Executive Function Impairment in Depression? – estimating the Role of Socioeconomic Influences Through Mixed-model Meta-analyses

Abstract Previous research syntheses have found cognitive impairment in depression—even in the remitted stage. Open questions pertain to the influence of socioeconomic status (SES) differences and to the role of aging. Our research synthesis focuses on executive function (EF) impairment and investigates the extent of EF impairment in younger individuals (adolescents, young adults) diagnosed with depression, and whether family SES exerts an influence. Literature searches in bibliographic databases (MedLine/Ovid and WoS up to April 2025) yielded k = 93 observed effects (k = 30 pertaining to inhibitory control [IC], k = 30 to working memory [WM], and k = 33 to cognitive flexibility [FL]) from 58 case–control studies. We used random-effects models and tested the moderator effects of adjustment for indicators of family SES through mixed-effects models (PROSPERO: CRD420251024704). The overall weighted mean effect sizes (Hedges’ g) were: -0.35 (CI95%: -0.48, -0.22), -0.56 (CI95%: -0.73, -0.40), -0.24 (CI95%:-0.45, -0.03) for IC, WM, and FL, respectively. The moderator effect of adjustment for family SES was significant for IC (p = .026) and WM (p = .003). Within the subsample of studies that adjusted for SES differences, mean effects were small (IC: -0.22 [CI95%: -0.37, -0.082] k = 10, WM: -0.28 [CI95%: -0.48, -0.08] k = 8) and not heterogenous (i.e. Cochran’s Q test was not significant). Relative to healthy individuals, adolescents and young adults with depression primarily show WM problems. However, relative to healthy individuals with a comparable family SES background, they do not show substantial EF impairment.