Metacognition and Mentalization in Patients with Major Depressive Disorder

Abstract

Social cognition is necessary to comprehend and interpret the behavioural intentions of oneself and others in social contexts. Despite an increasing understanding of social cognition deficits in mental illness, the relationship between Major Depressive Disorder (MDD) and high-order social cognition deficits (i.e., mentalization and metacognition) remains under-investigated. This paper aims to provide a holistic review of the existing empirical evidence on mentalization and metacognition in patients with MDD and suggest areas in need of further research. While a close relationship between MDD and metacognition has been consistently reported, some disagreement was raised regarding the association between mentalization capacity and MDD. Besides, the direction of the association between MDD, mentalization and metacognition was also underlined by studies examining the outcomes of high-order social cognition therapies. Mentalization and metacognition were both found to be predictors or at least moderators, of MDD diagnosis and symptom severity. Future evidence from developmental and neuroimaging studies may provide valuable insights into the field of study by uncovering the varying degrees of the impact caused by social cognition deficits and their associated neural mechanisms.