Adverse childhood experiences and late-life depression in older Chinese adults: the mediating roles of sleep disorders and chronic diseases.

Effect modification assessment To evaluate potential effect modification, the following steps were implemented: (1) Subgroup variable selection: Covariates were considered if they showed statistically significant ( p < 0.05) or marginally significant ( p < 0.10) interaction terms in preliminary fully adjusted models, or if theoretically relevant (e.g., physical activity due to its neurobiological links to depression resilience).

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Effect modification analysis revealed significant variation by geographic region (p-interaction = 0.029), with the strongest association in Central China (OR = 1.35, 95% CI = 1.23–1.47) compared to Western China (OR = 1.15), and a marginal trend by education level (p-interaction = 0.08), showing stronger associations among those with higher education (OR = 1.27–1.28) versus lower education (OR = 1.14).

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