Abstract
Depression is to be one of the leading causes of disease burden worldwide, with prevalence continuing to rise. Among the most robust predictors of risk for depression is exposure to adverse childhood experiences (ACEs). Interoception has been linked to both ACEs and depression independently, yet little research has explored how these three domains interact. Predictive-coding accounts suggest that interoception could be linked to depression through “noisy” or “poor” interoceptive signals, particularly under emotional load. This study explores the role of interoception in the ACEs-depression pathway, using a multi-method approach. Sex is also considered, given evidence that women report greater interoceptive sensibility, and mixed reports on behavioral accuracy. Sixty-four university students completed the Water Load Test (WLT), followed by self-report measures of interoceptive sensibility (MAIA-2), gastrointestinal symptoms (GSRS), depression (PHQ-9), and ACE questionnaires. Following the questionnaires, participants completed a heartbeat detection task (HDT) across baseline, sad, and neutral mood conditions (order counterbalanced). Across all models, ACEs were significantly related to depression severity scores; however, the sad mood induction did not produce meaningful changes in mood. As such, the hypothesized mediating or moderating roles of noisy interoception were tested but could not be meaningfully interpreted. Of interest, exploratory findings revealed a divergence between interoceptive accuracy and sensibility, with behavioral accuracy shown to be unrelated to depression, whereas trusting, attention, and self-regulation sensibility scales were. Further findings suggested that the association between noisy interoception and depression severity may differ by sex (surprisingly, with the relationship between noisy cardiac interoception and depression symptom severity stronger in men than in women), though this finding was not robust. The findings of this study suggest that interpretation and trust in bodily signals may matter more for the ACE-depression pathway than accurate interoceptive awareness, offering a more nuanced understanding of how ACEs confer risk for depression that warrants further research.