The association between depressive symptoms and cardiac interoceptive accuracy: A systematic review and meta-analysis

The relationship between cardiac interoception and mental illness, including depression, has attracted significant interest among neurocognitive scientists. The Interoceptive Bayesian Inference Model predicts that interoception is associated with depression; however, clinical studies have yielded inconsistent findings. This meta-analysis aims to confirm the association between depressive symptoms and objectively measured cardiac interoceptive accuracy (IAcc), and to evaluate whether potential moderators influence this relationship.

According to the PRISMA guidelines, we identified relevant studies through PubMed, Web of Science, and Scopus databases as of April 2024. Using R version 4.3.0, we conducted a meta-analysis to quantitatively synthesize the association between depressive symptoms and cardiac IAcc, as assessed by the heartbeat counting tasks (HCT) and the heartbeat discrimination tasks (HDT), and further performed a moderator analysis.

We found a small but significant negative correlation (k = 44 studies, r = -0.10, p < .001) between depressive symptoms and cardiac IAcc in the HCT, but neither in the HDT. There was low-moderate heterogeneity (Q = 60.04, p = .044, I² = 28.4%), indicating subtle variation among HCT studies, with none of the potential moderators identified to influence this negative relationship.

These findings may help uncover the disagreement about the effect size and direction of the association between depressive symptoms and cardiac interoception, and have potential implications for the treatment of depression.