Domain specificity and magnitude of cognitive-psychosocial associations in major depressive disorder: A systematic review and meta-analytic approach with multilevel sensitivity analyses

Cognitive deficits are a common and persistent feature of major depressive disorder (MDD) and likely account for impaired psychosocial functioning. However, the magnitude, domain specificity, and prospective relevance of the cognitive-psychosocial association remain unclear. This pre-registered systematic review and meta-analysis examined these associations and potential moderators. Six databases were searched for studies assessing cognitive-psychosocial associations in MDD up to February 2026. Effect sizes were synthesised per domain using inverse-variance weighted random-effects meta-analysis. Moderator and sensitivity analyses explored demographic, clinical, and methodological influences including multilevel sensitivity analyses to test robustness to within-study dependence. Forty-nine independent studies were included, with 383 effect sizes meta-analysed across 37 studies (N = 6,991 participants) assessing contemporaneous cognitive-psychosocial associations. Associations were domain-specific and typically small-to-moderate in magnitude, with processing speed, attention, verbal learning and memory, shifting, and global cognition significantly related to multiple psychosocial domains. Demographic and clinical factors such as depressive symptom severity had minimal influence on effects. Nonetheless, over half of the cognitive-psychosocial associations were non-significant with little evidence that work function was associated with any cognitive domain. Findings were robust in sensitivity analyses incorporating multilevel modelling. Limited prospective data were available but suggested that psychosocial function could be predicted by visual/verbal memory and shifting. Cognitive-psychosocial associations are modest, domain-specific, and largely not explained by demographic or clinical moderators. Cognitive assessment in treatment planning is important to map pathways for functioning, but prospective research is needed to clarify how cognition contributes to functional recovery and how it fits within broader mechanistic pathways to inform targeted treatment strategies.