Effort-Based Decision-Making in Psychopathology: A transdiagnostic multilevel meta-analysis

Effort-based decision making (EBDM) is fundamental to human motivation. This cognitive process weighs the effort required to obtain a reward against the magnitude of the reward and the probability of obtaining it. Research suggests both transdiagnostic and disorder-specific patterns of maladaptive EBDM in people with schizophrenia spectrum (SSD) or major depressive disorders (MDD). However, a meta-analytical comparison of EBDM between SSD, MDD and controls is lacking. This pre-registered meta-analysis (CRD42022344605) aimed to quantify EBDM in SSD and MDD compared to healthy controls and to disentangle transdiagnostic from disorder-specific pathomechanisms. PubMed, PsychInfo, Embase and Web of Science were systematically searched for studies investigating EBDM in people with either SSD or MDD compared to healthy controls. Fifty studies providing 71 effect sizes were included (NSZ = 1,776, NMDD = 886, NHC = 1,848). Multilevel meta-analyses revealed significantly less willingness to exert effort in the combined clinical groups than in controls (k = 71, SMD = -0.32, 95%CI[-.40;-.24]), with larger effects in SSD (k = 48, SMD = -0.37, 95%CI[-.46;-.28]) than in MDD (k = 23, SMD = -0.21, 95%CI[-.33;-.80]). Meta-regression models revealed maladaptive effort allocation across increasing reward and probability conditions with similar patterns across clinical groups, yet more pronounced in SSD than in MDD, which was associated with anhedonia and cognitive impairments in both groups. The findings suggest a transdiagnostic maladaptive allocation of effort to increasing reward and probability. Anhedonia and cognitive impairment may differ between SSD and MDD, potentially reflecting disorder-specific pathomechanisms and explaining the more pronounced EBDM deficits in SSD.