Associations of a perceived parental-rejection experience with self-harm or death thoughts in adolescents: evidence from symptom network analysis and structural equation modeling.

Background: Childhood trauma (CT) is associated with depression, anxiety, and suicide-related thoughts in adolescents. However, the item-level associations linking trauma-related experiences with internalizing symptoms and thoughts of self-harm or death remain unclear. Methods: We conducted a cross-sectional analysis of 2,413 adolescents who completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Symptom-level associations were examined using a Spearman-EBICglasso network, with a polychoric network as a sensitivity analysis. CTQ-SF item 8 was interpreted descriptively as a perceived parental-rejection experience. PHQ-9 items 1-8 indicated latent depressive symptoms, GAD-7 items 1-7 indicated latent generalized anxiety symptoms, and PHQ-9 item 9 represented thoughts of being better off dead or self-harm. Four cross-sectional structural equation model (SEM) specifications were compared using maximum likelihood (ML), with MLR and WLSMV sensitivity analyses. Results: Childhood trauma, depressive symptoms, and generalized anxiety symptoms formed distinct but interconnected network communities. CTQ-SF item 8 ranked seventh in bridge strength in the primary network and remained among the leading bridge items in the polychoric network. The correlated-factors SEM showed the best primary fit. Under ML, item 8 was associated with depressive symptoms (standardized β = 0.439, p < 0.001), generalized anxiety symptoms (standardized β = 0.377, p < 0.001), and item 9 directly (standardized β = 0.077, p = 0.012). The depressive-symptom association with item 9 was larger (standardized β = 0.562, p < 0.001) than the generalized-anxiety association (standardized β = 0.111, p = 0.073). MLR reproduced this pattern, whereas WLSMV identified a smaller but statistically significant generalized-anxiety association (standardized β = 0.166, p = 0.001). Conclusions: A perceived parental-rejection experience emerged as a salient bridge item linking childhood trauma with internalizing symptoms and thoughts of self-harm or death. Depressive symptoms showed the larger and more consistent conditional association with item 9, whereas the generalized-anxiety association was smaller and varied by estimator. These findings support further investigation of family relational experiences in adolescent mental-health assessment and prevention research.