Cognitive discrepancy patterns and their association with psychosocial functioning across affective disorders

Introduction: Individuals with major depressive disorder (MDD) and bipolar disorder (BD) frequently exhibit a disagreement between self-reported and objectively measured cognitive performance. Research suggests that these cognitive discrepancies may vary across disorders and are not exclusive to a specific diagnosis, potentially being influenced by clinical and sociodemographic factors. Overestimating cognitive abilities is associated with better psychosocial functioning in depression, whereas heightened sensitivity to cognitive deficits correlates with worse functioning. However, these phenomena remain underexplored in both depression and bipolar disorder. Materials and methods: We conducted a cross-sectional study of 200 participants, including 160 patients in full or partial clinical remission (94 with MDD and 66 with BD) and 40 healthy controls. Sociodemographic, clinical, and functional variables were collected, along with both subjective and objective cognitive measures. We conducted a multivariate binary logistic regression to identify factors associated with cognitive discrepancy patterns (under- vs overestimation). Finally, a two-way ANOVA tested the interaction between diagnosis and cognitive discrepancy patterns on psychosocial functioning. Results: Patients with MDD tend to underestimate their cognitive abilities, while bipolar patients often overestimate theirs. Patients with higher depressive symptoms (B = −.045, p = .040) and higher intellectual level (B = −.241, p = < .001) report more subjective cognitive disturbances. Worse psychosocial functioning is not associated with underestimation but rather with the diagnosis itself (F = .63, p = .431), with bipolar disorder patients experiencing the most significant impact on daily functioning. Conclusions: Personalized cognitive assessments, integrating both objective and subjective measures, are of paramount importance to avoid generalizations and to accurately evaluate cognitive symptoms in patients with affective disorders.