The relationship between subjective cognitive complaints and objective cognitive assessment in severe mental...

The study aims to examine the relationship between subjective cognitive complaints (SCC) and objective cognitive performance (OCP) in severe mental disorders, including schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD).

Systematic literature searches were conducted using Web of Science and PubMed, including articles published until September 2025. Studies were included if they assessed both SCC and OCP using validated instruments in individuals diagnosed with SCZ, BD, or MDD and were peer-reviewed English research articles. A series of meta-analyses was conducted using random-effects models to examine the associations between SCC and composite OCP scores, as well as the subdomains of objective cognition. Analyses were repeated for each diagnosis.

The sample included 49 articles with 5,007 participants. Our analyses yielded a small but statistically significant correlation between SCC and global OCP (r = -0.145). Domain-wise associations indicated correlations between SCC and OCPs in processing speed, attention/vigilance, working memory, and verbal learning/memory (correlation coefficients ranged from -0.107 to -0.172). In diagnosis-specific analyses, individuals with SCZ showed significant associations in all domains except executive function. In contrast, the associations were restricted to only a few cognitive domains in other disorders, specifically processing speed and working memory in BD, and processing speed and attention/vigilance in MDD.

Although significant, the strength of these associations was small, suggesting that SCC explains only a limited proportion of the variance in OCP. This suggests that while SCC cannot substitute for objective testing, it provides complementary information that reflects patients' experiences of cognitive dysfunction.