This study aims to identify baseline predictors of treatment efficacy in adolescents with Major Depressive Disorder (MDD) undergoing a combined intervention of repetitive transcranial magnetic stimulation (rTMS) and group therapy. Specifically, the study investigates the predictive value of family environment characteristics (cohesion, conflict, expressiveness) and cognitive functions (executive function, attention/inhibition).

Adolescent depression is a significant health concern, and while combined therapies involving neuromodulation and psychotherapy show promise, individual treatment responses vary heterogeneity. This prospective cohort study enrolled 163 adolescents aged 12-18 with MDD. All participants received a standardized 4-week intervention consisting of 20 sessions of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex (DLPFC) and 8 sessions of group Cognitive Behavioral Therapy (CBT).

Baseline assessments included the Family Environment Scale (FES) and a neuropsychological battery including the Stroop Color-Word Test and Wisconsin Card Sorting Test (WCST). The primary outcome was the percentage reduction in depressive symptoms measured by the HAMD-24 scale. The study employs multiple linear regression to determine which baseline factors independently predict superior treatment outcomes.

Inclusion Criteria:

• Primary diagnosis of Major Depressive Disorder (MDD) according to ICD-10 criteria.
• Score of ≥ 20 on the 24-item Hamilton Depression Rating Scale (HAMD-24).
• Sufficient intellectual and linguistic ability to complete assessments and participate in therapy.
• Provided written informed consent (participants and guardians).

Exclusion Criteria:

• Lifetime diagnosis of a psychotic or bipolar disorder.
• Current substance use disorder.
• Significant neurological illness (e.g., epilepsy) or metallic implants contraindicated for rTMS.
• Receiving concurrent formal psychotherapy outside the study protocol.

Inpatients aged 12 to 18 years recruited from the Department of Mental Health at The First Hospital of Hebei Medical University between August 2023 and July 2024. All participants had a primary diagnosis of Major Depressive Disorder (MDD) according to ICD-10 criteria and received a standardized combined intervention of rTMS and group therapy.