Cortical morphometric correlates of childhood adversity and learning burnout in depressive adolescents with non-suicidal self-injury.

Childhood adversity is a well-established risk factor for non-suicidal self-injury (NSSI) in adolescents, but how these early experiences become biologically embedded to shape not only self-harm but also broader functional outcomes such as academic functioning remains unclear. We examined cortical morphometry in 45 adolescents with major depression (MDD) and NSSI, and 45 matched healthy controls using structural MRI, as well as childhood experiences and learning burnout. Adolescents with MDD-NSSI showed a regionally specific pattern of cortical alterations: fronto-limbic thickening particularly in the orbitofrontal cortex (OFC), contrasted with thinning in the visual cortex, alongside reduced OFC surface area. These regionally specific cortical alterations were associated with learning burnout and early-experience: OFC cortical thickness was positively associated with learning burnout, visual cortical thickness was positively associated with physical abuse, and right PFC/ACC cortical thickness was negatively associated with paternal emotional warmth. Exploratory indirect-effect analysis suggested a possible pathway linking childhood sexual abuse, left OFC cortical thickness, and learning burnout. These findings suggest that early adversity may be biologically embedded in regionally specific cortical morphology in adolescents with MDD-NSSI and may be linked to broader functional outcomes such as learning burnout.