The Mediating Effect of Social Cognition on Neurocognition and Community Functioning in Outpatients with Schizophrenia in Taiwan

Objectives: Patients with schizophrenia often suffer from a wide range of functional impairments. The underlying cognitive factors that cause functional impairments have been a focus of clinical research. We hypothesized that social cognition in outpatients with schizophrenia would mediate the relationship between neurocognition and community functioning. In this study, we intended to use structural equation modeling (SEM) to test the hypothesized mediation relationship. Methods: We recruited 52 patients with schizophrenia from a community psychiatric rehabilitation institute in Taiwan. Neurocognitive latent construct was established on the basis of the measures of processing speed, vigilance, working memory, reasoning, and problem-solving. Social cognitive latent construct was established on the measures of emotional perception, social perception, and theory of mind. Community functioning latent variable was established on the subscales of interpersonal communication, recreation, and occupation/employment of the Chinese version of the Social Functioning Scale. Results: According to the results of SEM, a mediation model was obtained by the analysis of sample data. The model showed that the relationship between neurocognition and community functioning was fully mediated by social cognition. The model explained 55% of variance in community functioning. Conclusion: This study identified important cognitive components of neurocognition and social cognition associated with community functioning in outpatients with schizophrenia. Implications for the therapeutic targets and intervening steps of the cognitive rehabilitation to improve community functioning in schizophrenia are discussed and suggested.