Associations of family adversity and childhood trauma with multidomain psychopathology in adolescent depression

Background: Adolescent major depressive disorder (MDD) is heterogeneous, with diverse and frequently co-occurring psychopathological manifestations. Although family-related experiences, childhood trauma, rumination, and psychological resilience have each been linked to adolescent mental health, less is known about how they are interrelated and jointly associated with distinct psychopathological domains. This study examined these associations within an integrative framework. Methods: This cross-sectional study included 80 adolescents with MDD and 53 healthy controls. Family functioning, parenting, childhood trauma, rumination, psychological resilience, and four clinical domains, including affective distress, suicidal ideation, the non-suicidal self-injury (NSSI) spectrum, and self-regulation difficulties, were assessed using validated instruments. Partial least squares structural equation modeling (PLS-SEM) examined their multivariate associations. Sensitivity analyses restricted to the MDD sample and covariate-adjusted regression models assessed the robustness of the findings. Results: The four clinical domains showed high reliability and acceptable discriminant validity. Family dysfunction was associated with maladaptive parenting and childhood trauma, and maladaptive parenting was associated with childhood trauma (beta = .383-.600; all p < .001). Childhood trauma was associated with greater rumination (beta = .625) and lower psychological resilience (beta = -.405; both p < .001). Rumination and psychological resilience showed opposing associations with all four domains (rumination: beta = .280-.559; resilience: beta = -.265 to -.399; all p <= .006). Family dysfunction, maladaptive parenting, and childhood trauma showed significant total indirect associations with each domain (all p < .001). The model explained 53%-85% of the variance across the four domains. The MDD-only analysis reproduced the principal associations observed in the combined sample and additionally showed direct associations between maladaptive parenting and all four clinical domains. Covariate-adjusted analyses retained all principal associations except the resilience-NSSI association. Conclusions: The findings support a multidimensional characterization of adolescent MDD comprising distinguishable yet interrelated domains of affective-psychosomatic distress, suicidal ideation, the NSSI spectrum, and self-regulation difficulties. The partly shared and partly distinct associations of these domains with family-related adversity, rumination, and psychological resilience support considering domain-level psychopathology alongside diagnostic status and global depression severity in research on adolescent MDD.