Anxiety/stress symptoms uniquely predict greater negative global metacognitive bias in post-9/11 veterans

Negative metacognitive bias, underestimating one's abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and posttraumatic stress disorder (PTSD) with metacognitive bias in post-9/11 veterans.

Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N = 601; 90% male; M age = 34.31) completed 21-item Depression, Anxiety, and Stress Scale (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, and attention). Bias was computed as self-report minus objective cognition. A subsample (n = 239) repeated testing ∼2 years later.

At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r = -.41), depressive (r = -.37), and PTSD symptoms (r = -.31) (all ps < .001). In a simultaneous model, anxiety/stress (β = -.29 p < .001) and depressive symptoms (β = -.12, p = .045) explained unique variance though PTSD symptoms did not (β = -.03, p = .524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β = -.33, p < .001) and PTSD (β = -.16, p = .001), but not depression (β = -.10, p = .137).

Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report versus objective cognition gap and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.