A latent class analysis of depressive symptoms in youth from the Texas Youth Depression and Suicide Research Network (TX-YDSRN): Clinical and socio-ecological correlates.

Abstract

Background: Adolescent depression is heterogeneous, yet many studies rely on aggregate symptom scores that may obscure meaningful differences in symptom presentation. Latent class analysis (LCA) offers a person-centered approach for identifying symptom subgroups, but few studies have examined depressive symptom classes longitudinally with attention to social determinants of health (SDoH). This study identified depressive symptom classes among youth with depression and/or suicidality, examined demographic, clinical, and socio-ecological correlates of class membership, and evaluated changes in psychological outcomes over 6 months.

Methods: Participants were 1,825 youth ages 8-20 years who screened positive for depression, endorsed suicidal thoughts or behaviors, or were receiving treatment for depression. Baseline Patient Health Questionnaire for Adolescents (PHQ-A) item responses were used to identify latent classes of depressive symptoms. Associations between class membership and sociodemographic characteristics, trauma exposure, health-related social needs, treatment barriers, anxiety, suicidality and resilience were examined using chi-square tests and analyses of variance. Mixed-effect models evaluated changes in clinical symptoms and resilience across 6 months of follow-up.

Results: A five-class solution was identified: Somatic Symptoms (15.6%), No Symptoms (12.4%), Mild Symptoms (20.5%), Moderate Symptoms (27.8%), and High Symptoms (23.5%). Classes differed significantly by sex, trauma exposure, interpersonal safety concerns, treatment barriers, anxiety severity, suicidality, and resilience. In contrast, household income and basic resource insecurities did not differ significantly across classes. Longitudinally, depressive symptoms, anxiety, and suicidality showed significant time-by-class interactions; however, within- and between-class effect sizes were generally small. Resilience did not exhibit differential changes across classes.

Conclusions: Depressive symptom classes among youth with depression or suicidality demonstrate distinct clinical and socio-ecological profiles, highlighting meaningful heterogeneity beyond symptom severity alone. Person-centered approaches may improve characterization of adolescent depression and inform more tailored assessment and intervention strategies. Future longitudinal research should examine the stability of these classes and predictors of transitions between symptom classes.