The relationship between self-reported interoception and depression: A systematic review and multilevel meta-analysis

Background: Emerging research highlights interoceptive dysfunction as a potential mechanism underlying depression. Whereas physiological measures of interoception (e.g., cardiac accuracy tasks) have shown inconsistent associations with depression, subjective self-report measures may provide greater insight. However, no previous meta-analysis has synthesised evidence on self-reported interoception and depression. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus and Web of Science identified 49 studies (N = 21,755) meeting our inclusion criteria. A three-level meta-analysis was conducted to account for nested effect sizes. Primary analyses focused on the Multidimensional Assessment of Interoceptive Awareness (MAIA), with secondary analyses including other self-report tools. Moderator analyses tested study design, depression and interoception measures, age, sex, and publication year. Study quality was evaluated using the AXIS tool. The review was preregistered on the OSF (https://osf.io/vq62p/?view_only=6fb11fb930194ebe9a67091154023fe0). Results: Self-reported interoception was significantly associated with depression as assessed using the MAIA and several other measures of interoception. Depression measure moderated the strength of association, as did study design (for the MAIA only), with larger effect sizes for between-group designs than within-group designs. Participant age, sex and publication year were not significant moderators in any analyses. Conclusions: Depression is reliably linked to self-reported interoceptive dysfunction, particularly in domains that involve the metacognitive evaluation and regulation of bodily states. Our findings reinforce the view of interoception as a multidimensional construct and identifies specific interoceptive capacities, such as trust in bodily signals, self-regulation, and not worrying, as promising targets for psychological interventions aimed at reducing depression.