Towards an integrative approach to understanding quality of life in schizophrenia: the role of neurocognition, social cognition, and psychopathology

Abstract The term “schizophrenia” refers to a debilitating group of disorders that usually results in a severely impaired quality of life (QoL). Symptomatology appears to have a substantial role in determining QoL, although the relationship between QoL and specific psychotic symptoms is still unclear and has demonstrated mixed results. Due to the intrinsic importance of social functioning in QoL, and the mediating effect of social cognition on social functioning, the aim of this study was to try to investigate QoL in schizophrenia, not only in terms of symptomatology, but also in consideration of potential neurocognitive and social cognitive contributing factors. Methods Twenty-eight clinically stable patients with schizophrenia performed a broad range of neurocognitive and social cognitive assessments, and also participated in a semi-structured interview of QoL, assessing four partially independent subdomains of QoL. A stepwise regression model was used to determine the best predictors of QoL, and additionally a mediator analysis was performed to test for the mediating power of social cognition on QoL. Results Negative symptoms, intelligence, executive functioning and social cognition all had some power in predicting QoL in schizophrenia. Though most interestingly, mental state reasoning was specifically found to be most strongly related with the Intrapsychic Foundation subdomain of QoL, whereas neurocognition and symptom severity were associated with other subdomains of QoL. Conclusions The association between mental state reasoning and the more “internal” aspects of QoL in schizophrenia may reflect a specific role for social cognition in introspective and subjective judgments of one's own QoL, whereas neurocognition and negative symptomatology may be more predictive of the external or extrinsic aspects of QoL. In conclusion, social cognitive skills appear to play a crucial role in the experience of one's own subjective well-being, which could help to explain previous inconsistencies in the literature investigating QoL in schizophrenia.