From social-environmental stress to core psychological dysfunction and suicidality in first-episode depressed...

Adolescent depression involves complex interactions among social-environmental stressors, protective psychological resources, and psychological dysfunction. Traditional models inadequately capture cross-level interactions between these domains.

We employed multilevel symptom network analysis to elucidate how childhood trauma, adolescent life events, and resilience are linked to core psychological dysfunction and suicide ideation in adolescent depression, with core psychological dysfunction defined as impairments in cognition, emotion, behavior and social functioning that characterize vulnerability to depression.

Network analysis in a sample of 326 first-episode, treatment-naïve adolescents diagnosed with major depressive disorder was conducted. Nodes represented environmental stressors (e.g., physical neglect, interpersonal stress), protective resources (resilience), core psychological dysfunction (impulsivity, cognitive/functional impairment, anxiety, depression), and suicidal ideation (passive, active). Centrality and bridge connectivity indices were estimated.

Physical neglect and interpersonal stress emerged as the most central stressors, demonstrating strong connections to impulsivity, anxiety, and social dysfunction. Resilience showed protective links by negatively connecting with cognitive impairment. Passive suicidal ideation was closely linked to depressive mood and physical abuse, while active ideation was connected to cognitive dysfunction and total stress load, suggesting a progression pathway.

Network analysis reveals dimension-specific pathways linking environmental stress to psychological dysfunction and suicide risk in adolescent depression. Central nodes such as physical neglect, interpersonal stress may serve as early intervention targets, while resilience buffers cognition-related vulnerability. By focusing on first-episode, treatment-naïve adolescents, this study provides network-based evidence for precision prevention and tiered intervention in adolescent depression.