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| 住院青年抑郁症患者元认知能力及其与临床症状的关系 |
| Impaired metacognitive abilities and their association with clinical symptoms in hospitalized youth with major depressive disorder |
| 投稿时间：2024-06-11 修订日期：2024-10-16 |
| DOI： |
| 中文关键词: 抑郁症 抑郁症状 元认知 元认知效率 |
| 英文关键词:Major Depressive Disorder Depressive symptom Metacognition Metacognitive efficiency |
| 基金项目:泸州科技局-西南医科大学联合项目(抑郁症目标导向-习惯学习系统异常及其神经机制,2019LZXNYDJ39)；西南医科大学校级科研项目(项目名称:rTMS治疗对抑郁障碍患者元认知及其监控决策作用的认知神经机制,项目编号:2022ZD004)；合江县人民医院-西南医科大学科技战略合作项目(项目名称:压力敏感性在青少年抑郁症患者自伤中的作用与生理机制,项目编号:2021HJXNYD16) |
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| 中文摘要: |
| 背景 元认知能力是对认知过程监督和调控的能力，在决策和行为调整中发挥重要作用。抑郁症（MDD）患者存在认知功能受损，但不同研究关于MDD患者元认知能力的结果不一致，且元认知能力与患者临床症状的关系仍不清楚。目的 探讨住院青年MDD患者元认知能力及其与抑郁和焦虑症状之间的关系，以期为MDD的临床干预提供新的视角。方法 选取2022年3月—2023年6月于西南医科大学附属医院精神科住院的、符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）抑郁症诊断标准的56例青年患者为研究对象（MDD组）。同期选取泸州市62名健康人为对照组。采用信心评估任务评估两组的元认知能力，指标包括信心偏差和元认知效率。采用贝克抑郁量表（BDI）和贝克焦虑量表（BAI）分别评定患者的抑郁和焦虑症状严重程度。采用Pearson相关分析考查患者元认知能力与临床症状的相关性。结果 MDD组BDI评分和BAI评分均高于对照组，差异均有统计学意义（t=-13.722、-9.674，P均<0.01）。在决策表现方面，MDD组和对照组决策准确率和决策反应时间比较，差异无统计学意义（t=-0.655、0.975，P均>0.05）。在元认知表现方面，MDD组总的信心、决策正确的信心及元认知效率均低于对照组，但在决策错误的信心低于对照组，差异均有统计学意义（t=3.044、2.769、3.667、2.836，P均<0.01）。对照组信心评估反应时间长于MDD组，差异有统计学意义（t=-2.561，P<0.05）。相关分析显示，MDD组的信心偏差（总的信心、决策正确的信心、决策错误的信心）与BDI评分均呈负相关（r=-0.310、-0.307、-0.298，P均<0.05）。MDD组的总的信心、决策正确的信心与BAI评分均呈负相关（r=-0.284、-0.280，P均<0.05），但决策错误的信心与BAI评分的相关性无统计学意义（r=-0.229，P>0.05）。MDD患者元认知效率与BDI评分和BAI评分均呈负相关（r=-0.269、-0.290，P均<0.05）。结论 MDD患者的元认知能力受损，其元认知能力与焦虑抑郁症状严重程度有关。 |
| 英文摘要: |
| Background Metacognitive ability, the capacity to monitor and regulate one's cognitive processes, is crucial for effective decision-making and behavioral adaptation. Previous research suggests that individuals with Major Depressive Disorder (MDD) experience impairments in cognitive and metacognitive abilities. However, these findings have been inconsistent across studies, and the exact relationship between metacognitive abilities and clinical symptoms remains uncertain. Objective This study aims to examine the metacognitive abilities of hospitalized youth with MDD and explore their relationship with depressive and anxiety symptoms. The goal is to provide new perspectives that could inform and improve clinical interventions for MDD. Methods This study included 56 youths with MDD who were hospitalized in the Psychiatry Department at the Affiliated Hospital of Southwest Medical University from March 2022 to June 2023 and met the diagnostic criteria for depression as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). These patients comprised the MDD group. Additionally, a control group of 62 healthy individuals from Luzhou, selected during the same period, was included for comparison.Metacognitive indicators, such as confidence bias and metacognitive efficiency, were assessed in both groups using a confidence evaluation task. The severity of depressive and anxiety symptoms was measured with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Pearson correlation analysis was utilized to examine the relationship between metacognitive abilities and clinical symptoms. Results Group comparisons indicated that the MDD group had significantly higher scores on the BDI and the BAI than the control group, with both differences attaining statistical significance（t=-13.722, -9.674, P<0.01）. There were no statistically significant differences in decision accuracy?and?decision?reaction times?between?patients?with MDD and healthy controls (t=-0.655, 0.975, P>0.05). In terms of metacognitive performance, the MDD group had lower overall confidence, confidence in correct decisions, and metacognitive efficiency than the control group but demonstrated lower confidence in incorrect decisions, with all differences being statistically significant (t=3.044, 2.7693.667, 2.836, P<0.01). The control group demonstrated significantly longer response times for confidence assessments than the MDD group, with this difference being statistically significant (t=-2.561, P<0.05).Correlational analysis reveals that within the MDD group, confidence?biase—comprising overall confidence, confidence in correct decisions, and confidence in incorrect decisions—negatively correlate with BDI scores (r=-0.310, -0.307, -0.298, all P<0.05). In MDD group, overall confidence and confidence in correct decisions are also negatively correlated with BAI scores (r=-0.284, -0.280, P<0.05). In contrast, the correlation between confidence in incorrect decisions and BAI scores is not statistically significant (r=-0.229, P>0.05). Additionally, metacognitive efficiency in patients shows negative correlations with both BDI and BAI scores (r=-0.269, -0.290, P<0.05).?Conclusion Patients with MDD have impaired metacognition, and the extent of this impairment was more pronounced as clinical symptoms worsen. |
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