Differential symptom connectivity between depressive and psychotic symptoms in patients with major depressive disorder: a network analysis of first-onset and recurrent patients

Major depressive disorder with psychotic features (MDDP), as a specifier of major depressive disorder, is characterized by the concurrent presence of depressive and psychotic symptoms. However, the interrelations between these symptom domains remain unclear. Guided by a network-based psychopathology framework, this study employed the symptom network and Bayesian network analysis to examine the connections between depressive-related and psychotic-related symptoms in MDDP. A total of 535 patients (female = 395, male = 140; Mean age = 34.52, SD age = 17.45, range age = 12–77) diagnosed with MDDP were included in the data analysis. Of these, 195 were classified as first-onset (female = 126, male = 69; M age = 31.90, SD age = 16.70) and 340 as recurrent (female = 269, male = 71; M age = 36.10, SD age = 17.70) based on clinical diagnosis and patients’ self-reports. All patients completed the Hamilton Depression Rating Scale and the Brief Psychiatric Rating Scale. In the full sample, the psychotic symptom (i.e., motor retardation ) shares central bridge symptoms ( Z score above 2) linking the HDRS symptom and BPRS symptom communities. One depressive and one psychotic symptom (i.e., depressed mood; depressive mood ) were central bridge symptoms in the first-onset group. Only one depressive symptom (i.e., loss of weight ) acted as a bridge symptom and was significantly stronger in the recurrent group than the first-onset group. Bridge centrality values were not significantly correlated with bridge path number in the overall MDDP sample ( r = 0.19, p = 0.28) or in patients with recurrent MDDP ( r = 0.14, p = 0.42), whereas a significant positive correlation was observed in patients with first-onset MDDP ( r = 0.37, p = 0.032). Network stability, accuracy, and sensitivity were also assessed. These findings suggest that first-onset and recurrent MDDP may require differentiated treatment approaches, with early interventions targeting psychotic-affective linkages in first-onset patients and symptom-specific treatment of somatic manifestations in recurrent patients. Not applicable.