Top-down rather than bottom-up attention processing mediates the pathway from childhood trauma exposure to depression...

Childhood trauma (CT) is a critical risk for major depressive disorder (MDD), yet the cognitive mechanisms linking CT to adolescent depression remain poorly understood. While alterations in attentional processing are core features of MDD, it remains unclear whether attentional dysfunctions, particularly in the domain of social cognition, mediate the link between CT and adolescent depression.

This study employed a dual-method approach: (1) categorical determination of attentional alterations in adolescent with MDD, and (2) dimensional examination of the mediating effect of attentional alterations in CT-depression pathways.

122 adolescents including 72 first-episode treatment-naïve MDD and 50 healthy controls were recruited in this study.

Attentional processing was assessed using an anti-saccade paradigm with pro-saccade (bottom-up allocation) and anti-saccade (top-down control) conditions across non-social shapes and social-emotional faces. CT exposure and depressive symptoms were measured via Childhood Trauma Questionnaire (CTQ) and Self-rating Depression Scale (SDS), respectively.

Compared to healthy controls, adolescents with MDD exhibited lower accuracy, longer response latency, and a novel trial sequential analysis revealed more errors in switch trials and slower post-error responses during the anti-saccade task. Only top-down attentional control, not bottom-up allocation, specifically mediated the association between CT and depression.

Adolescents with MDD showed reduced cognitive flexibility and impaired post-error adjustment, particularly in tasks requiring top-down attentional control in dynamic or emotionally changing context. Top-down attentional dysfunction constitutes a specific mechanistic pathway linking CT to depression in adolescence, highlighting executive attention as a critical early intervention target for trauma-related depression.