Selective attention in adults with major depressive disorder: A systematic review and meta-analysis of task-specific differences and negative bias

Several studies report that adults with Major Depressive Disorder (MDD) present with a negative attentional bias compared to individuals without a history of MDD. We conducted a systematic review and meta-analysis to: evaluate the hypothesis that selective attention differs in adults with MDD; determine whether this difference consists of a negative attentional bias (e.g., paying more attention to negative stimuli); and assess whether it is more severe with more severe MDD. Following PRISMA guidelines, we conducted a literature search of MEDLINE, PsycINFO, and EMBASE from inception through April 11, 2025, supplemented by manual searches, to identify published peer-reviewed manuscripts in English, French, or Korean comparing measures of selective attention in adults with MDD and non-psychiatric controls (HC). Results were synthesized narratively, and measures of selective attention in studies that used some versions of the Stroop task, or the dot-probe task were extracted and meta-analyzed. Of the 87 included studies, 73 (83.9%) showed a difference in selective attention (with 40 of 54 74.1% showing a negative bias) in adults with MDD compared to HC. Qualitatively, attention was impaired in the MDD group compared to HCs with all tasks. However, a significant difference in attention and negative bias was observed only with the dot-probe task in quantitative synthesis. Given the small number of relevant studies, power to identify moderators was limited. Age significantly moderated negative attentional bias for the dot-probe task, which increased with age. Future larger, higher-powered studies are needed to confirm selective attention differences in MDD and identify additional moderators.