Neurophysiological Correlates of Pain-Related Cognitive-Affective Dysregulation in Adolescent Depression

Adolescent major depressive disorder (MDD) is characterized by altered processing and regulation of negative emotional and bodily experiences. Pain lies at the interface of sensory and cognitive-affective processing, encompassing both perceptual sensitivity and appraisal of pain-related experiences. Yet, how pain catastrophizing, a pain-specific cognitive-affective pattern characterized by rumination, magnification, and helplessness, relates to depressive severity and neurophysiological dynamics during adolescence remains poorly understood. In this cross-sectional case-control study, we recruited 140 participants aged 12-23 years with and without MDD and investigated behavioral and electrophysiological correlates of pain-related cognitive-affective dysregulation using clinical assessments and resting-state electroencephalography (EEG). Structural equation modeling revealed a significant indirect association between pain catastrophizing and depressive severity through anxiety, highlighting anxiety-related processes within this relationship. Compared with healthy controls, adolescents with MDD exhibited increased δ- and θ-band power and altered EEG microstate dynamics, characterized by greater temporal involvement of microstate B, reduced temporal persistence of microstate D, and increased bidirectional B-C transitions. EEG-informed path models further linked microstate features to the indirect relationship between pain catastrophizing, anxiety, and depressive severity. Together, these findings identify convergent behavioral and neurophysiological correlates of pain-related cognitive-affective dysregulation and highlight dynamic EEG features for further investigation in adolescent MDD.