Lower- and Higher-Level Social Cognitive Factors Across Individuals With Schizophrenia Spectrum Disorders and Healthy Controls: Relationship With Neurocognition and Functional Outcome

Abstract

Background: Schizophrenia spectrum disorders (SSDs) often feature social cognitive deficits. However, little work has focused on the factor structure of social cognition, and results have been inconsistent in schizophrenia. This study aimed to elucidate the factor structure of social cognition across people with SSDs and healthy controls. It was hypothesized that a 2-factor model, including lower-level "simulation" and higher-level "mentalizing" factors, would demonstrate the best fit across participants.

Methods: Participants with SSDs (N = 164) and healthy controls (N = 102) completed social cognitive tasks ranging from emotion recognition to complex mental state inference, as well as clinical and functional outcome, and neurocognitive measures. Structural equation modeling was used to test social cognitive models, models of social cognition and neurocognition, measurement invariance between cases and controls, and relationships with outcome measures.

Results: A 2-factor (simulation and mentalizing) model fit the social cognitive data best across participants and showed adequate measurement invariance in both SSD and control groups. Patients showed lower simulation and mentalizing scores than controls, but only mentalizing was significantly associated with negative symptoms and functional outcome. Social cognition also mediated the relationship between neurocognition and both negative symptoms and functional outcome.

Conclusions: These results uniquely indicate that distinct lower- and higher-level aspects of social cognition exist across SSDs and healthy controls. Further, mentalizing may be particularly linked to negative symptoms and functional outcome. This informs future studies of the neural circuitry underlying social cognition and the development of targeted treatment options for improving functional outcome.

Keywords: emotion recognition; functional outcome; mentalizing; negative symptoms; neurocognition; schizophrenia; simulation; social cognition; theory of mind.

Fig. 1.

Factor structure and standardized loadings for the (a) two-factor and (b) one-factor models of social cognition, and the (c) higher-order model of social cognition and neurocognition. ER40, Penn Emotion Recognition Test; RMET, Reading the Mind in the Eyes Test; EA, Empathic Accuracy task; TASIT, The Awareness of Social Inference Test–Revised; SimSar, Simple Sarcasm; ParSar, Paradoxical Sarcasm; Sar, Sarcasm; TMT, Trail Making Test: Part A; BACS, Brief Assessment of Cognition in Schizophrenia: Symbol Coding; Fluency, Category Fluency: Animals; NAB, Neuropsychological Assessment Battery: Mazes; CPT, Continuous Performance Test: Identical Pairs; WMS, Wechsler Memory Scale; SS, Spatial Span; LNS, Letter-Number Span; HVLT, Hopkins Verbal Learning Test–Revised; BVMT, Brief Visuospatial Memory Test–Revised.

Fig. 2.

Mediation analyses. The association between neurocognition and (a) Birchwood Social Functioning Scale (BSFS), (b) Scale for the Assessment of Negative Symptoms (SANS), and (c) Quality of Life Scale (QLS) total scores, mediated by social cognition. The relationships between neurocognition and the outcome measures of interest reflect those once social cognition has been added as a mediator (values prior to this are reported in the “Results” section).