Anxiety/stress symptoms uniquely predict greater negative global metacognitive bias in post-9/11 veterans

Objective: Negative metacognitive bias, underestimating one’s abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and PTSD with metacognitive bias in post-9/11 veterans. Methods: Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N=601; 90% male; M_age=34.31) completed DASS-21 (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, attention). Bias was computed as self-report minus objective cognition. A subsample (n=239) repeated testing ~2 years later. Results: At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r=−.41), depressive (r=−.37), and PTSD symptoms (r=−.31) (all ps<.001). In a simultaneous model, anxiety/stress (β=−.29 p<.001) and depressive symptoms (β=−.12, p=.045) explained unique variance, though PTSD symptoms did not (β=−.03, p=.524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β=−.33, p<.001) and PTSD (β=−.16, p=.001), but not depression (β=−.10, p=.137). Conclusions: Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report vs. objective cognition gap, and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.