Nice or effective? Social problem solving strategies in patients with major depressive disorder

Depressive symptoms and the processing of unexpected social feedback: Differences in surprise levels, feedback acceptance, and "immunizing" cognition

Negative social expectations are a key symptom of depression. It has been suggested that individuals with depressive symptoms tend to maintain these expectations by devaluing new experiences that do not fit prior expectations. However, our understanding of the role of such "immunizing" cognition in response to unexpected social feedback in depression, as well as the cognitive mechanisms involved, remains limited. This study investigated the association between depressive symptoms and the cognitive processing of unexpected positive or negative social feedback using a novel, video-based approach featuring naturalistic social stimuli in a subclinical online sample (N = 155). We also examined how surprise levels, feedback acceptance and immunizing cognition relate to other cognitive processes, such as attributional style and rumination, using cross-sectional network analyses. Robust multiple linear regression analyses revealed that depressive symptoms were associated with higher surprise levels (R2adj. = .27), lower feedback acceptance (R2adj. = .19), and higher levels of immunizing cognition (R2adj. = .09) in response to unexpected positive social feedback, but only partially to unexpected negative social feedback. The network analysis suggested that self-efficacy expectations for coping with negative feelings and acceptance of positive social feedback had the strongest expected influence on the different cognitive processes. Our study highlights the challenges that individuals with depressive symptoms face in utilizing positive social feedback to modify negative expectations. For clinicians, our findings suggest the importance of promoting acceptance of positive social feedback, while simultaneously inhibiting immunizing cognition and avoiding the use of overly positive feedback.

Emotional awareness for self and others and empathic abilities in clinical depression during acute illness and recovery

BACKGROUND

The present longitudinal investigation had two major goals. First, we intended to clarify whether depressed patients are characterized by impairments of emotional awareness for the self and the other during acute illness and whether these impairments diminish in the course of an inpatient psychiatric treatment program. Previous research based on the performance measure Levels of Emotional Awareness Scale (LEAS) provided inconsistent findings concerning emotional self-awareness in clinical depression. Second, we investigated whether cognitive and affective empathic abilities change from acute illness to recovery in depressed patients.

METHODS

Fifty-eight depressed patients were tested on admission and after 6-8 weeks of inpatient psychiatric treatment. A sample of fifty-three healthy individuals were also examined twice at an interval of 6-8 weeks. The LEAS and the Interpersonal Reactivity Index (IRI) were administered to assess emotional awareness and empathic abilities. Written texts were digitalized and then analyzed using the electronic scoring program geLEAS, the German electronic Levels of Emotional Awareness Scale.

RESULTS

Depressed patients reported more depressive symptoms than healthy controls and less severe depressive symptomatology at time 2 compared to time 1. Independent of time, depressed individuals tended to show lower geLEAS self scores and had lower geLEAS other scores than healthy individuals. Depressed patients showed higher personal distress scores than healthy individuals at both measurement times. No group differences were observed for the cognitive empathy scales of the IRI (perspective taking and fantasy) and empathic concern, but empathic concern decreased significantly in depressed patients from time 1 to time 2. Empathic abilities as assessed by the IRI were not significantly correlated with emotional awareness for others, neither in the whole sample, nor in the patient and control subsample.

CONCLUSIONS

Depressed patients seem to be characterized by impairments in emotional awareness of others during acute illness and recovery, but they also tend to show deficits in emotional self-awareness compared to healthy individuals. Self-reported cognitive empathic abilities seem to be at normal levels in depressed patients, but their heightened self-focused affective empathy may represent a vulnerability factor for depressive disorders.

Cognitive factors as mediators of the relationship between childhood trauma and depression symptoms: the mediating roles of cognitive overgeneralisation, rumination, and social problem-solving

Background: Childhood trauma has negative immediate and long-term impacts on depression. Questions remain, however, regarding the cognitive factors influencing this relationship. This study aimed to investigate the role of three cognitive factors - cognitive overgeneralisation, rumination and social problem-solving - as mediating factors in the relationship between childhood trauma and symptoms of depression.Methods: We conducted a cross-sectional study in Iran from March to July 2023. Participants (N = 227; Mean age 32.44 ± 8.95 years) with depression completed measures of childhood trauma, depression, self-overgeneralisation, cognitive errors, memory specificity, rumination and social problem-solving. The conceptual model was assessed using structural equation modelling.Results: Structural equation modelling indicated that childhood trauma had a positive direct effect on depression symptoms. Childhood trauma had a positive indirect effect on depression symptoms through both self-overgeneralisation and rumination and a negative indirect effect on depression through effective social problem-solving strategies.Conclusions: The findings suggest increased exposure to childhood trauma may be associated with elevated depression and self-overgeneralisation, rumination, and effective social problem-solving strategies may play an important role in this relationship. These findings hold potential implications for those working with patients with depression and a history of childhood trauma.

Atypical Interpersonal Problem-Solving and Resting-state Functional Connectivity in Adolescents with Maltreatment Experience

BACKGROUND

Childhood maltreatment is associated with altered neurocognitive functioning, which is thought to reflect, in part, adaptation to early adverse environmental experiences. However, we continue to lack a precise mechanistic understanding linking atypical neurocognitive processing with social functioning and psychiatric outcomes following early adversity.

OBJECTIVE

The present work investigated interpersonal problem-solving, resting-state functional connectivity (rsFC), and mental health symptoms in adolescents with documented maltreatment experience and explored whether altered neural function contributes in part to poorer social functioning.

METHODS

Forty adolescents (aged 12-17) with documented experiences of abuse or neglect and a carefully matched group of 42 non-maltreated peers participated in this study that measured task-based interpersonal problem-solving skills and rsFC.

RESULTS

Adolescents with maltreatment experience showed poorer interpersonal problem-solving performance, which partly accounted for their elevated mental health symptoms. Resting-state seed-based analyses revealed that adolescents with maltreatment experience showed a significant increase in rsFC between medial Default Mode Network (DMN) hubs, the medial prefrontal cortex (mPFC), with a posterior cluster, including the posterior cingulate cortex (PCC), precuneus (PCu), retrosplenial cortex (RSC), and lingual gyrus (LG). Moderation analyses revealed that maltreatment-related increased DMN rsFC partly accounted for poorer performance in interpersonal problem-solving.

CONCLUSION

Poorer interpersonal problem-solving, partly accounted for by atypical coupling between DMN medial hubs, was associated with maltreatment exposure. Interventions tailored to enhance interpersonal problem-solving represents a promising avenue to promote resilience and reduce the likelihood of mental health disorder following maltreatment experience.

Social cognition and occupational reintegration in primary central nervous system lymphoma long-term survivors: a secondary analysis of a combined data set

OBJECTIVE

Although sociocognitive impairment is linked to failure of occupational reintegration in other clinical populations, less is known on the association of sociocognitive functioning and occupational reintegration in brain tumor patients such as primary central nervous system lymphoma (PCNSL).

METHODS

Twenty PCNSL patients with ongoing complete response to therapy for at least one year were evaluated of whom eight resumed work. The association between occupational status, empathy, alexithymia and social problem solving was analyzed.

RESULTS

Employed and non-employed patients were significantly different in their ability to provide appropriate solutions for social situations even when accounting for neurocognition. Decreased quality of life was associated with sociocognitive impairment.

CONCLUSIONS

Although the results must be replicated in larger, more representative populations, this exploratory analysis tentatively adds facets to the literature on occupational reintegration in brain tumor patients. Forthcoming psychosocial research and clinical practice may target sociocognitive impairment when addressing reintegration after neuro-oncological treatment.

Social problem solving and trait socioemotional abilities in ambulatory stroke patients

INTRODUCTION

Stroke has been associated with sociocognitive impairment, so far well documented for emotion recognition and Theory of Mind. However, more complex abilities, such as social problem solving, which directly facilitate appropriate behavior in social situations have been neglected in previous research.

METHOD

The present study aimed to address this gap by focusing on performance-based social problem solving abilities and self-reported socioemotional abilities (i.e., empathy and alexithymia) in outpatient stroke patients (n = 36) compared to a group of healthy controls (n = 36) equivalent on age, gender, and education. In further analyses, potential lateralization effects and correlations between social problem solving/socioemotional functioning and demographic and clinical data were investigated.

RESULTS

In the main analyses, patients were impaired in their ability to freely generate appropriate solutions for challenging interpersonal situations depicted in written scenarios but performed on a comparable level as healthy controls when they had to choose the optimal solution presented amidst a range of less optimal options. While showing difficulty in identifying the awkward elements in the scenarios, the patient group nevertheless rated the degree of discomfort attributed to these elements on a level comparable to the control group. On the self-report measures, stroke patients reported overall higher degrees of alexithymia (i.e., an inability to describe and identify one's own and other persons´ emotions) and more personal distress in response to other individuals´ emotional suffering as assessed by self-report.

CONCLUSIONS

The present results suggest that stroke is associated with a broad impact on socioemotional and social problem solving abilities. As difficulties in social problem solving might be associated with increased psychosocial burden they ought to be addressed in stroke rehabilitation.

Theory of mind performance in depression: A meta-analysis

BACKGROUND

Theory of mind (ToM) is a social-cognitive skill that involves the ability to understand the thoughts and feelings of others. Evidence is mixed regarding the extent of ToM ability in individuals with depression.

METHODS

We conducted a meta-analysis of 43 studies to investigate the strength of the association between ToM and depression.

RESULTS

Results indicated significant, small- to moderate impairment in ToM with a medium overall effect size (g = -0.398) in individuals with depression. Moderator analyses compared effect sizes across groups for the following variables: ToM content, process, and sample type. Additionally, meta-regression analyses tested age and gender as continuous moderators.

LIMITATIONS

The cross-sectional nature of included studies limits this meta-analysis from clarifying temporal or bidirectional relations.

CONCLUSIONS

We discuss findings in the context of the extant developmental, cognitive, social, and clinical literatures. We also suggest several possible explanations for these findings and offer implications for intervention.

The relationship between theory of mind and executive functions in major depressive disorders: A review

Patients suffering from major depressive disorder (MDD) experience difficulties in multiple cognitive and affective abilities. A large body of literature has argued that MDD patients show impaired executive functions (EFs) and deficits in theory of mind (ToM), the ability to infer the mental states of others. However, the relationship between ToM and EFs has been poorly investigated. The aim of this review is to provide an overview of studies that evaluated the association between ToM and EFs in patients with MDD diagnosis. A literature review was conducted to identify all published studies in which ToM and EFs measures were administered to individuals with MDD and in which the relationship between these two domains was investigated. Eleven studies were included, and for each study, we discussed the findings related to ToM, EFs, and the nature of the link between these two aspects. Most of the studies reported that patients with MDD, compared with healthy controls, showed significant impairments in both ToM and EFs abilities. Moreover, this review indicates the presence of a significant association between these two domains in MDD patients, supporting the evidences that executive functioning is important to perform ToM tasks. Although the results that emerged are interesting, the relationship between ToM and EFs in MDD needs further investigation.

A network analysis of social problem-solving and anxiety/depression in adolescents

Social problem-solving (SPS) involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems; it is considered to contribute to anxiety and depression. The Social Problem-Solving Inventory Revised is a popular tool measuring SPS problem orientations and problem-solving styles. Only a negative problem orientation (NPO) is considered strongly related to anxiety and depression. In the present study, we investigated the detailed connections among the five components of SPS and 14 anxiety-depression symptoms and specified the role of NPO and other components in the anxiety-depression network. We employed network analysis, constructed circular and multi-dimensional scaling (MDS) networks, and calculated the network centrality, bridge centrality, and stability of centrality indices. The results were as follows: (1) the MDS network showed a clustering of anxiety and depression symptoms, with NPO and avoidance style components from SPS being close to the anxiety-depression network (demonstrated by large bridge betweenness and bridge closeness); (2) the NPO and positive problem orientation from SPS were most influential on the whole network, though with an opposite effect; (3) strength was the most stable index [correlation stability (CS) coefficient = 0.516] among the centrality indices with case-dropping bootstraps. We also discussed this network from various perspectives and commented on the clinical implications and limitations of this study.

Emotional and Cognitive Empathy in Caregivers of Persons with Neurodegenerative Disease: Relationships with Caregiver Mental Health

Caregiving for a person with dementia or neurodegenerative disease (PWD) is associated with increased rates of depression and anxiety. As the population ages and dementia prevalence increases worldwide, mental health problems related to dementia caregiving will become an even more pressing public health concern. The present study assessed emotional empathy (physiological, behavioral, and self-reported emotional responses to a film depicting others suffering) and two measures of cognitive empathy (identifying the primary emotion experienced by another person; providing continuous ratings of the valence of another person's changing emotions) in relation to mental health (standard questionnaires) in 78 caregivers of PWDs. Greater emotional empathy (self-reported emotional responses) was associated with worse mental health, even after accounting for known risk factors. Neither measure of cognitive empathy was associated with mental health. A relationship between high levels of emotional empathy and poor mental health in caregivers suggests possible risk indicators and intervention targets.

What Is on Your Mind? Impaired Social Cognition in Primary Central Nervous System Lymphoma Patients Despite Ongoing Complete Remission

Simple Summary

Prolonged survival after treatment of primary central nervous system lymphoma (PCNSL) led to considering patients’ everyday functional needs. Apart from cognitive functions (e.g., memory, attention), which have been investigated previously, social participation affects the quality of life (QoL). Although successful navigation in a social world is crucial for participation, social functioning in PCNSL patients has not been addressed so far. In this study, we investigated social abilities in PCNSL patients with ongoing complete remission for at least one year. PCNSL patients had difficulties in inferring others’ mental states and were impaired in providing optimal solutions for difficult social situations as compared to matched healthy controls. This demonstrates that PCNSL patients differ from healthy controls in their social functioning even in the absence of (residual) disease itself. Social difficulties may represent an additional burden affecting patients’ and caregivers’ QoL.

Abstract

Within the past decades, long-term survival was achieved in a substantial fraction of primary central nervous system lymphoma (PCNSL) patients, expanding the focus of research to their quality of life (QoL). Social relationships crucially contribute to well-being in the context of adversity. Therefore, abilities that facilitate social interactions essentially determine QoL. The present study specifically targeted those sociocognitive abilities. Forty-three PCNSL patients with ongoing complete remission to therapy for at least one year and 43 healthy controls matched for age, gender and education were examined with standardized self-report and behavioral measures of social cognition. An impaired ability to comprehend others’ feelings was found in patients for both positive and negative mental states. Patients had difficulties in identifying the awkward element in challenging social situations, whereas the degree of discomfort experienced in those situations was comparable between groups. Both the production of optimal solutions for social situations and the mere recognition of these among less optimal strategies were impaired in patients. Clinicians should be aware of possible sociocognitive impairment and ought to address this in additional supportive interventions. Impaired sociocognitive abilities may entail social conflicts at a time when patients rely on social support. This, in turn, could detrimentally affect QoL.

Plasma acetylcholine and nicotinic acid are correlated with focused preference for photographed females in depressed males: an economic game study

Interpersonal difficulties are often observed in major depressive disorder (MDD), while the underlying psychological and biological mechanisms have not yet been elucidated. In the present case–control study, a PC-based trust game was conducted for 38 drug-free MDD patients and 38 healthy controls (HC). In the trust game, participants invested money in a partner (trusting behaviors), and also rated each partner’s attractiveness (preference for others). In addition, blood biomarkers including metabolites were measured. Both MDD and HC males exhibited more trusting behaviors compared to females. MDD males’ preference for ordinary-attractive partners (lay-person photographs) was lower than HC males, whereas their preference for high-attractive females (fashion-model photographs) was similar levels to HC males. This tendency in MDD males could reflect a “focused (narrowed) preference for females”. As for blood biomarker analysis, the levels of 37 metabolites including acetylcholine, AMP, GMP, nicotinic acid and tryptophan were significantly different between two groups. Interestingly, among male participants, acetylcholine and nicotinic acid were negatively correlated with the level of focused preference for photographed females. In sum, we have revealed some behavioral, psychological and biological traits of trusting behaviors and preference for others especially in MDD males. Larger studies should be conducted to validate our preliminary findings.

Understanding versus feeling the emotions of others: How persistent and recurrent depression affect empathy

Empathy refers to the ability to understand the emotions of others. It encompasses a cognitive component of decoding a mental state, and an affective component that relates to an emotional response. Deficits in empathy have been associated with social dysfunction in depression. It is further assumed that impairments are aggravated when depression takes a chronic course. Existing evidence in the literature, however, is scarce and heterogeneous. The present study investigated empathy in patients with persistent and recurrent depression as well as in healthy controls (N = 102). Empathy measurements included both self-report (Interpersonal Reactivity Index, IRI) as well as a laboratory task (Multifaceted Empathy Task, MET). A mixed model analyses of covariance, which accounted for differences in executive functioning, found no evidence for impaired cognitive empathy in depression. All three groups performed equally well in understanding mental states. However, both IRI and MET confirmed the hypothesis of significant deficits in affective empathy. Patients reported higher personal distress than controls, and showed lower affective responses towards positive emotions in others. There was no difference between patient groups. Childhood maltreatment was further related to reduced affective empathy. The present results contribute to our understanding of social dysfunction in depression, since loss of emotional reactivity to the feelings of others is considered to reduce the desire to engage in social interaction, thus leading to isolation and aggravation of depression.

Social problem solving in adult patients with attention deficit hyperactivity disorder

Patients with Attention Deficit Hyperactivity Disorder (ADHD) experience interpersonal difficulties potentially linked to impaired social cognition. We aimed to investigate social problem solving strategies in adults with ADHD. Nineteen patients with ADHD and 20 healthy controls were assessed with a scenario-based battery gauging the ability to understand other people's mental states, to recognize interpersonal conflicts and to generate and identify optimal (i.e. both socially sensitive and practically effective) solutions to these conflicts. Furthermore, measures of socioemotional and executive functioning were administered. Patients and controls performed on a similar level with respect to theory of mind, the generation of the "best" solution to problematic social situations and the selection of the optimal solution out of alternatives. However, in a fluency task, patients generated fewer optimal solutions, while the number of only socially sensitive, only practically effective or irrelevant solutions was comparable in both groups. The overall ability to freely generate problem solutions was not linked to executive functioning or trait empathy, but better generation abilities were related to lower social interaction anxiety in the patients only. This suggests impaired generation fluency of optimal interpersonal conflict solutions in patients with ADHD which might contribute to higher levels of anxiety in social interactions.

Impairment of sociocognitive functions in patients with brain tumours

The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.

A systematic review of the impact of social cognitive deficits on psychosocial functioning in major depressive disorder and opportunities for therapeutic intervention

Social cognition is the ability to identify, perceive and interpret socially relevant information from the external world. It is an important adaptive trait, but is frequently affected in major depressive disorder by a mood-congruent interpretive bias. The present review examined the existing body of literature to determine (i) the impact social cognitive deficits in depression have on psychosocial functioning; and (ii) the utility of psychotropic, psychological and procedural interventions employed to target these deficits. A total of 107 studies met inclusion criteria for review. Social cognitive performance was found to adversely impact depressed patients' psychosocial functioning across the key domains of general cognitive functioning and quality of life. Secondly, many current therapies were found to have a normalising effect on the social cognitive abilities of subjects with major depressive disorder, both at a neural and functional level. In particular, certain anti-depressant medications corrected facial affect recognition deficits, while several psychotherapeutic approaches improved impairments in theory of mind and negative interpretive bias.

The relationship between social cognition and executive function in Major Depressive Disorder in high-functioning adolescents and young adults

To understand how cognitive dysfunction contributes to social cognitive deficits in depression, we investigated the relationship between executive function and social cognitive performance in adolescents and young adults during current and remitted depression, compared to healthy controls. Social cognition and executive function were measured in 179 students (61 healthy controls and 118 patients with depression; M_age = 20.60 years; SD_age = 3.82 years). Hierarchical regression models were employed within each group (healthy controls, remitted depression, current depression) to examine the nature of associations between cognitive measures. Social cognitive and executive function did not significantly differ overall between depressed patients and healthy controls. There was no association between executive function and social cognitive function in healthy controls or in remitted patients. However, in patients with a current state of depression, lower cognitive flexibility was associated with lower performance in facial-affect recognition, theory-of-mind tasks and overall affect recognition. In this group, better planning abilities were associated with decreased performance in facial affect recognition and overall social cognitive performance. While we infer that less cognitive flexibility might lead to a more rigid interpretation of ambiguous social stimuli, we interpret the counterintuitive negative correlation of planning ability and social cognition as a compensatory mechanism.

Genome-wide analyses of self-reported empathy: correlations with autism, schizophrenia, and anorexia nervosa

Empathy is the ability to recognize and respond to the emotional states of other individuals. It is an important psychological process that facilitates navigating social interactions and maintaining relationships, which are important for well-being. Several psychological studies have identified difficulties in both self-report and performance-based measures of empathy in a range of psychiatric conditions. To date, no study has systematically investigated the genetic architecture of empathy using genome-wide association studies (GWAS). Here we report the results of the largest GWAS of empathy to date using a well-validated self-report measure of empathy, the Empathy Quotient (EQ), in 46,861 research participants from 23andMe, Inc. We identify 11 suggestive loci (P < 1 × 10^-6), though none were significant at P < 2.5 × 10^-8 after correcting for multiple testing. The most significant SNP was identified in the non-stratified analysis (rs4882760; P = 4.29 × 10^-8), and is an intronic SNP in TMEM132C. The EQ had a modest but significant narrow-sense heritability (0.11 ± 0.014; P = 1.7 × 10^-14). As predicted, based on earlier work, we confirmed a significant female advantage on the EQ (P < 2 × 10^-16, Cohen's d = 0.65). We identified similar SNP heritability and high genetic correlation between the sexes. Also, as predicted, we identified a significant negative genetic correlation between autism and the EQ (r_g = -0.27 ± 0.07, P = 1.63 × 10^-4). We also identified a significant positive genetic correlation between the EQ and risk for schizophrenia (r_g = 0.19 ± 0.04; P = 1.36 × 10^-5), risk for anorexia nervosa (r_g = 0.32 ± 0.09; P = 6 × 10^-4), and extraversion (r_g = 0.45 ± 0.08; 5.7 × 10^-8). This is the first GWAS of self-reported empathy. The results suggest that the genetic variations associated with empathy also play a role in psychiatric conditions and psychological traits.

Social functioning in major depressive disorder

Depression is associated with social risk factors, social impairments and poor social functioning. This paper gives an overview of these social aspects using the NIMH Research and Domain Criteria 'Systems for Social Processes' as a framework. In particular, it describes the bio-psycho-social interplay regarding impaired affiliation and attachment (social anhedonia, hyper-sensitivity to social rejection, competition avoidance, increased altruistic punishment), impaired social communication (impaired emotion recognition, diminished cooperativeness), impaired social perception (reduced empathy, theory-of-mind deficits) and their impact on social networks and the use of social media. It describes these dysfunctional social processes at the behavioural, neuroanatomical, neurochemical and genetic levels, and with respect to animal models of social stress. We discuss the diagnostic specificity of these social deficit constructs for depression and in relation to depression severity. Since social factors are importantly involved in the pathogenesis and the consequences of depression, such research will likely contribute to better diagnostic assessments and concepts, treatments and preventative strategies both at the diagnostic and transdiagnostic level.

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.

Theory of Mind in Depressive Disorders: A Review of the Literature

BACKGROUND

Theory of mind (ToM) is the ability to infer the mental states of others in order to understand and predict their behaviour. This ability is thought to be essential to social functioning and interpersonal relationships. As major depression is characterized by considerable social and interpersonal difficulties, exploration of the quality of ToM functioning can be particularly relevant in this and in related disorders. We aim to review the current state of research on ToM in depressive disorders in order to find out the extent to which ToM impairment is associated with these illnesses.

METHODS

An internet database search was carried out to collect all publications on the subject.

RESULTS

A total of 32 publications in English met our inclusion criteria: (a) 17 studies on ToM in major depression, (b) 4 studies on ToM in psychotic depression, (c) 3 studies on ToM in dysphoria or mild depression, (d) 4 studies on ToM in euthymic major depression, (e) 2 studies on ToM in chronic versus episodic depression, and (f) 2 studies on ToM in another psychiatric disorder with comorbid major depression.

CONCLUSIONS

Despite an increased interest in the research of the topic in recent years, no firm conclusions can be drawn, as the reviewed articles present some conflicting results. Acutely depressed patients have been found to be impaired on tasks involving both ToM social-perceptual and social-cognitive components. On the other hand, a number of studies have not reported significant between-group differences between depressed patients and healthy controls or have found minimal differences. Further research is needed in order to confirm and extend these results.

Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder

The aim of the present study was to investigate the social cognitive functioning of participants with depression when compared with healthy controls, and to assess the impact of symptom severity. One hundred and eight patients with depression (66 remitted and 42 current) and 52 healthy controls were assessed using the Wechsler Advanced Clinical Solutions: Social Perception Subtest, measuring facial affect recognition in isolation and in combination with prosody and body language interpretation. When healthy controls, remitted depression and currently depressed groups were compared, no associations were found on any of the social cognition subscales. Severity of depressive and anxious symptoms predicted performance on all social cognition subscales in currently depressed participants, controlling for age, gender, education and psychotropic medication. Affective depressive symptoms were inversely related to ACS Pairs and Prosody subscales, while somatic symptoms were inversely related to the ACS Affect Recognition and Total scores. There was no association between severity and the WAIS ACS in remitted depression participants. People with MDD exhibiting more severe depressive and anxious symptoms and a cluster of affective symptoms have greater difficulty undertaking complex social cognitive tasks. Given the state like nature to these deficits, these impairments may cause problems with day to day functioning and have implications in targeted therapeutic interventions.