Family-related experiences, childhood trauma, and cognitive-emotional correlates across psychopathological domains in adolescent depression

Background

Adolescent major depressive disorder (MDD) is heterogeneous, with diverse and frequently co-occurring psychopathological manifestations. Family-related experiences, childhood trauma, rumination, and psychological resilience are linked to adolescent mental health, but whether their associations are broadly shared or differ across clinical domains remains unclear. This study examined these associations within an integrative framework.

Methods

This cross-sectional study included 80 adolescents with MDD and 53 healthy controls. Family functioning, parenting, childhood trauma, rumination, psychological resilience, and four clinical domains comprising affective distress, suicidal ideation, the non-suicidal self-injury (NSSI) spectrum, and self-regulation difficulties were assessed using validated instruments. Partial least squares structural equation modeling examined multivariate associations. MDD-only and covariate-adjusted sensitivity analyses assessed robustness.

Results

The four clinical domains showed high reliability and generally acceptable discriminant validity. Family dysfunction was associated with maladaptive parenting and childhood trauma, and maladaptive parenting was associated with childhood trauma (β =.383–.600; all p <.001). Childhood trauma was associated with greater rumination (β =.625) and lower psychological resilience (β = −.405; both p <.001). Rumination and psychological resilience showed opposing associations with all four domains (rumination: β =.280–.559; resilience: β = −.399 to −.265; all p ≤.006). Family dysfunction, maladaptive parenting, and childhood trauma showed significant total indirect associations with all four domains (all p <.001). The model explained 53%– 85% of variance across the four domains. The MDD-only analysis largely preserved the overall structural pattern and showed broader direct associations of maladaptive parenting with the clinical domains. Covariate adjustment retained all principal associations except the association between psychological resilience and NSSI.

Conclusions

Psychopathology relevant to adolescent MDD was multidimensional, with related but distinguishable clinical domains sharing several psychosocial and cognitive-emotional correlates. The findings support examining domain-level psychopathology alongside diagnostic status and global depression severity.

Plain Language Summary

Adolescents with depression can show very different combinations of emotional distress, suicidal thoughts, self-injury, and problems with self-regulation. We asked whether several psychosocial and cognitive-emotional factors were linked to these different clinical problems in broadly similar ways, or whether their associations were more selective.

We studied 80 adolescents with major depressive disorder and 53 healthy adolescents. Family functioning, parenting, childhood trauma, rumination, and psychological resilience were examined together in relation to four areas of psychopathology: affective distress, suicidal ideation, non-suicidal self-injury, and self-regulation difficulties.

Rumination and lower psychological resilience were associated with greater difficulties across all four areas. Family dysfunction, maladaptive parenting, and childhood trauma were also related to each of the four areas through broader patterns of association. At the same time, the four clinical areas remained distinguishable rather than forming one undifferentiated severity score.

The same overall pattern was largely seen within adolescents with depression alone, although parenting showed broader direct associations in this group.

These findings suggest that adolescent depression may be better characterized by examining specific clinical domains alongside diagnosis and overall symptom severity.