To construct a risk prediction model for poor discharge readiness in patients undergoing elective unilateral lower extremity joint replacement based on clinical and psychosocial factors.

In 2021, the global prevalence of depressive disorders among adolescents aged 10–19 years was approximately 2.4%, with major depressive disorder (MDD) accounting for 2.0% (). According to the Global Burden of Disease Study 2023 (), the age-standardized prevalence of mental disorders (12 categories combined) was 14,210.7 per 100,000 population globally in 2023 (). The peak burden has shifted to the 15–19 age group, with a disability-adjusted life year (DALY) rate of 2617.3 per 100,000, largely driven by depressive and anxiety disorders. The presence of depressive symptoms during adolescence increases the risk of future functional impairments and psychological disorders (). Furthermore, depressive symptoms are among the strongest correlates and predictors of suicidal ideation (). The familial environments established during childhood are pivotal in influencing adolescent development. Adolescents’ perceptions and expressions of difficulties are not primarily derived from a sense of social emptiness; rather, their cognitive status plays a significant role in this process (). A comprehensive meta-analysis has demonstrated a strong association between impaired cognitive function in individuals with mood disorders and experiences of childhood trauma. Such trauma can disrupt normative developmental trajectories (). Childhood trauma encompasses both psychological and physical forms, including sexual abuse, emotional abuse, emotional neglect, physical neglect, and physical abuse (). These experiences can have both immediate and long-lasting effects on mental health, increasing the risk for a range of issues such as antisocial behavior, sleep disturbances, and depression (; ). Any form of childhood trauma more than doubles the likelihood of developing depression in adulthood (). Therefore, childhood trauma is considered a key predictor of depressive symptoms. In clinical practice, adolescents with depression often do not disclose their experiences of childhood trauma, preferring to conceal or avoid discussing such events (). Early identification of individuals with a history of childhood trauma can significantly reduce the risk of major adverse outcomes, such as suicide, thereby improving treatment outcomes and facilitating better integration into social environments. Despite the well-documented adverse effects of childhood trauma on the quality of life and future productivity of adolescents with depression, the neurobiological characteristics associated with depression in this context are only beginning to be elucidated (). reported a correlation between increased childhood trauma and heightened depressive symptoms in adulthood (). Childhood trauma exerts profound and long-lasting effects on cognitive and emotional development. A meta-analysis confirmed that childhood trauma is associated with significant deficits in attention, working memory, emotion regulation, and executive function (). Furthermore, a study on Alzheimer’s disease indicated that stressful events during early adulthood may promote phosphorylated-tau in later life, while events during early to middle adulthood may have differential effects on brain integrity (). Additionally, enhanced resting-state functional connectivity between the ventral striatum and cingulate cortex during adolescence has been linked to more severe depressive symptoms and greater exposure to childhood trauma (). This disruption in brain network connectivity may serve as a neurobiological risk factor for adolescent depression in the context of childhood trauma. Investigating the relationship between childhood trauma and brain network connectivity in adolescent depression could further clarify individualized risk factors and guide prevention strategies.