Theory of mind in major depressive disorder: A meta-analysis

Objective: Social cognitive deficits can contribute to risk for depression and to psychosocial impairment during depression. However, available evidence suggests that emotion recognition is only marginally impaired in major depressive disorder (MDD). Recent studies have investigated theory of mind (ToM) abilities, a cognitively more demanding aspect of social cognition.

Methods: We conducted a meta-analysis of studies comparing ToM abilities in MDD and healthy controls. 18 studies comparing 613 patients with MDD and 529 healthy controls were included.

Results: MDD patients significantly underperformed healthy controls in ToM (d=0.51-0.58). ToM impairment in MDD was evident in response to different types of ToM tasks (verbal/visual and cognitive/affective and reasoning/decoding). ToM impairment was significantly related to severity of depressive symptoms.

Conclusion: Theory of mind abilities are impaired during depression and can potentially contribute to psychosocial difficulties during depression. There is a need to investigate ToM abilities in different subtypes and stages of depression, especially in remitted patients.