Negative Global Metacognitive Biases are Associated with Greater Depressive Symptoms and Covary with Symptom Changes over Time

AbstractObjective: We sought to better characterize global metacognitive sensitivity and bias in a Veteran sample. Methods: In the current study, we examined a sample of trauma-exposed post-9/11 Veterans (N = 467), across subjective cognitive functioning on the World Health Organization Disability Assessment Schedule II and objective functioning on a global battery of neuropsychological tasks including memory, attention, task-switching, verbal skills, and inhibition. Metacognitive health awareness scores were calculated using self-reported general health and an objective index of five cardiometabolic dimensions. Metacognitive sensitivity was calculated as a correlation between subjective and objective measures, while bias was calculated as a difference score between subjective and objective measures. Longitudinal analyses occurred in a reduced sample (N = 267) tracking changes in metacognition and clinical symptoms. Results: Metacognitive sensitivity was comparable between individuals with and without PTSD and depression diagnoses (r ~=.21-.30). However, metacognitive bias was significantly more negative in individuals with greater depressive symptoms independent of PTSD symptoms, such that Veterans with greater depressive consistently underestimated their cognitive abilities and health relative to healthy Veterans. Further, changes in metacognitive bias covaried with changes in depressive and PTSD symptoms two years later. Conclusions: Our results suggest specificity to negative metacognitive bias in Veterans with depressive symptoms independent of PTSD, though metacognitive sensitivity was relatively stable. Further, changes in metacognitive bias covary with changes in PTSD and depressive symptoms.