Cooperation patterns in depression: Insights from a meta-analysis of responsive and expressive social interactive...

The use of high-ecological validity social interactive paradigms to study social impairments in depression has burgeoned in recent 10 years. However, abnormal social behaviors in depression have exhibited substantial yet unexplained variations, ranging from reduced to increased cooperation. We proposed an attentional focus theory and introduced a novel classification of social interactive paradigms, distinguishing between responsive (attentional focus on others) and expressive (attentional focus on self) paradigms. This framework systematically elucidates the underlying reasons for reduced and increased cooperation in depression. Depression encompasses current depressive episodes, remitted depression, and subclinical depressive symptoms in undiagnosed individuals. We systematically searched Web of Science, PsycInfo, and PubMed and performed a three-level meta-analysis on 44 studies with 71 effect sizes. We found an overall significant negative association between depression and cooperation, and a significant moderation effect of the responsive versus expressive category. Depression was negatively associated with cooperation in responsive paradigms overall and in each individual responsive paradigm (Cyberball game, responder-role Ultimatum Game, Prisoner's Dilemma, and investor-role Trust Game). Depression was positively associated with cooperation in expressive paradigms overall and in the trustee-role Trust Game, and a trend of positive association in allocation tasks. In our multiple-moderator analysis, while controlling for other significant single moderators, the responsive versus expressive category remained significant, explaining 66.32 % of the total variations in effect sizes. Our study completed the half-missing landscape of social dysfunctions in social interactive paradigms in depression, which may help practitioners develop different social rehabilitation strategies tailored to responsive and expressive social scenarios.