Systematic review and meta-analysis of the calibration of confidence judgments in individuals with schizophrenia spectrum disorders

Abstract

AbstractBackgroundMetacognitive deficits are well documented in schizophrenia spectrum disorders as a decreased capacity to adjust confidence to first-order performance in a cognitive task. Because metacognitive ability directly depends on first-order performance, observed metacognitive deficits might be driven by lower first-order performance. We aimed to determine the extent to which individuals with schizophrenia experience specific deficits when producing confidence judgments and examined whether studies controlling for first-order performance found metacognitive deficits of smaller magnitude.MethodElectronic databases were searched for studies published until April 24th2020. We conducted a Bayesian meta-analysis of 43 studies comparing the calibration of confidence in 1458 individuals with schizophrenia compared to 1337 matched controls. Group analyses and meta-regressions quantified how metacognitive deficits depended on task performance, cognitive domains, clinical severity, and antipsychotic dosage.OutcomesWe found a global metacognitive deficit in schizophrenia (g = -0.57, 95% CrI [-0.71, -0.43]), which was driven by studies which did not equate first-order performance between groups (g = -0.64, 95% CrI [-0.77, -0.51]), and inconclusive among controlled-studies (g = -0.28, 95% CrI [-0.63, 0.07], BF01= 1.3). Plus, the metacognitive deficit in non-controlled studies was correlated with first-order performance. No correlation was found between metacognitive deficit and clinical features of schizophrenia.InterpretationWe provide evidence for the existence of a deficit in the calibration of confidence judgments in schizophrenia, which is inflated due to non-equated first-order performance. Thus, efforts should be made to develop experimental protocols accounting for lower first-order performance in schizophrenia.