Major Depressive Disorder With Versus Without Psychosocial Triggers: A Secondary Analysis of a Prospective Cohort Study

Background Few studies have examined differences in symptom presentation and antidepressant response between patients with major depressive disorder (MDD) with and without psychosocial triggers. Methods This was a secondary analysis of a multicenter, multistage prospective cohort study conducted at nine top tertiary hospitals across six provinces/municipalities in China. The cohort included patients with first‐episode MDD, with or without psychosocial triggers, who received one of six selective serotonin reuptake inhibitors (SSRIs). Results Of 359 enrolled patients with first‐episode MDD, 303 (mean [SD] age, 39.6 [10.1] years; 201 [66.8%] women) were included in the final analysis. There were no significant differences in network structure ( M = 0.40; p = 0.97) or global strength (global strength difference [GS] = 0.483; p = 0.91) between the two groups. However, network analyses identified distinct core and influential bridge symptoms: psychic anxiety (node strength [Str] = 2.161; bridge strength [BStr] = 1.908) and somatic anxiety (Str = 2.142; BStr = 1.664) in the MDD with psychosocial triggers group, while depressed mood (Str = 3.114; BStr = 2.793) and genital symptoms (Str = 3.085; BStr = 3.085) in the group without psychosocial triggers. There were no significant differences in response rates at all visits. Median time to first response was 4.0 weeks in both groups (log‐rank p = 0.23). Conclusions While patients with MDD with and without psychosocial triggers shared broadly similar clinical profiles and SSRI responses, differences in symptom network architecture may have implications for individualized symptom monitoring and treatment strategies.