Objective and subjective measures of decision-making impairment do not show an association in patients with major depressive disorder (MDD), suggesting these measures should be used concurrently to assess patients’ cognition and decision-making abilities, according to a study in the Journal of Affective Disorders.

An important aspect contributing to disability in MDD is the neurocognitive impairment experienced by patients. However studies focused on decision-making are lacking, specifically objective and subjective measures.

A total of 109 patients with MDD (mean age, 40 years) were recruited at hospitalization admissions at a hospital in France between May 2012 and July 2015. Patients were assessed with the Iowa Gambling Task to identify objective decision-making impairment (O-DMI), whereas subjective decision-making impairment (S-DMI) was assessed with item 9 of the Beck Depression Inventory (BDI).

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The investigators also collected several different patient data, including psychiatric history, medication adherence (Medication Adherence Rating Scale), childhood trauma (Childhood Trauma Questionnaire), physical and psychological pain (11-point numerical rating scale), and negative life experiences (12-item yes/no questionnaire).

According to responses to item 9 of the BDI, approximately 46.8% of patients and 65.1% of patients had O-DMI and S-DMI, respectively. There was a discrepancy between the O-DMI and S-DMI in 49.5% of patients. Approximately 68.5% had a positive discrepancy, in that the S-DMI without the O-DMI underestimated their decision-making capabilities. Additionally, 31.4% had a negative discrepancy, in that the O-DMI in absence of the S-DMI overestimated the participants’ ability to make decisions. The investigators found no association between the S-DMI and O-DMI (P =.753).

Binary logistic regression analyses demonstrated that a predictor of O-DMI included the number of negative life events in the past 6 months (odds ratio [OR], 1.37; 95% CI, 1.06–1.7; P =.015). Predictors of S-DMI included self-reported depression severity (OR, 1.17; 95% CI, 1.04-1.32; P =.007) and medication adherence (OR, 0.65; 95% CI, 0.43–0.96; P =.034). Additionally, predictors of the type of discrepancy (positive vs negative) were medication adherence (OR, 2.23; 95% CI, 1.01–4.89; P =.045) and depression severity (OR, 0.74; 95% CI, 0.57–0.97; P =.029).

Limitations of the study were the recruitment of patients from a single center at time of hospitalization admission, its cross-sectional design, and the reliance on a single item to obtain the S-DMI variable.

The investigators concluded that their findings suggests that the elucidation of factors associated with “discrepancy between objective and subjective cognition may be useful to identify subjects who could be priority for neuropsychological assessment.”


Baeza-Velasco C, Guillaume S, Olié E, Alacreu-Crespo A, Cazals A, Courtet P. Decision-making in major depressive disorder: Subjective complaint, objective performance, and discrepancy between both. J Affect Disord. 2020;270:102-107.