Latent Symptom Profiles in Adolescents With Major Depressive Disorder: Subjective Sleep Disturbance and Biopsychosocial Correlates

Abstract

Background Adolescent major depressive disorder (MDD) is clinically heterogeneous, with sleep disturbance often emerging as a prominent but variably expressed symptom dimension. This study aimed to identify latent symptom profiles in drug‐naïve adolescents with MDD and examine their associations with recorded trauma/stressor exposure and neuroendocrine markers. Methods This cross‐sectional study included 711 drug‐naïve adolescents with MDD. Latent profile analysis (LPA) was conducted using 16 symptom indicators derived from the Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HAMA), and Pittsburgh sleep quality index (PSQI). Multinomial logistic regression examined associations of recorded trauma/stressor exposure and neuroendocrine markers with profile membership. Results A three‐profile solution was retained: low overall symptoms (Profile 1; n = 200, 28.1%), PSQI‐elevated subjective sleep disturbance (Profile 2; n = 215, 30.2%), and high overall symptoms (Profile 3; n = 296, 41.6%). Recorded family trauma/stressor exposure and violent incident exposure were associated with higher odds of Profile 3 membership relative to Profile 1, and these associations remained significant after neuroendocrine markers were added. Higher standardized testosterone (T) showed a modest association with Profile 3 membership, whereas FT3 showed only a marginal association. However, adding neuroendocrine markers did not significantly improve model fit beyond trauma‐related variables. Conclusion LPA identified three clinically interpretable symptom profiles in adolescent MDD, including a profile characterized primarily by elevated PSQI‐assessed subjective sleep disturbance. Recorded trauma/stressor exposure was associated with the high overall symptom profile, whereas neuroendocrine markers showed limited incremental value. These findings highlight multidimensional symptom profiling and trauma assessment in adolescent depression, while suggesting that neuroendocrine findings should be considered exploratory.