Influence of childhood maltreatment on major depressive disorder in adulthood: mediating role of social support

Abstract Background: Childhood maltreatment is strongly associated with major depressive disorder (MDD) in adulthood, social support can buffer the effect of childhood maltreatment on MDD, but there are few studies on the role of different types of social support and gender differences in mediating models. Methods: The study included 965 MDD patients and 443 healthy participants from nine centers. MDD patients are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV). The Childhood Trauma Questionnaire-Short Form (CTQ-SF), 17-item Hamilton Depression Rating Scale and Social Support Rate Scale (SSRS) were used to assess the status of childhood maltreatment, MDD and social support. Multivariable mediation analyses were used to examine the mediating role of social support between childhood maltreatment and MDD. Results: After controlling for sex, age, ethnicity, educational level, family history, work status and marriage, childhood maltreatment increases the risk of MDD (OR=1.07, 95%CI: 1.05-1.09). Total social support (OR=0.88, 95%CI: 0.86-0.90) , subjective social support (OR=0.83, 95%CI：0.80-0.86), objective social support (OR=0.84, 95%CI: 0.80-0.89) and support utilization (OR=0.73, 95%CI: 0.68-0.78) all significantly reduced the risk of MDD. Total social support, subjective support and support utilization played a mediating role in childhood maltreatment and MDD, but not objective social support. For males, only subjective social support mediated the relationship between childhood maltreatment and MDD, while for females, both subjective social support and support utilization mediated the relationship. Conclusions: For those who experienced childhood maltreatment, suitable social support, especially subjective support and support utilization, may reduce the risk of MDD. Different social support seems necessary for male and female for alleviating the influence of childhood maltreatment on MDD.