Prefrontal-limbic dysconnectivity tracks emotion regulation deficits in depressed adolescents with social anxiety symptom severity.

BACKGROUND

Major depressive disorder (MDD) in adolescence is frequently accompanied by emotion regulation (ER) deficits, particularly in socially stressful contexts. Social anxiety symptoms frequently co-occur with adolescent depression and are associated with individual differences in emotional and neural responses to social threat. However, how individual differences in social anxiety symptom severity relate to ER processes during social exclusion in depressed adolescents remains insufficiently understood.

METHODS

Sixty-two adolescents (30 MDD, 32 healthy controls; aged 12-18) completed a social-exclusion-stimuli task. Assessing social anxiety dimensionally via the Liebowitz Social Anxiety Scale (LSAS) and using EEG in combination with a dedicated paradigm showing social exclusion (versus neutral situations), ER ability was assessed via cognitive reappraisal performance, negative affect ratings, EEG, and prefrontal-limbic functional connectivity.

RESULTS

Compared to healthy peers, adolescent MDD showed reduced cognitive reappraisal use and heightened negative affect during social exclusion, accompanied by increased LPP amplitudes and greater left prefrontal theta-band activity during reappraisal, alongside disrupted prefrontal-limbic functional coupling. Across participants, higher LSAS were associated with greater ER impairments and altered fronto-limbic neural dynamics.

CONCLUSIONS

Adolescent depression is characterized by disrupted prefrontal-limbic connectivity supporting ER during social exclusion. Dimensional variability in social anxiety symptom severity is associated with individual differences in affective and neural responses to social stress, underscoring the value of considering social anxiety symptoms when studying ER deficits in depressed adolescents. These findings provide insight into neural processes associated with ER under social stress and may inform future research on intervention targets in adolescent depression.