Social Cognition Linked to Negative Outcome in Schizophrenia Spectrum Disorders

Investigators examined the factor structure of social cognition in individuals with schizophrenia spectrum disorders and healthy control.

A 2-factor model for evaluating social cognition in patients with schizophrenia spectrum disorders was effective in determining a significant association between mentalizing factors, negative symptoms, and functional regression, according to a study published in Schizophrenia Bulletin.

This study sought to delineate the components, or factor structure, of social cognition in people with schizophrenia spectrum disorders as well as in healthy controls using a range of social cognitive tasks.

The study included 164 people diagnosed with schizophrenia spectrum disorders and 102 healthy controls; those with schizophrenia spectrum disorders met criteria established in the Diagnostic and Statistical Manual of Mental Disorders-5 and had no change in antipsychotic medication regimens or functional support in the 30 days prior to study enrollment. Researchers assessed participants for clinical and functional outcome using the Brief Psychiatric Rating, Assessment of Negative Symptoms, Quality of Life, and Birchwood Social Functioning scales.

Researchers used structural equation modeling to test social cognitive models, specifically 2-factor and 1-factor models, and compare them to a higher-order (hierarchical) model of social cognition and neurocognition. The 2-factor model assessed participants for lower-level social cognition, or “simulation,” involving empathy and emotion recognition, in contrast to higher-level social cognition, or “mentalizing,” involving complex mental state recognition.

Study investigators tested measurement invariance between participants with schizophrenia spectrum disorders and controls, as well as invariance across genders based on evidence of different social cognitive processing in women vs men. The study further determined any relationships between social cognitive and neurocognitive task performance data and outcome measures.

Study results showed that a 2-factor model fit the observed social cognitive constructs in all participants significantly better than the 1-factor model. The 2-factor model further demonstrated adequate measurement invariance using a series of multi-group confirmatory factor analyses, including invariance across female and male participants. In both schizophrenia spectrum disorder and control groups, only mentalizing factors were significantly associated with negative symptoms and quality of life scores; simulation factors did not demonstrate a significant association with either. In mediation analyses, researchers found social cognition factors mediated the relationship between neurocognition and regression of clinical and functional outcomes.

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Limitations of the study included the lack of any measures of attributional style; score distributions suggested that task difficulty did not necessarily determine factor distinction, and use of the Scale of Assessment of Negative Symptoms may have conflated total scores, as negative symptoms were shown to have a multifactorial structure.

Using a 2-factor model to evaluate social cognition, people with schizophrenia spectrum disorders demonstrated lower simulation and mentalizing scores compared with healthy controls; however, only mentalizing factors were significantly linked to negative symptoms and functional outcome. This study demonstrated that the 2-factor model fit data from both groups very well, suggesting that both lower- and higher-social cognitive constructs exist in patients with schizophrenia spectrum disorders as well as in healthy individuals.


Oliver LD, Haltigan JD, Gold JM, et al. Lower- and higher-level social cognitive factors across individuals with schizophrenia spectrum disorders and healthy controls: relationship with neurocognition and functional outcome [published online August 10, 2018]. Schizophr Bull. doi: 10.1093/schbul/sby114