Abstract
Background: Patients with major depressive disorder (MDD) have various theory of mind (ToM) impairments which often predict a poor outcome. However, findings on ToM deficits in MDD are inconsistent and suggest the role of moderating factors. Child abuse and neglect are strong predictors of adult MDD and are often associated with a poorer clinical course trajectory. Objective: Because early-life adversities result in various forms of ToM deficits in clinical and nonclinical samples, our aim was to investigate if they are significant confounding factors of ToM impairments in MDD. Methods: We investigated 60 mildly or moderately depressed, nonpsychotic adult patients with MDD during an acute episode, and 32 matched healthy controls. The mental state decoding subdomain of ToM was examined with the Reading the Mind in the Eyes Test (RMET). Childhood adversities were assessed with the childhood trauma questionnaire (CTQ) and the early trauma inventory. Results: There was no difference between the control and MDD groups in RMET performance. However, when we divided the MDD group into two subgroups, one (N = 30) with high and the other (N = 30) with low levels of childhood adversities, a significant difference emerged between the controls and the highly maltreated MDD subgroup in RMET performance. A series of 3 (group) × 3 (valence) mixed-model analyses of covariance (ANCOVAs) revealed that childhood emotional and physical neglect had a significant negative impact on the response accuracy in RMET in general, whereas emotional abuse specifically interfered with the accuracy in the positive and negative valences if it co-occurred with early-life neglect. To test the dose-response relationship between the number of childhood adversities and RMET capacities, we subjected RMET data of the MDD group to multiple hierarchical regressions: the number of childhood adversities was a significant predictor of RMET total scores and RMET scores in the negative valence after controlling for age, sex, years of education, and the severity of current depression. Conclusion: Childhood adversities impair ToM capacities in MDD. Exposure to early-life emotional abuse and neglect have a negative impact on the performance in the emotional valences of RMET. Multiple early-life adversities have a dose-dependent association with mental state decoding deficits.
Highlights
Patients with major depressive disorder (MDD) have various impairments in social functioning, e.g., withdrawal from social interactions, impaired social competence, negative interpersonal experiences, as well as less enjoyment in social relations [1]
We examined the mental state decoding (RMET) capacities in patients with acute, nonpsychotic MDD and in healthy, never-depressed, population controls
To characterize the effect of childhood adversities further, we evaluated the effect of physical, emotional, sexual abuse, and neglect on the response accuracy across the various RMET valences
Summary
Patients with major depressive disorder (MDD) have various impairments in social functioning, e.g., withdrawal from social interactions, impaired social competence, negative interpersonal experiences, as well as less enjoyment in social relations [1]. Theory of mind (ToM) is one of the essential components of social cognition: the ability to infer the mental states of others by representing their beliefs, intentions, desires, and fears. ToM is the capacity to attribute mental states (i.e., beliefs, desires) to self and other people, and to understand and predict their behaviors, intentions, and wishes [3]. The findings are inconsistent, numerous studies detected that patients with MDD have ToM impairments. A recent meta-analysis aggregating 18 clinical studies demonstrated that patients with MDD significantly underperformed healthy controls in different types of ToM tasks [4]. Patients with major depressive disorder (MDD) have various theory of mind (ToM) impairments which often predict a poor outcome. Findings on ToM deficits in MDD are inconsistent and suggest the role of moderating factors. Child abuse and neglect are strong predictors of adult MDD and are often associated with a poorer clinical course trajectory
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