Impact of Adverse Childhood Experiences and Rumination on Metacognition in Chinese Urban Adolescents with Major Depressive Disorder

Jiuju Li,1,* JiaQi Zhu,2,* Bingjie Zhou,3 Jiaqi Sun,3 Shuangjiang Zhou,1 Meng Qi,1 Jingxu Chen1 1Sleep Medicine Center, Beijing Huilongguan Hospital, Capital Medical University, Beijing, 100096, People’s Republic of China; 2Department of Psychiatry and Psychology, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, People’s Republic of China; 3Department of Psychology, Chengde Medical University, Chengde, 067000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingxu Chen, Sleep Medicine Center, Beijing Huilongguan Hospital, No. 7, Nandian Road, Changping District, Beijing, 100096, People’s Republic of China, Email chenjx1110@163.comBackground: Major depressive disorder (MDD) in adolescents represents a significant global public health challenge. Moreover, metacognitive dysfunction plays a critical role in its onset, progression, and prognosis, but research on the metacognitive characteristics of Chinese adolescents with MDD remains highly limited.Methods: The study was conducted from January 2024 to January 2025 and employed a cross-sectional design with convenience sampling. The participants included 202 adolescents who were diagnosed with MDD, with a mean age of 15 years. All the subjects completed a self-administered general information questionnaire to collect demographic information. The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Adverse Childhood Experience Questionnaire-Revised (ACE), Rumination Response Scale Chinese Version (RRS), and Metacognitive Questionnaire-30 (MCQ) were utilized to evaluate the psychological well-being of adolescents diagnosed with MDD.Results: Multiple linear regression analyses demonstrated the potential of the RRS total score, reflective pondering and household dysfunction as predictors of metacognitive deficits in adolescents diagnosed with MDD, with statistical significance at p < 0.05. Furthermore, the total ACE scores of adolescents diagnosed with MDD were significantly positively correlated with the MCQ (β = 0.189, p < 0.001) and RRS (β = 0.380, p < 0.001) scores. Additionally, the total RRS score was positively correlated with the MCQ score (β = 0.675, p < 0.001). Mediation analyses demonstrated that rumination mediated the association between adverse childhood experiences and metacognitive deficits, with a mediating effect value of 1.136 and a 95% confidence interval of [0.639, 1.635], explaining 57.32% of the total effect.Conclusion: Rumination mediates the relationship between adverse childhood experiences and metacognitive deficits in adolescents with MDD. Rumination, reflective pondering and household dysfunction in adolescents with MDD can predict metacognitive dysfunction to varying degrees. Our study highlights that interventions targeting rumination may be particularly effective in mitigating the negative impact of ACEs on metacognitive functioning in adolescents with MDD.Keywords: adolescents, major depressive disorder, metacognition, rumination, adverse childhood experiences, mediation