Huang Ziyang, A Liya, Yan Kewen, Ran Hailiang, Che Yusan, Yang Runxu, Jiang Linling, Xiao Rui, Zeng Rushuang, Li Tong, Xie Yiling, Xiao Yuanyuan, Lu Jin
Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Mental Health Institute of Yunnan, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Psychiatry. 2025 Aug 8;16:1645303. doi: 10.3389/fpsyt.2025.1645303. eCollection 2025.
Adolescent depression is a global public health issue strongly associated with suicidal ideation and childhood abuse. Although family systems and ecological theories highlight the multilevel influences of family environment on mental health, most studies focus on overall symptom scores rather than examining how specific forms of abuse relate to distinct symptoms. Employing symptom network analysis, this study investigates the interactions among depressive symptoms, anxiety, and childhood abuse in adolescents diagnosed with major depressive disorder (MDD) and suicidal ideation.
We analyzed data from 733 Chinese adolescents diagnosed with MDD (mean age = 14.81 years). Symptom networks were constructed via LASSO-regularized models using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Centrality (strength and bridge strength) and stability analysis identified core symptoms and bridging pathways.
Depressive and anxiety symptoms showed strong comorbidity, with "Uncontrollable worry" (GAD2) and "Fatigue" (PHQ4) as central nodes. Key bridge symptoms included "Motor" (PHQ8), "Death" (PHQ9), "Restless" (GAD5), and "Emotional abuse" (EA). Childhood abuse exhibited intra-group correlations (emotional-physical abuse), and emotional abuse was directly linked to death-related thoughts. The network demonstrated strong stability.
Emotional abuse and bridge symptoms (e.g., fatigue and uncontrolled worry) are critical intervention targets for suicide-prevention interventions. A multimodal approach integrating cognitive-behavioral therapy for core symptom management, family-based interventions to address attachment disruptions, and policy initiatives to reduce childhood abuse is recommended.
青少年抑郁症是一个全球公共卫生问题，与自杀意念和童年期虐待密切相关。尽管家庭系统和生态理论强调了家庭环境对心理健康的多层次影响，但大多数研究关注的是总体症状评分，而非考察特定形式的虐待如何与不同症状相关联。本研究采用症状网络分析方法，调查了被诊断为重度抑郁症（MDD）并有自杀意念的青少年的抑郁症状、焦虑与童年期虐待之间的相互作用。
我们分析了733名被诊断为MDD的中国青少年（平均年龄 = 14.81岁）的数据。使用患者健康问卷-9（PHQ-9）、广泛性焦虑障碍-7（GAD-7）和儿童创伤问卷简表（CTQ-SF），通过套索正则化模型构建症状网络。中心性（强度和桥接强度）和稳定性分析确定了核心症状和桥接路径。
抑郁症状和焦虑症状显示出强烈的共病性，“无法控制的担忧”（GAD2）和“疲劳”（PHQ4）为中心节点。关键的桥接症状包括“多动”（PHQ8）、“死亡”（PHQ9）、“坐立不安”（GAD5）和“情感虐待”（EA）。童年期虐待表现出组内相关性（情感虐待与身体虐待），且情感虐待与死亡相关的想法直接相关。该网络显示出很强的稳定性。
情感虐待和桥接症状（如疲劳和无法控制的担忧）是预防自杀干预措施的关键干预目标。建议采用多模式方法，包括用于核心症状管理的认知行为疗法、解决依恋障碍的家庭干预措施以及减少童年期虐待的政策举措。
