ObjectiveTo explore the relationship between negative life events and depression severity in adolescent patients with depressive disorder， as well as the chain mediating role of insomnia symptoms and quality of life. Methods374 outpatient patients and hospitalized patients with adolescent depressive disorders were enrolled. The Adolescent Life Event Scale （ASLEC）， the Insomnia Severity Index （ISI）， the World Health Organization Quality of Life Questionnaire Short Form （WHOQOL-BREF）， and the Center for Epidemiology Depression Scale （CES-D） were used to evaluate the negative life event situation， insomnia symptoms， quality of life level and depression severity of the subjects， respectively. In addition， the PROCESS 4.0 macroprogram was used to analyze the chain mediating effect of insomnia symptoms and quality of life between negative life events and depression severity in patients with adolescent depressive disorder. ResultsThe results of correlation analysis showed that there was a significant correlation between negative life events and insomnia symptoms， quality of life， and depression severity （all P<0.05）. In addition， the results of chain mediation showed that negative life events had a significant direct effect on depression severity， with an effect size of 0.12 （P<0.001）. Insomnia symptoms and quality of life played a mediating role in the relationship between negative life events and depression severity in patients with adolescent depressive disorders， with indirect effect sizes of 0.062 （95%CI： 0.040-0.087） and 0.091 （95%CI： 0.059-0.123）， respectively. It could also play a chain mediation role， and the effect size was 0.039 （95%CI： 0.024-0.057）. ConclusionNegative life events experienced by patients with adolescent depressive disorder not only directly affect the severity of depressive symptoms， but may also indirectly exacerbate depression through insomnia symptoms and quality of life.

Objective:To explore the correlation of excessive daytime sleepiness (EDS)with clinical features as well as inflammatory cytokines in adolescents with major depressive disorder.Methods:From January to December 2021, a total of 164 adolescents with major depressive disorder were included in the psychiatry departments of two hospitals in Anhui province, China, and divided into the EDS group ( n=70) and the non-EDS group ( n=94) according to whether or not they were accompanied by EDS. The center for epidemiological studies depression scale (CES-D) and the positive and negative suicidal ideation scale (PANSI) were used to assess patients' depressive symptoms severity and suicidal ideation levels, respectively. Additionally, plasma levels of inflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-10, IL-17A, and tumour necrosis factor-α (TNF-α) were measured using the MSD ultrasensitive multifactor electrochemiluminescence analyzer. Statistical analysis were performed using SPSS 23.0 software, and independent influences of EDS were analyzed by Logistic stepwise regression. Results:The prevalence of EDS was 42.7%(70/164) in adolescents with major depressive disorder. In univariate analysis, patients in the EDS group had higher body mass index (BMI), CES-D total score, PANSI total score, IL-1β (Log) and IL-6 (Log) compared to the non-EDS group (all P<0.05). Logistic stepwise regression analysis showed that BMI ( OR=1.094, 95% CI=1.007-1.189, P=0.033), CES-D total score ( OR=1.043, 95% CI=1.012-1.075, P=0.007), and IL-1β (Log) ( OR=3.868, 95% CI=1.484-10.079, P=0.006) were independent influencing factors of EDS in adolescents with major depressive disorder. Conclusions:The risk of EDS in adolescents with major depressive disorder is relatively high, and EDS may be closely related to BMI, depression severity, suicidal ideation and IL-1β level.

Objective: To explore the characteristic of obesity in adolescents with major depressive disorder and its relationship with inflammatory cytokines. Methods : One hundred and forty adolescents with major depressive disorder were enrolled. According to the classification standard of body mass index(BMI) for adolescents in China, the patients were classified into underweight group, normal group, overweight group and obese group. The center for epidemiologic studies depression scale(CES-D) was used to evaluate symptoms of depression in patients, and ultrasensitive multiplex electrochemiluminescence detection technology was used to measure the levels of plasma inflammatory cytokines including interleukin(IL)-6,IL-17A,IL-1β,IL-6,IL-8 and tumour necrosis factor(TNF)-α. One-way ANOVA or Kruskal-WallisHtest and chi-square test were used for comparison between groups. Binary Logistic regression was used to analyze the influencing factors of obesity in adolescent patients with major depressive disorder. Results : Among the 140 adolescent patients with major depressive disorder, wasting were 9.3%(13/140), overweight were 17.9%(25/140) and obesity were 6.4%(9/140) respectively. There were statistically significant differences in gender(χ2=8.301,P<0.05) and inflammatory cytokines IL-6(H=16.217,P<0.01), IL-8(H=10.926,P<0.05) and TNF-α(H=7.879,P<0.05) among the four groups. Analysis of covariance showed that the difference in levels of the inflammatory cytokine IL-6(F=4.486,P<0.01) remained statistically significant after controlling for age, gender and antidepressant use. The results of multiple comparisons showed that compared with the wasting group, the plasma IL-6(Z=-3.843,PBonferroni calibrate<0.01) were higher in the obese group; compared with the normal group, the obesity rate of males was higher than that of females(χ2=8.812,PBonferroni calibrate<0.01), and the level of IL-6 in the obese group(Z=-3.023,PBonferroni calibrate<0.05) was higher. Binary Logistic regression analysis showed that plasma IL-6(OR=2.500,P<0.01) and gender(OR=11.292,P<0.01) were independent influencing factors for obesity in patients with adolescent depressive disorders. Conclusion There are gender differences in obesity rates in adolescents with depressive disorders, and obesity is associated with elevated levels of inflammatory cytokines.

Objective : To explore the predictive value of depression severity plasma thyroid-stimulating hormone(TSH) and brain-derived neurotrophic factor(BDNF) levels for agitated symptoms in patients with adolescent depressive disorder(MDD). Methods : Ninety-one patients with adolescent depressive disorder were enrolled, and the degree of agitation was assessed according to the modified outward aggressive behavior scale(MOAS); 24-item hamilton depression scale(HAMD24) was used to determine the severity of depression; chemiluminescence immunoassay(CLIA) was used to determine the plasma thyroid-stimulating hormone(TSH) level; and electrochemiluminescence immunoassay(ECL) was used to determine the plasma BDNF. SPSS 26.0 was used for statistical analysis of the data, Spearman correlation analysis was used to analyze the relationship between HAMD24and plasma TSH and BDNF levels and the degree of agitation, multiple linear regression analysis was used to analyze the factors influencing the degree of agitation in adolescents with MDD, and binary Logistic regression analysis and subjects′ work characteristic curves(ROC) were used to establish predictive models. Results: The degree of agitation in adolescent MDD patients was positively correlated with HAMD24total score(P<0.001); both HAMD24total score and plasma BDNF level were identified as risk factors for agitation severity(bothP<0.05); both HAMD24total score and plasma BDNF levels were risk factors for the degree of agitation(allP<0.05); HAMD24total score, plasma TSH, BDNF levels were all risk factors for concomitant agitation symptoms in adolescent MDD patients; ROC curve analysis showed that the three combined prediction models(AUC=0.889,P<0.001) had a higher predictive value than the single prediction model(P<0.01). Conclusion Concomitant agitation symptoms in adolescents with MDD are strongly associated with HAMD24total score and plasma TSH and BDNF levels, and the three combined models have good predictive power.

BackgroundNon-suicidal self-injury （NSSI） represents a prevalent clinical feature among adolescent patients with major depressive disorder. Existing research has suggested that interoceptive awareness might be linked to NSSI behaviors， but investigations into this association among adolescent patients with major depressive disorders remain limited. ObjectiveTo elucidate the correlation between NSSI behaviors and interoceptive awareness in adolescent patients with major depressive disorder， and to identify influencing factors of NSSI behaviors， in order to provide clinical prevention and treatment strategies. MethodsA total of 125 adolescent patients who met the diagnostic criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from the Fourth People's Hospital of Hefei from December 2022 to June 2024. These participants were subsequentially categorized into NSSI behavior group （n=60） and non-NSSI behavior group （n=65） based on the presence or absence of NSSI behaviors. Additionally， a control group comprising 40 healthy adolescents was concurrently assembled for comparison. The Hamilton Depression Scale-17 item （HAMD-17） was used to assess the depressive symptoms of adolescent patients with major depressive disorder， and the Multidimensional Assessment of Interoceptive Awareness version 2- Chinese （MAIA-2） was used to evaluate the interoceptive awareness level of all subjects. Pearson correlation analysis was employed to examine the correlation between HAMD-17 scores and MAIA-2 scores. Binary Logistic regression analysis was conducted to identify the influencing factors of NSSI behaviors in adolescent patients. Then the receiver operating characteristic （ROC） curve was drawn to verify the predictive efficacy of MAIA-2 scores for NSSI behaviors in adolescent patients with major depressive disorder. ResultsSignificant differences were identified across six MAIA-2 subscales （noticing， not distracting， not worrying， attention regulation， emotional awareness， body listening） and the MAIA-2 total score among the three groups （F=18.475， 20.631， 6.044， 5.621， 18.456， 12.889， 12.741， P<0.01）. Correlation analysis underscored a notable negative correlation between the MAIA-2 total score and the HAMD-17 total score， as well as its scores on subscales pertaining to weight and cognitive impairment factors（r=-0.315， -0.203， -0.278， P<0.05）. Binary Logistic regression results indicated that longer disease duration （OR=1.112， 95% CI： 1.043–1.206） and higher HAMD-17 total score （OR=2.071， 95% CI： 1.361–3.150） were risk factors for NSSI behavior in adolescents with depressive disorder， while a higher MAIA-2 total score was a protective factor against NSSI behavior in this population （OR=0.580， 95% CI： 0.407–0.828）. The MAIA-2 total score demonstrated a relatively high predictive value for NSSI behaviors in adolescent patients with major depressive disorder （AUC=0.793）. ConclusionNSSI behaviors in adolescent patients with major depressive disorder are closely related to the disease course， severity of depression， and specific interoceptive awareness patterns. Moreover， interoceptive awareness may serve as a predictive indicator for the occurrence of their NSSI behaviors. ［Funded by the National Key Clinical Specialty Construction Project of China； Anhui Provincial Clinical Key Specialty Construction Project； the Hospital-Level Scientific Research Project of the Fourth People's Hospital of Hefei （number， HFSY2022YB07）］

Objective:To explore the correlation of excessive daytime sleepiness (EDS)with clinical features as well as inflammatory cytokines in adolescents with major depressive disorder.Methods:From January to December 2021, a total of 164 adolescents with major depressive disorder were included in the psychiatry departments of two hospitals in Anhui province, China, and divided into the EDS group ( n=70) and the non-EDS group ( n=94) according to whether or not they were accompanied by EDS. The center for epidemiological studies depression scale (CES-D) and the positive and negative suicidal ideation scale (PANSI) were used to assess patients' depressive symptoms severity and suicidal ideation levels, respectively. Additionally, plasma levels of inflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-10, IL-17A, and tumour necrosis factor-α (TNF-α) were measured using the MSD ultrasensitive multifactor electrochemiluminescence analyzer. Statistical analysis were performed using SPSS 23.0 software, and independent influences of EDS were analyzed by Logistic stepwise regression. Results:The prevalence of EDS was 42.7%(70/164) in adolescents with major depressive disorder. In univariate analysis, patients in the EDS group had higher body mass index (BMI), CES-D total score, PANSI total score, IL-1β (Log) and IL-6 (Log) compared to the non-EDS group (all P<0.05). Logistic stepwise regression analysis showed that BMI ( OR=1.094, 95% CI=1.007-1.189, P=0.033), CES-D total score ( OR=1.043, 95% CI=1.012-1.075, P=0.007), and IL-1β (Log) ( OR=3.868, 95% CI=1.484-10.079, P=0.006) were independent influencing factors of EDS in adolescents with major depressive disorder. Conclusions:The risk of EDS in adolescents with major depressive disorder is relatively high, and EDS may be closely related to BMI, depression severity, suicidal ideation and IL-1β level.

BackgroundPatients demonstrating depressive disorder with psychotic symptoms often have increased risk of death and poor prognosis. A large amount of research has explored the factors influencing psychotic symptoms in adult patients with depressive disorder， but few has focused on adolescent patients. ObjectiveTo explore the influencing factors of psychotic symptoms in adolescent patients with depressive disorder， so as to provide references for early screening and intervention in clinic. MethodsA total of 96 adolescent patients who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） for depressive disorder and were seen in the psychiatry departments of Chaohu Hospital of Anhui Medical University and The Fourth People's Hospital of Hefei from September 2022 to January 2023 were included. Another 56 healthy individuals from the health examination center of Chaohu Hospital of Anhui Medical University were concurrently recruited as control group. Patients were assigned into psychotic group （n=32） and non-psychotic group （n=64） according to the presence or absence of psychotic symptoms. Hamilton Depression Scale-24 item （HAMD-24）， Positive and Negative Syndrome Scale （PANSS）， Positive and Negative Suicide Ideation （PANSI） and Childhood Trauma Questionnaire-Short Form （CTQ-SF） were used for evaluation. Plasma brain-derived neurotrophic factor （BDNF） concentration was obtained using Meso Scale Discovery electrochemiluminescence assay. Pearson and Spearman correlation analysis were adopted to determine the correlation of PANSS positive symptom subscale score with plasma BDNF concentration and clinical characteristics of adolescent depression patients with psychotic symptoms. Binary Logistic regression analysis was used to identify the factors influencing the presence of psychotic symptoms in adolescent patients with depressive disorder， and multiple linear regression analysis was utilized to screen the factors affecting the severity of psychotic symptoms. ResultsThe plasma BDNF concentration of adolescent patients with depressive disorder was lower than that of control group （t=-3.080， P<0.01）.The plasma BDNF concentration of psychotic group was lower than that of non-psychotic group （t=2.418， P<0.05）， while the body mass index （BMI） PANSI scores， CTQ-SF scores and HAMD-24 total scores were all higher than those of non-psychotic group （t=-2.024， -2.530， -2.187， -4.977， P<0.05 or 0.01）. Correlation analysis showed that PANSS positive symptom subscale scores were negatively correlated with anxiety/somatization factor score and weight factor score in HAMD-24 of psychotic group （r=-0.438， -0.498， P<0.05 or 0.01）. Binary Logistic regression showed that BMI， plasma BDNF concentration， HAMD-24 total scores and cognitive dysfunction factor score were the influencing factors of psychotic symptoms in adolescent patients with depressive disorder. Multiple linear regression analysis demonstrated that weight factor scores （β=-0.349， P<0.05） and anxiety/somatization factor score （β=-0.433， P<0.05） in HAMD-24 were the factors influencing the severity of psychotic symptoms. ConclusionHigh BMI， low plasma BDNF concentration， severe depressive symptoms and cognitive dysfunction may be the risk factors of psychotic symptoms in adolescent patients with depressive disorder， furthermore， BMI and anxiety symptoms are found to be associated with the severity of psychotic symptoms. ［Funded by Scientific Research Fund Project of Anhui Institute of Translational Medicine （number， 2022zhyx-B01）； Central Finance Supported Provincial Key Clinical Specialty Construction Project of Anhui Province in 2019］

Objective:To investigate the difference of the attention bias of the resilience level of professional technicians in hospital to negative information.Methods:A total of 383 professional technicians of logistics admin-istrative posts in a third-level military hospital were selected and divided into high and low groups according to their scores on the resilience scale(the top 27％of the participants were in the high resilience group,and the bottom 27％were in the low resilience group).There were 22 participants in each of the high and low resilience groups that met the requirements.The attention bias test was conducted on the professional technicians in the high and low resil-ience groups using the Dot-probe Paradigm.A mixed experimental design of 2(group:low resilience group,high re-silience group)x 2(stimulus clues:negative stimulus,neutral stimulus)was adopted.The dependent variables were correct rate and reaction time.Results:The interaction between the response group and the stimulus cue was statisti-cally significant(P＜0.05),the response time of negative stimulus in low resilience group was lower than that of neutral stimulus.The main effect of the cue condition was statistically significant in both groups(P＜0.05),the correct rate of negative stimulus was lower than that of neutral stimulus.Conclusion:This study shows that the pro-fessional technicians in the high resilience group do not have obvious attention bias to negative information,while the professional technicians in the low resilience group have obvious attention bias to negative emotional informa-tion.

Objective:To investigate grey matter volume changes and their correlation with the severity of anxiety in adolescents with major depressive disorder (MDD) accompanied by anxious distress specifier (ADS).Methods:From June 2022 to June 2023, totally 71 inpatients with MDD in the child and adolescent psychiatry department of Anhui Mental Health Center were included. According to the definition of ADS in the DSM-5, MDD adolescents were divided into the group with anxious distress (MDD/ADS+ group, n=44) and the group without anxious distress (MDD/ADS- group, n=27). Healthy adolescents matched in terms of gender, age, education level were recruited as the control group (HC group, n=19). Voxel-based morphometry (VBM) was used to compare changes in grey matter volume among the three groups.Grey matter volume values of brain regions with significant differences between the MDD/ADS+ group and MDD/ADS- group were collected, and their correlation with Hamilton anxiety rating scale (HAMA) score were analyzed by Pearson correlation analysis using SPSS 26.0 software. Results:Compared to the MDD/ADS- group, the MDD/ADS+ group showed a significant decrease in grey matter volume in the right dorsolateral prefrontal cortex (MNI: x=16.5, y=34.5, z=52.5, t=4.48, P<0.05) and the right cerebellum (MNI: x=49.5, y=-69.0, z=-24.0, t=5.18, P<0.05). In MDD adolescents, the grey matter volumes of the right dorsolateral prefrontal cortex and the right cerebellum were negatively correlated with HAMA score ( r=-0.249, -0.491, both P<0.05). Conclusion:In adolescents with MDD accompanied by ADS, a decrease in gray matter volume is observed in the right dorsolateral prefrontal cortex and the right superior cerebellum. These brain regions may serve as potential biological markers for the severity of anxiety in adolescents with MDD.

Objective:To explore the correlation between peripheral plasma cytokine levels and disease severity in adolescents with first-episode and recurrent depression.Methods:Clinical data were prospectively collected on a total of 134 adolescents with depression, including 36 males and 98 females, aged 12-18 (15.3±1.5) years, who were either the outpatients or the inpatients in the Department of Psychiatry of Chaohu Hospital of Anhui Medical University and the Hefei Fourth People′s Hospital from October 2020 to March 2022. Patients were classified into 76 first-episode depression (first-episode group) and 58 recurrent depression (recurrent group) according to whether the depressive symptoms were in their first episode or not. During the same period, 76 age-matched healthy controls (health controls group) were recruited, including 45 males and 31 females, aged 12-18 (15.1±1.8) years. The 24-item Hamilton Depression Scale (HAMD 24) was used to assess the severity of depression in the patients, and a total HAMD 24 score of 35 was used as the cutoff point to classify the depressive patients into mild-to-moderate (52 patients) and severe depression (24 patients). Plasma interleukin (IL)-10, IL-17A, IL-1β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) levels of patients were measured using meso scale discovery. Spearman correlation analysis was used to analyze the relationship between cytokine levels and disease severity in patients with depression; multiple linear regression was used to analyze the factors influencing disease severity in the first-episode group, and binary logistic regression was used to analyze the risk factors in severely ill patients in the first-episode group. Results:Comparison of plasma IL-1β, IL-6 and TNF-α ( H=6.46, 6.75, 6.41, all P<0.05) levels between the 3 groups of subjects showed statistically significant differences; posthoc analysis showed no statistically significant differences in plasma cytokine levels between the first-episode group and the recurrent group(all P>0.05); the plasma IL-6 levels in the first-episode group were significantly higher compared with the healthy controls [ M( Q1, Q3)] [1.69 (1.17, 2.45) ng/L vs 1.34 (1.05, 2.06) ng/L, Z=-2.67, PBonferroni correction=0.030]. Spearman correlation analysis showed a positive correlation between the HAMD-24 total score and the levels of IL-17A, IL-1β, IL-6, and TNF-α ( r=0.275, 0.260, 0.300, 0.331, all P<0.05) in the first-episode group, and no correlation was found between the HAMD 24 total score and any cytokine in the recurrent group. In the first-episode group, plasma IL-10, IL-17A, IL-1β, IL-6, and TNF-α levels were significantly higher in severely ill patients compared to mildly/moderately ill patients[0.48 (0.33, 0.72) ng/L vs 0.63 (0.46, 1.10) ng/L, 1.89 (1.22, 3.04) ng/L vs 3.01 (1.94, 5.18) ng/L, 0.17 (0.12, 0.36) ng/L vs 0.42 (0.22, 0.65) ng/L, 1.55 (1.12, 2.05) ng/L vs 2.30 (1.68, 3.75) ng/L, 0.92 (0.77, 1.38) ng/L vs 1.42 (0.95, 2.15) ng/L respectively, all P<0.05]. Both multiple linear regression and binary logistic regression analyses showed that LgIL-6 level was independently associated with the severity of disease (multiple linear regression: β=2.550,95 %CI:1.258-10.724, P<0.05; binary logistic regression: OR=12.499,95 %CI:2.061-75.806, P<0.05). Conclusion:Higher levels of plasma IL-6 correlate with more severe depressive symptoms in adolescents with first-episode depressive disorder and are a risk factor for severely ill patients with depression.