Structural heterogeneity of the psychosocial network in adolescent depression: a comparison between first-episode and recurrent patients.

BACKGROUND: Adolescent depression is a recurrent disorder characterized by progressively severe psychosocial impairment, which is frequently accompanied by a fundamental structural shift in the patient's support ecosystem from real-world interactions to virtual networks. However, the structural heterogeneity of the broader psychosocial network between first-episode and recurrent patients remains unclear. METHODS: We analyzed cross-sectional data from 471 adolescents diagnosed with depression, including 171 first-episode and 300 recurrent patients. The study assessed 14 dimensions encompassing internet support, school connection, social adaptation, family care, self-esteem, and depressive symptoms. We estimated Gaussian Graphical Models and conducted a Network Comparison Test to evaluate structural differences between disease stages. RESULTS: In the overall network, interpersonal harmony emerged as the primary central hub, while self-esteem functioned uniquely as a system stabilizer. The Network Comparison Test revealed significant structural differences between the two groups (Max Edge M = 0.243, P = 0.039). Specifically, the association between family care and learning autonomy was absent in the recurrent group (P < 0.01). Instead, family care formed a newly emerged, significant connection with self-esteem in recurrent patients (P < 0.01). Furthermore, recurrent adolescents demonstrated significantly stronger compensatory connections in the digital domain, particularly between online information support and life independence, and between online emotional support and classmate support (P < 0.05). CONCLUSIONS: Adolescent depression networks show clinical-stage heterogeneity. Globally, interpersonal harmony acts as the primary central hub, while self-esteem functions as a system stabilizer. In recurrent patients, real-world academic associations are absent; instead, family care forms a specific correlation with self-esteem regulation, and digital networks provide compensatory social connections. Nursing interventions should universally target interpersonal relationships and the cognitive rebalancing of self-esteem. For recurrent patients, clinicians must prioritize family-based self-esteem regulation and utilize digital communities as transitional bridges for social functioning.