Family environment and cognitive function as predictors of efficacy for rTMS combined with group therapy in...

While repetitive transcranial magnetic stimulation (rTMS) combined with group therapy has demonstrated efficacy for adolescent depression, clinical responses vary; this study aimed to identify baseline family environment and cognitive function predictors of symptomatic improvement to support personalized treatment strategies.

A prospective cohort (August 2023-July 2024) enrolled 163 adolescents with major depressive disorder receiving a 4-week program of high-frequency rTMS (20 sessions) and group cognitive behavioral therapy (8 sessions). All participants were on stable antidepressants. Predictors included Family Environment Scale (cohesion, conflict) and neuropsychological tests (Stroop, Wisconsin Card Sorting Test [WCST]). The primary outcome was HAMD-24 reduction at week 4.

Of the 163 enrolled patients, 148 (90.8%) completed the study and were included in the final analysis. The mean HAMD-24 reduction was 48.6% ± 14.2%. Multivariate regression analysis, validated by bootstrapping, indicated that greater baseline family cohesion (β = 0.29, p = 0.002), lower family conflict (β = -0.25, p = 0.004), and better executive function indexed by fewer WCST perseverative errors (β = -0.24, p = 0.003) were independently associated with larger symptom reductions. The model explained 32.5% of outcome variance (adjusted R² = 0.325). Medication dose was not a significant predictor.

Higher family cohesion, lower conflict, and intact executive function predict favorable response to combined rTMS and group therapy in adolescent MDD. Baseline screening for these factors may inform adjunctive approaches such as family therapy or cognitive remediation to optimize outcomes. These findings represent prognostic associations requiring further interventional validation.