Gender differences in the associations of adverse childhood experiences with depression and anxiety: A systematic review and meta-analysis

Background: Gender differences in the associations of adverse childhood experiences (ACEs) with depression and anxiety, remain underexplored. We aimed to quantify and directly compare gender-specific associations between ACEs and depression and anxiety. Methods: We systematically searched PubMed, Medline, and Embase for observational studies. Eligible articles should have reported effect sizes for depression or anxiety associated with varying number or specific types of ACEs. Using a random-effects model, we calculated the gender-specific pooled odds ratios (ORs) and derived the pooled women-to-men ratio of ORs (RORs) for the associations of ACEs with depression or anxiety, with corresponding 95 % confidence intervals (CIs). Results: In total, 42 articles met inclusion criteria. Regarding anxiety, gender differences were most pronounced for individuals exposed to 2 ACEs (compared to none), with women showing significantly higher odds of anxiety than men (ROR = 2.04, 95 % CI = 1.15–3.62), In addition, women exposed to emotional abuse (ROR = 0.66, 95 % CI = 0.52–0.83), sexual abuse (ROR = 0.58, 95 % CI = 0.37–0.91), and having a family member incarcerated (ROR = 0.83, 95 % CI = 0.71–0.98) showed lower odds of anxiety than men. For depression, women exposed to bullying showed lower odds of depression compared to men (ROR = 0.86, 95 % CI = 0.83–0.88). Conclusions: Gender differences in the associations between ACEs and mental health outcomes vary by type and cumulative exposure to ACEs. This finding highlights the importance of incorporating gender-specific perspectives in research and interventions addressing the long-term mental health effects of ACEs.