Exploring the functioning trajectories and associated factors in adolescents with first-diagnosis major depressive...

Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders among adolescents, significantly impairing psychosocial functioning. Early functional changes in adolescents with first-diagnosis MDD are poorly understood.

This prospective cohort study utilized data from the sBEAD cohort between 2020 and 2024, comprising 274 adolescents with first-diagnosis MDD. Participants were evaluated psychosocial functioning based on Children's Global Assessment Scale scores with assessments at baseline, 4 weeks, 8 weeks, 3 months, and 12 months. Growth mixture models were applied to identify distinct trajectories of psychosocial functioning. Demographic and clinical data were collected, including household income, academic performance, age at illness onset, psychotic symptoms, and anxiety levels. A multinomial logistic regression model was used to identify factors significantly associated with functional trajectory membership.

Four distinct functional trajectories were identified including persistent impairment (19.7%), early improvement with decline (30.7%), gradual improvement (33.9%), and sustained good functioning (15.7%). Baseline key factors influencing trajectory membership included household income, academic performance, years of education, psychic anxiety, and psychotic symptoms. Higher education and better academic performance were linked to more favorable trajectories, whereas higher anxiety scores and psychotic symptoms were associated with poor outcomes.

This study identified heterogeneous functional trajectories among adolescents with first-diagnosis MDD and associated factors. The findings highlight the importance of early identification and targeted interventions for adolescents at risk of persistent functional impairment. Future research should focus on integrating biological markers and expanding follow-up duration to support more robust risk stratification and intervention strategies.