Metacognitive dysfunction in depressive disorders: Associations with illness severity and duration

Abstract

Metacognitive impairments, which play a key role in the chronification of affective disorders, have been insufficiently studied. The aim of this research was to assess these deficits in depression and analyze their relationship with the clinical severity and duration of the illness. The study included 120 psychiatric inpatients (38 with bipolar affective disorder, 35 with a depressive episode, and 47 with recurrent depressive disorder). Psychopathological symptoms were assessed using the Beck Depression Inventory (BDI), the Apathy Evaluation Scale (AES-S), and the Symptom Checklist-90-Revised (SCL-90-R). Metacognitive deficits were assessed using the Dysfunctional Attitude Scale (DAS), the Ruminative Responses Scale (RRS), the Mindful Attention Awareness Scale (MAAS), and the Metacognitions Questionnaire (MCQ-30) and perfectionism scales. The results showed that metacognitive impairments are transdiagnostic in nature and intensify with increasing severity of depression. Patients with moderate depression are characterized by rumination and distress about low mood, while with greater subjective severity of symptoms, metacognitive impairments related to perfectionism and cognitive incompetence come to the fore. Rumination about loneliness is more pronounced in patients with unipolar depression, especially at the onset of the illness. The association between suicidal ideation and rumination about helplessness and loneliness indicates an increased risk of developing hopelessness and suicidal tendencies. A significant clinical factor determining the severity of metacognitive impairments is the subjective severity of the condition, rather than the nosological affiliation or duration of the illness. It is important to consider the severity of the condition when choosing targets for psychological intervention, as this contributes to the personalization of treatment. Particular attention should be paid to experiences of loneliness, which are most pronounced in patients with recent-onset depression and are closely associated with suicidal thoughts.