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

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.