Decision making in depression: differences in decisional conflict between healthy and depressed individuals

This study investigated differences in the emergence of decisional conflict in healthy and depressed participants. The two groups of interest were questioned about their experience of decisional conflict and ongoing thoughts and impressions during decision making. As predicted, depressed participants experienced more decisional conflict than healthy participants. Furthermore, the diverse processes hypothesis was supported: In healthy participants, preoccupation with the task was the only predictor of decisional conflict. In depressed participants, decisional conflict was predicted by a combination of depression‐related processes (e.g., low self‐efficacy, lack of concentration, rumination, etc.). This research reduces the gap between the relevance of the symptom of indecisiveness (e.g., for diagnostic purposes) and the lack of knowledge in this realm of psychopathology. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: Depressed inpatients report more every day decisional conflict than healthy people. Practitioners should be aware of this symptom of depression that has not received much attention in research and practice yet. Beyond this quantitative difference, there is also a qualitative difference between the decisional conflict experienced by depressed and healthy individuals: While healthy individuals' decisional conflict revolves around a thorough consideration of the decision task, depressed individuals' decisional conflict seems to be characterized by an inward focus of attention. They engage in an evaluation of their personal resources and competences as a decision maker. Improving self‐efficacy and reducing feelings of helplessness related to decision making should alleviate decisional conflict in depressed people. These means may thus constitute a powerful intervention to reduce every day stress for patients and enhance recovery from depression. This research highlights the detrimental effects of self‐focused thinking in depression. Decision making seems to be another task that is negatively affected by this type of depressogenic thinking. Interventions tackling depressive rumination appear beneficial in the light of this study.