Examining the Contribution of Childhood Maltreatment to the Sex Gap in Depression: Insights from the German National Cohort (NAKO).

Authors

Maja P Völker, Aina L Kresken, Jerome C Foo, Josef Frank, Iris Reinhard, Johanna Klinger-König, Lea Zillich, Diana S Ferreira de Sá, Rafael Mikolajczyk, Michael F Leitzmann, Patricia Fromherz, Lilian Krist, Thomas Keil, Claudia Meinke-Franze, Steffi G Riedel-Heller, Halina Greiser, Barbara Bohn, Hermann Brenner, Nadia Obi, Volker Harth, Tobias Pischon, Hans Joergen Grabe, Klaus Berger, Emanuel Schwarz, Jutta Mata, Stephanie Witt, Fabian Streit

Published in

Psychotherapy and psychosomatics. Pages 1. Aug 31, 2026. Epub Aug 31, 2026.

Abstract

Childhood maltreatment is a major risk factor for depression and may contribute to sex differences in depression prevalence. We examined sex-specific associations between childhood maltreatment and depression and estimated the proportion of depression cases attributable to maltreatment subtypes. We analyzed baseline data from 159,045 participants (49.4% female; aged 19-72) in the German National Cohort (NAKO). Childhood maltreatment was assessed via the Childhood Trauma Screener; depression via self-reported physician's diagnosis and MINI classification (lifetime) and the PHQ-9 (current). Associations, including sex interactions, were modeled using binary logistic regressions. Disparity decomposition and sex-stratified population attributable fractions quantified the contribution of childhood maltreatment to depression. Childhood maltreatment was associated with increased odds of lifetime (ORphysician's diagnosis=2.45 [2.38,2.53]; ORMINI=2.30 [2.18,2.43]) and current depression (OR=2.90 [2.79,3.02], all padj<0.001). Sex interactions were observed for physician's diagnosis: physical abuse (padj=0.024) and neglect (padj<0.001) had stronger associations in females (ORphysical abuse=2.74 [2.59,2.90]; ORphysical neglect=1.36 [1.28,1.44]) than males (ORphysical abuse=2.36 [2.21,2.52]; ORphysical neglect=1.08 [1.00,1.16]), whereas sexual abuse (padj=0.003) showed stronger associations in males (OR=3.23 [2.91,3.57]) than females (OR=2.61 [2.48,2.75]). Overall, childhood maltreatment accounted for 21.2-26.2% of lifetime and 33.4% of current depression. Population attributable fractions were higher in females than males for lifetime (24.5-28.5% vs. 16.0-20.9%) and current depression (36.1% vs. 28.4%). Emotional subtypes contributed the highest population attributable fractions (up to 10.2%). Childhood maltreatment contributed 19.2-22.4% to the association between sex and depression. Childhood maltreatment accounts for a substantial proportion of depression in both sexes, with stronger overall associations in females. Sex-specific prevention may help reduce depression prevalence.

PMID:
42671980
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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