Abuse, neglect, and adolescent depression: distinct symptom networks and potential intervention targets

Childhood abuse and neglect may be associated with depressive symptoms through distinct developmental pathways, yet little is known about whether depressive symptom networks differ across trauma profiles. This study compared depressive symptom networks across abuse-only, neglect-only, and combined-trauma groups and identified potential intervention and prevention targets using computer-simulated interventions. A total of 6,094 trauma-exposed adolescents were included and classified into abuse-only ( n = 437), neglect-only ( n = 3,489), and combined-trauma ( n = 2,168) groups based on Childhood Trauma Questionnaire-Short Form cutoff scores. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Ising network models were estimated, and the network structure, global strength, and centrality were compared using network comparison tests. Computer-simulated alleviating and aggravating interventions were conducted using the NodeIdentifyR algorithm. Fatigue, anhedonia, and sleep disturbances were the most prevalent symptoms across all trauma groups; depressive symptom severity was highest in the combined-trauma group. Psychomotor changes and concentration difficulties were most central in the abuse-only network, despite low centrality stability (CS-C = 0.128). Fatigue and sad mood were central symptoms in the neglect-only network, and fatigue in the combined-trauma network. Global strength differed between abuse-only and neglect-only networks (S = 7.81, p < 0.001) and between the abuse-only and combined-trauma networks (S = 6.89, p < 0.001), whereas network structure differed only between the abuse-only and combined-trauma groups (M = 1.32, p = 0.03). Under simulated alleviation, fatigue emerged as a candidate target across three trauma profiles, with change rates at 31.1%, 58.8%, and 42.9% for the abuse-only, neglect-only, and combined-trauma groups, respectively. Anhedonia emerged as another effective alleviation target in the combined-trauma group (43.1%). Under simulated aggravation, concentration difficulties (36.1%), psychomotor changes (92.7%), and suicidal ideation (34.6%) were identified as the candidate prevention targets in the abuse-only, neglect-only, and combined-trauma groups, respectively. The current study suggests that abuse-related and neglect-related childhood adversities may be associated with partially distinct depressive symptom pathways. Trauma-informed interventions may benefit from targeting fatigue across trauma profiles while tailoring prevention strategies to trauma-specific symptom patterns. Not applicable.