Decision-making in major depressive disorder: Subjective complaint, objective performance, and discrepancy between both

Abstract

Background: Studies comparing objective and subjective cognition in major depressive disorder (MDD) are scarce, and available data concern different cognitive functions but not decision-making specifically. This cross-sectional study aimed to explore objective (O-DMI) and subjective decision-making impairment (S-DMI) as well as the discrepancy between both in people with MDD. Secondly, we assessed the association between S-DMI and O-DMI. Finally, we explored sociodemographic, clinical, and psychosocial factors related to decision-making impairment status.

Method: One hundred and nine people with MDD were assessed with the Iowa Gambling Task to identify "O-DMI". The item 9 of the Beck Depression Inventory was used to compose the variable "S-DMI". Psychiatric history, medication adherence, childhood trauma, physical and psychological pain, and negative life experiences were also collected.

Results: Forty-six percent of participants have O-DMI and 65.1% S-DMI. From 49.5% showing a discrepancy between both, 68,6% have positive discrepancy and 31,4% negative (i.e. under and overestimation respectively). O-DMI and S-DMI were not associated. Binary logistic regressions showed that the number of negative life events in the past 6 months was predictor of O-DMI, while depression severity and medication adherence predicted S-DMI. Finally, medication adherence and depression severity predicted the type of discrepancy.

Limitations: The variable S-DMI was obtained through a single item.

Conclusion: These results confirm the lack of association between objective and subjective measures of cognition in MDD, and for the first-time concerning decision-making. This suggest that both assessments should be done in order to have a deeper knowledge of the cognitive functioning of each patient.

Keywords: Cognition; Decision-making; Iowa gambling task; Major depression; Subjective measures.