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Error processing in major depressive disorder: a systematic review and meta-analysis of event-related potential

Kai-Jie Liang¹, Chun-Che Hung², Chia-Wen Ko³

¹Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology

|January 21, 2026

Abstract

Objective:

Alterations in error-related negativity (ERN) and error positivity (Pe)-electrophysiological markers of error processing-have been frequently reported in major depressive disorder (MDD); findings, however, remain inconsistent.

Methods:

Literature search was performed using Web of Science, MEDLINE/PubMed, and Scopus electronic databases. The effect sizes (Hedges' g) in the comparisons of ERN (22 studies) and Pe (10 studies) amplitudes between MDD and healthy controls (HC) were employed by a random-effect, inverse-variance weighted model.

Results:

ERN and Pe amplitudes in MDD patients were generally comparable to those of HC. Nevertheless, moderator analyses revealed specific conditions under which Pe amplitudes were reduced in MDD. Specifically, MDD patients with comorbid conditions showed diminished Pe amplitudes relative to HC (p = 0.001). Moreover, task type moderated Pe responses: studies using the Flanker task reported significantly reduced Pe amplitudes in MDD patients (p = 0.012), a pattern not observed with other paradigms. No significant moderators were identified for ERN amplitudes.

Conclusions:

Comorbidity and task design, particularly the use of the Flanker task, appear to influence Pe amplitudes in patients with MDD and should be carefully considered in future research.

Significance:

Our data highlight the importance of methodological factors in interpreting error processing deficits in MDD.

Keywords:

Error positivity (Pe)Error processing Error-related negativity (ERN)Flanker task Major depressive disorder Meta-analysis

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