[28] Pearlin LI. The life course and the stress process: some conceptual comparisons. The Journals of Gerontology. 2010; 65B: 207–215.

[29] Cheong EV, Sinnott C, Dahly D, Kearney PM. Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor. BMJ Open. 2017; 7: e013228.

[30] Sahle BW, Reavley NJ, Li W, Morgan AJ, Yap MBH, Reupert A, et al. The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses. European Child & Adolescent Psychiatry. 2022; 31: 1489–1499.

[31] Austin AE, Herrick HWB. The effect of adverse childhood experiences on adult health: 2012 North Carolina behavioral risk factor surveillance system survey. North Carolina State Center for Health Statistics Study. 2014; 167: 1–15.

[32] Song L, Lee M. Traumatic experiences in childhood and depressive symptoms in adulthood: the effects of social relationships. 2016. Available at: https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002123904 (Accessed: 22 June 2025).

[33] Kim HS, Pyo HJ, Fava M, Mischoulon D, Park MJ, Jeon HJ. Bullying, psychological, and physical trauma during early life increase risk of major depressive disorder in adulthood: a nationwide community sample of Korean adults. Frontiers in Psychiatry. 2022; 13: 792734.

[34] Kim HY, Choi SY, Chae SM. Effects of cumulative trauma on health. Korean Journal of Health Education and promotion. 2022; 39: 67–80.

[35] National Center for Mental Health. 2021 Mental health survey. 2021. Available at: https://mhs.ncmh.go.kr/board.es?mid=a10301000000&bid=0005&nPage=1&b\_list\_cnt=9&ord=&dept\_cd=&tag=&list\_no=16&listNo=&act=view&view\_sdate\_param=&keyField=&keyWord= (Accessed: 19 December 2024).

[36] Lee SY. Factors related to suicidal thoughts and experiences of depression by gender in adulthood. Journal of the Korean Public Health Nursing. 2014; 28: 71–86. (In Korean)

[37] Lee HJ, Cho KS, Yoon JH, Park HS. Factors influencing the experience, diagnosis, and treatment of depression. Journal of the Korean Society for Clinical Health Promotion. 2014; 14: 9–16. (In Korean)

[38] Schwabe L, Dickinson A, Wolf OT. Stress, habits, and drug addiction: a psychoneuroendocrinological perspective. Experimental and Clinical Psychopharmacology. 2011; 19: 53–63.

[39] Choi SY. Chronic drug poisoning. The Korean Nurse. 1970; 9: 52–58. (In Korean)

[40] Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry. 1985; 142: 1259–1264.

[41] Jacobsen LK, Southwick SM, Kosten TK. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. American Journal of Psychiatry. 2001; 158: 1184–1190.

[42] Triffleman E. Issues in implementing posttraumatic stress disorder treatment outcome research in community-based treatment programs. In Sorensen J, Rawson J (eds.) Drug abuse treatment through collaboration (pp. 227–247). American Psychological Association: Washington, DC. 2003.

[43] Chae SM, Jeong JW, Lee SY, Heo KH. Relationship between drug misuse, depression, subjective health status, and health behavior according to working status. Korean Journal of Occupational Health Nursing. 2015; 24: 245–257. (In Korean)

[44] Pickover AM, Messina BG, Correia CJ, Garza KB, Murphy JG. A behavioral economic analysis of the nonmedical use of prescription drugs among young adults. Experimental and Clinical Psychopharmacology. 2016; 24: 38–47.

[45] McCabe SE, Teter CJ, Boyd CJ, Wilens TE, Schepis TS. Sources of prescription medication misuse among young adults in the United States: the role of educational status. The Journal of Clinical Psychiatry. 2018; 79: 17m11958.

[46] Hughes A, Williams M, Lipari RN, Bose J, Copello EA, Kroutil LA. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. 2016. Available at: https://archive.org/details/nsduh-ffr-2-2015 (Accessed: 31 May 2025).

[47] Miech RA, Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2018: volume I, Secondary school students. 2018. Available at: https://monitoringthefuture.org/wp-content/uploads/2022/08/mtf-vol1\_2018.pdf (Accessed: 31 May 2025).

[48] Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Results from the 2017 National Survey on Drug Use and Health: detailed tables. 2018. Available at: https://archive.org/details/nsduhdetailed-tabs-2017-1 (Accessed: 31 May 2025).

[49] Catalano RF, White HR, Fleming CB, Haggerty KP. Is nonmedical prescription opiate use a unique form of illicit drug use? Addictive Behaviors. 2011; 36: 79–86.

[50] Schepis TS, West BT, Teter CJ, McCabe SE. Prevalence and correlates of co-ingestion of prescription tranquilizers and other psychoactive substances by U.S. high school seniors: results from a national survey. Addictive Behaviors. 2016; 52: 8–12.

[51] McCabe SE, Veliz PT, Boyd CJ, Schepis TS, McCabe VV, Schulenberg JE. A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife. Drug and Alcohol Dependence. 2019; 194: 377–385.

[52] Marmorstein NR, Iacono WG, Malone SM. Longitudinal associations between depression and substance dependence from adolescence through early adulthood. Drug and Alcohol Dependence. 2010; 107: 154–160.

[53] Parker H, Aldridge J, Measham F. Illegal leisure: the normalization of adolescent recreational drug use. Routledge: London. 1999.

[54] LeClair A, Kelly BC, Pawson M, Wells BE, Parsons JT. Motivations for prescription drug misuse among young adults: considering social and developmental contexts. Drugs. 2015; 22: 208–216.

[55] Kelly BC, Rendina HJ, Vuolo M, Wells BE, Parsons JT. Influences of motivational contexts on prescription drug misuse and related drug problems. Journal of Substance Abuse Treatment. 2015; 48: 49–55.

[56] Vsevolozhskaya OA, Anthony JC. Estimated probability of becoming a case of drug dependence in relation to duration of drug-taking experience: a functional analysis approach. International Journal of Methods in Psychiatric Research. 2017; 26: e1513.

[57] NIDA. Community monitoring systems: tracking and improving the well-being of America’s children and adolescents. 2007. Available at: https://archives.nida.nih.gov/sites/default/files/cms.pdf (Accessed: 31 May 2025).

[58] Volkow ND, Morales M. The brain on drugs: from reward to addiction. Cell. 2015; 162: 712–725.

[59] Clark DB, Pollock N, Bukstein OG, Mezzich AC, Bromberger JT, Donovan JE. Gender and comorbid psychopathology in adolescents with alcohol dependence. Journal of the American Academy of Child and Adolescent Psychiatry. 1997; 36: 1195–1203.

[60] Woo JH. A study on the trauma experiences of male and female alcoholics. Journal of the Korean Contents Association. 2014; 14: 299–307. (In Korean)

[61] McLellan AT, Koob GF, Volkow ND. Preaddiction—a missing concept for treating substance use disorders. JAMA Psychiatry. 2022; 79: 749–751.

[62] Kwon HJ. The relationship between trauma experience and substance abuse problems: moderating effects of social recovery capital [master’s thesis]. Catholic University. 2019.

[63] Shim H. The effect of juvenile drug abuse experience on suicidal ideation, suicidal planning, and suicide attempts. 2023. Available at: https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART003045662 (Accessed: 20 June 2025).

[64] Seong CH, Park MR, Kim YJ. An analysis of the structural model of social support for drug knowledge and drug abuse in the dwelling elderly. Journal of the Korea Academia-Industrial Cooperation Society. 2014; 15: 2160–2169.

[65] Ahn JY, Seo ER, Lim KH, Shin JH, Kim JB. Standardization study of the Korean version of the depression screening tool (Patient Health Questionnaire-9, PHQ-9). 2013. Available at: www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001766067 (Accessed: 31 May 2025).

[66] Spitzer RL, Kroenke K, Williams JB. Validation andutility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999; 282: 1737–1744.

[67] Chae SM. The current status of drug misuse and improvement measures. Health and Welfare Forum. 2015; 66–76. (In Korean)

[68] Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the adverse childhood experiences study. JAMA. 2001; 286: 3089–3096.

[69] Schwartz A, Arsandaux J, Montagni I, Meschke LL, Galera C, Tzourio C. Adverse childhood experiences and substance use among university students: a systematic review. Journal of Substance Use. 2023; 28: 823–833.

[70] Son SM, Kim JB. Associations between adverse childhood experiences and adult depression. Journal of School Social Work. 2023; 62: 27–51. (In Korean)

[71] Ministry of Health and Welfare. 2023 major statistics on child abuse. 2023. Available at: https://www.mohw.go.kr/board.es?mid=a10411010200&bid=0019&act=view&list\_no=1482961&tag=&nPage=1 (Accessed: 31 May 2025).

[72] Jeong H, Lee B. Development of a comprehensive child protection support service model and its effects on child maltreatment recurrence prevention. 2021. Available at: https://kiss.kstudy.com/ExternalLink/Ar?key=4065660 (Accessed: 31 May 2025).

[73] Ministry of Health and Welfare; Ministry of Food and Drug Safety; Ministry of Justice. Introducing a justice-treatment-rehabilitation model for drug users. 2024. Available at: www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list\_no=376767&form=MG0AV3 (Accessed: 19 December 2024).

[74] Kim SY, Cho NW, Yoo MS, Han SY, Oh JW. Narcotics information management system in South Korea: system development and innovation. BMC Health Services Research. 2023; 23: 73.

[75] Lee H, Kim H, Kim J, Kim S, Kim D. Comparative analysis of controlled substance monitoring systems based on health information technology—focusing on prescriptions and dispensing. Yakhak Hoeji. 2024; 68: 36–43. (In Korean)

[76] Sarah H, Ashley L, Michael S, Carter A. Patient experiences of prescription drug monitoring programs: a qualitative analysis from an Australian pharmaceutical helpline. International Journal of Drug Policy. 2022; 109: 103847.

[77] Kim YH, Jeon JY, Lim JH, Lim SH, Yoo ES, Park HI. The factors affecting drug addiction and suicide: focusing on the relationship between drug addiction and suicide. Addiction and Welfare. 2018; 2: 28–53. (In Korean)