Impaired cognitive inhibition in schizophrenia: a meta-analysis of the Stroop interference effect

Schizophrenia has been consistently shown to be associated with impairment in executive functioning. However, although frequently treated as such, the term executive functioning does not refer to a unitary cognitive function; it rather represents a set of basic, lower-level cognitive sub-components, e.g. updating, shifting, and cognitive inhibition. This specification into sub-components allows for a further differentiation of the executive deficits found in schizophrenia. Focusing on the sub-component of cognitive inhibition, we here present a meta-analysis of interference effect as assessed with the Stroop Color-Word Interference paradigm. Including the results of 36 studies with 1081 schizophrenia patients and 1026 healthy control subjects, it was shown that schizophrenia patients exhibit an increased Stroop interference effect both in response time (mean effect size: M(g) = 0.43; 95% confidence interval, CI95%: 0.35-0.52) and accuracy (M(g) = 0.62; CI95%: 0.47-0.77) measures of interference. However, a meta-regression analysis revealed that the size of the effect varies depending on the version of the Stroop paradigm used. Regarding the response time measures of interference, studies using the classical card version of the paradigm showed a significantly larger effect size than studies using a single-trial computerized version of the paradigm (M(g) = 0.60 vs. M(g) = 0.19). Despite of the dissociation between the two versions of the paradigm, the results of the present meta-analysis indicate that the reported global deficits in executive functioning found to be associated with schizophrenia are at least partly due to a reduced ability of cognitive inhibition.