The correlations between psychotic symptoms and childhood maltreatment as well as sex differences in adolescents with major depressive disorder.

BACKGROUND: Previous studies have demonstrated that childhood maltreatment (CM) is associated with a greater risk of experiencing psychotic symptoms. However, research remains insufficient regarding the prevalence of comorbid psychotic symptoms in adolescents with major depressive disorder (MDD), as well as their links with CM, clinical symptoms, and potential sex differences. METHODS: A sample of 398 adolescents with MDD was recruited for this study. The Positive and Negative Syndrome Scale-Positive Subscale (PANSS-P), the Childhood Trauma Questionnaire (CTQ), and the 17-item Hamilton Depression Rating Scale (HAMD-17) were used to evaluate patients' psychotic symptoms, CM, and depression severity. Finally, to identify independent correlates of psychotic symptoms, a stepwise logistic regression analysis was performed. RESULTS: Comorbid psychotic symptoms were identified in 30.2% of adolescents with MDD. In the total sample, younger age, being a non-only child, lack of antidepressant use, history of CM, and depression severity were identified as independent correlates of psychotic symptoms. In males, being a non-only child and depression severity were the independent correlates. In females, the independent correlates were younger age, lack of antidepressant use, history of CM, and depression severity. CONCLUSION: Adolescents with MDD, particularly females, exhibit a high prevalence of comorbid psychotic symptoms, closely associated with CM and depression severity. While these cross-sectional findings reflect observed associations rather than causal relationships, they highlight significant vulnerability. Thus, early screening for psychotic symptoms is warranted in adolescent females with MDD, especially those with CM histories and severe depressive symptoms, to guide timely, individualized psychiatric management.