Family-related experiences, childhood trauma, and cognitive-emotional correlates across psychopathological domains in adolescent depression

Background: Adolescent major depressive disorder (MDD) is heterogeneous, with diverse and frequently co-occurring psychopathological manifestations. Family-related experiences, childhood trauma, rumination, and psychological resilience are linked to adolescent mental health, but whether their associations are broadly shared or differ across clinical domains remains unclear. 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 comprising 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 examined multivariate associations. MDD-only and covariate-adjusted sensitivity analyses assessed robustness. Results: The four clinical domains showed high reliability and generally 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} = -.399 to -.265; all p [&le;] .006). Family dysfunction, maladaptive parenting, and childhood trauma showed significant total indirect associations with all four domains (all p < .001). The model explained 53%-85% of variance across the four domains. The MDD-only analysis largely preserved the overall structural pattern and showed broader direct associations of maladaptive parenting with the clinical domains. Covariate adjustment retained all principal associations except the association between psychological resilience and NSSI. Conclusions: Psychopathology relevant to adolescent MDD was multidimensional, with related but distinguishable clinical domains sharing several psychosocial and cognitive-emotional correlates. The findings support examining domain-level psychopathology alongside diagnostic status and global depression severity.