Cardiac perception and self-reported interoception in common mental health disorders: A systematic review and meta-analysis

Atypical interoception may represent a transdiagnostic marker for mental health difficulties. Reviews to date exploring the relationships between interoception and mental health have presented mixed findings, with a narrow focus on cardiac measures of interoception. We conducted a systematic review and meta-analysis of studies that measured the association of cardiac perception and self-reported interoception with common mental health disorders, including anxiety, depression, schizophrenia, bipolar disorder, and obsessive-compulsive disorder, in clinical and non-clinical samples of adults. A total of 206 effect sizes from 57 articles (total N = 6,652) were eligible for inclusion in random effects meta-analyses. Overall, pooled associations showed no significant association of mental health difficulties with performance on the Heartbeat Counting Task ( r = -.042), but a significant, negative association with Heart Rate Discrimination Task performance ( r = -.137). Problems in adaptive interoceptive attention ( r = -.183) but not sensing ( r =.136), or interpretation ( r = -.117), were associated with worse mental health symptomology, as was greater maladaptive interoceptive attention ( r =.381). Moderator analyses showed that the size of the effect often varied between different mental health disorders, and there was some evidence of overly influential effect sizes as well as wide 95% prediction intervals. Our findings highlight the importance of methodological choices and potential differences between different performance-based tasks of cardiac interoception and different self-reported interoceptive dimensions. Our results show some support for interoception as a transdiagnostic marker for mental health difficulties that can support the development of evidence-based interventions.