Current Evidence and Theories in Understanding the Relationship between Cognition and Depression in Childhood and Adolescence: A Narrative Review

Abstract

The present narrative review has covered the current evidence regarding the role of cognitive impairments during the early phase of major depressive disorder (MDD), attempting to describe the cognitive features in childhood, adolescence and in at-risk individuals. These issues were analyzed considering the trait, scar and state hypotheses of MDD by examining the cold and hot dimensions, the latter explained in relation to the current psychological theoretical models of MDD. This search was performed on several electronic databases up to August 2022. Although the present review is the first to have analyzed both cold and hot cognitive impairments considering the trait, scar and state hypotheses, we found that current evidence did not allow to exclusively confirm the validity of one specific hypothesis since several equivocal and discordant results have been proposed in childhood and adolescence samples. Further studies are needed to better characterize possible cognitive dysfunctions assessing more systematically the impairments of cold, hot and social cognition domains and their possible interaction in a developmental perspective. An increased knowledge on these topics will improve the definition of clinical endophenotypes of enhanced risk to progression to MDD and, to hypothesize preventive and therapeutic strategies to reduce negative influences on psychosocial functioning and well-being.

Keywords: adolescent; at-risk subjects; cognitive functions; cognitive vulnerability; cold cognition; depression; early detection; hot cognition; staging model.

Figure 1

A possible model of cognitive impairments in major depressive disorder (MDD) according to trait, scar and state hypotheses. The central rectangle (dots lines) describes a model of possible interaction between cold and hot cognitive domains during an acute depressive episode: (1) triggered by stressful and/or negative events, cold cognitive impairments (mainly of the executive functioning) could activate cognitive biases and maladaptive schemata; (2) when an acute depressive episode occurs, depressive symptoms exacerbate cognitive impairments by turning and incorporating cold cognitive deficits into the expression and maintenance of hot cognitive biases; (3) the depletion of cognitive resources allocated to everyday functioning are further depleted by cognitive biases and maladaptive emotion regulation (i.e., ruminations) prolonging the depressive mood state further contributing to broader cognitive deficits across several cold domains; (4) during the remission phase of a depressive episode, persistent cold cognitive impairments (mainly in executive functioning) act as trait or scar-like impairments leading to a recurrence of the depressive cycle, especially when stressing mediators (personal internal/external factors) restart hot cognitive disturbances (i.e., maladaptive schemata and ruminations). The model is adapted from Allot et al., 2016 [60] and Ahern et al., 2019 [38].