Adverse childhood experiences (ACEs) have been associated with an increased risk of low back pain (LBP). However, the role of depressive symptoms (DS) in this relationship remains insufficiently explored. This study aims to investigate the mediating effect of DS on the association between ACEs and LBP.

This retrospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). DS were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Logistic regression analyses evaluated associations between ACEs and both DS and LBP. Mediation analysis further examined the mediating effect of DS on the ACEs-LBP association.

This study included 8186 participants (3979 males; 4207 females). Logistic regression revealed associations between ACEs and both DS and LBP. Mediation analysis identified DS as a partial mediator in the relationship between LBP and eight ACEs: loneliness, peer bullied, poor self-reported health status, sibling death, parental mental health issues, starvation, and poor childhood neighborhood safety and quality. DS accounted for 18.42 % of the total association between ACE count and LBP. After adjusting for the demographics and DS, marginal analysis confirmed a dose-response relationship, with escalating ACE exposure linked to a higher probability of LBP.

Our study demonstrates a significant association between ACEs and LBP and DS in middle-aged and older Chinese adults. Critically, DS serves as a mediator in the relationship between ACEs and LBP, underscoring its role as a psychological pathway through which early-life adversity influences LBP.