Decision-Making Difficulty in Major Depression: Understanding Indecisiveness and the Role of Expected Affect
Date of Award
Doctor of Philosophy (PhD)
Decision-making difficulty is a prevalent symptom among individuals with major depressive disorder (MDD). Decision-making difficulty has been found to be pervasive across different areas of decision-making in current MDD; however, its exact nature for some areas (e.g., indecisiveness) is not well characterized, and the extent to which it is a scar of MDD is not determined. Furthermore, affective disturbances (e.g., in expected affect) have been theorized to contribute to decision-making difficulty in MDD, but empirical studies are needed to test this theory. In my two-study dissertation on depression, Study 1 focused on the dimensionality and validity of indecisiveness, and Study 2 focused on the link between disturbances in expected affect and decision-making difficulty. In Study 1, I administered self-report questionnaires of indecisiveness and of depression and a behavioral task of indecision to an online sample of adults (n = 602). I found evidence of a two-factor model corresponding to indecisiveness and decision-making confidence; indecisiveness was strongly positively associated with depressive symptoms and with situational indecision. In Study 2, I used ecological momentary assessment (EMA) to evaluate expected affect for the outcomes of anticipated decisions and subsequent decision-making difficulty for these decisions (i.e., whether anticipated decisions were made) in the daily lives of people with current depression (n = 48), people with remitted depression (n = 80), and healthy controls (n = 87). I found that higher expected negative affect characterized the current depressed group, although there were no group differences in decision-making difficulty or in the association between expected affect and decision-making difficulty. Findings from both studies refine our understanding of decision-making difficulty in MDD, highlighting the importance of indecisiveness as an area of decision-making difficulty (Study 1) and highlighting the possibility that anticipated decisions in daily life are not associated with decision-making difficulty (Study 2). In terms of affective disturbances, heightened negative affect surfaced in both studies as part of the decision-making process and would be worthwhile to target in future research on factors that contribute to decision-making difficulty. Furthermore, findings from both studies inform the design of future studies, shedding light on how the assessment of indecisiveness can be improved (i.e., by excluding items related to decision-making confidence; Study 1) and on how EMA studies can more strongly elicit decision-making difficulty as well as assess for potentially important moderators to help elucidate the complexity of decision-making in daily life (Study 2). Although decision-making difficulty in MDD was not reflected in making daily decisions, addressing other aspects of indecisiveness (e.g., longer decision-making times) in the context of existing treatments for MDD may help to alleviate symptoms and enhance overall quality of life and functioning for depressed individuals.
Chair and Committee
Renee J. Thompson
Deanna M. Barch, Thomas L. Rodebaugh, Amitai Shenhav, Michael J. Strube,
Hallenbeck, Haijing Wu, "Decision-Making Difficulty in Major Depression: Understanding Indecisiveness and the Role of Expected Affect" (2020). Arts & Sciences Electronic Theses and Dissertations. 2321.