Exploring metacognition: a systematic review of measures of metacognition and a systematic review and meta-analysis of functioning and symptom correlates of metacognition across adult mental health
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Date
24/11/2021Item status
Restricted AccessEmbargo end date
24/11/2022Author
Freeman, Elizabeth Lois
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Abstract
Background: The last decade has seen significant growth in research that explores
metacognition and its facets within the field of psychiatric disorders. A substantive body of
research supports a link between reduced metacognitive capacity and psychological distress
across the diagnostic spectrum. As our understanding of the role of metacognition in the
maintenance of psychological distress grows, the assessment of metacognitive capacity is
increasingly important within research and clinical settings. Emerging psychotherapeutic
approaches theorise increased metacognitive capacity to be central to the mechanism of
change. This creates additional need for reliable, valid and robust measurement tools to
establish metacognitive capacity and track change. Despite this need we see variance in the
conceptualisation of metacogntion which is mimicked in the instruments of measurement,
covering a spectrum view from discreetly defined skills to integrated processes and sub-domains. Current research explores the associations between these conceptualisations of
metacognition and functioning and symptom correlates. These associations were initially
reported to cluster around populations with experience of psychosis but have latterly
expanded to those with non-psychotic disorders. This suggests that metacognitive capacity
can be viewed as an underlying mechanism of psychological distress.
Objectives: A systematic review of measures of metacognition synthesised data on published
measures of metacognition applicable for use in an adult mental health population. The
methodological quality of each included study and the psychometric properties reported
were critically appraised with comment on measure accessibility and generalisability.
A systematic review and meta-analysis synthesised extensive data from studies on
metacognition and its correlates. Using sub-group analyses to explore the associations
between functioning, symptom and demographic variables and metacognitive capacity across
the diagnostic spectrum drawing samples from clinical and non-clinical populations.
Methods: The systematic review protocols for both studies were registered on the
International Prospective Register of Systematic Reviews (PROSPERO) prior to formal
screening. Eligibility criteria was establish a priori, and both systematic database searches
were performed in accordance with the Preferred Reported Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines.
For the first systematic review the methodological quality of each included study was
assessed using the COnsensus-based Standards for the Selection of health Measurement
Instruments (COSMIN) checklist.
For the second systematic review and meta-analysis Pearson’s correlation was selected as the
common effect size metric and data were analysed using the Metafor package in R. A random
effects model was applied with separate meta-analyses for each correlate and sub-group
analysis by clinical population.
Results: Database searching produced 254 units of identified data, 11 papers met criteria for
inclusion and these reported on seven different measures of metacogntion. The psychometric
properties of the measures reviewed showed inconsistency in the properties reported and
acceptability judgements. Concept inconsistency was also evident. The Metacognitive Self-Assessment Scale (MSAS; Pedone et al., 2017) was rated to have the highest methodological
quality.
Database searching for the second study produced 626 units of identified data, 30 papers met
criteria for inclusion. The pooled sample across all included studies represented 2,360
participants. Meta-analytic findings showed general functioning to be significantly negatively
associated with metacognition transdiagnostically. Sub-group analysis revealed this effect to
be strongest amongst samples with experience of psychosis and weakest in non-clinical
samples. Social functioning also showed a moderate effect size, transdiagnostically. Sub-group analysis revealed this effect to be strongest amongst clinical samples without
experience of psychosis. All symptom variables were shown to be significantly negatively
associated with metacognition.
Conclusions: The systematic review on measures of metacognition highlights the need for
more consistent and robust evaluation of the psychometric properties of metacognitive
measures. This synthesis provides those selecting a measure of metacognition with
comparative data on methodological quality and psychometric properties as well as guidance
on accessibility and generalisability. We highlight the importance of considering the purpose
of the measure (discriminative, predictive, evaluative) and the characteristics of the
instrument (number of items, accessibility, interpretation options) specific to the scenario of
use, in addition to psychometric properties, when selecting a measure of metacognition.
Study limitations were presented.
The systematic review and meta-analysis of functioning and symptom correlates brings new
depth and clarity to our understanding of metacognitive capacity and its associations across
different adult mental health populations. This work supports previous literature that
suggests metacognition should be considered transdiagnostically, and therefore designates it
as underlying symptom phenomenology. Study limitations were presented.