Social cognition as a mediator between neurocognition and functional outcome in early course schizophrenia

Social cognition is an established mediator between neurocognition and functional outcome in schizophrenia, but there is limited evidence for this model specifically in the early course, which is a critical window for intervention to reduce long-term disability. This study aimed to test the social cognition mediator model in the early course of schizophrenia and identify social cognitive subdomains that may have stronger indirect effects on the relationship between neurocognition and functional outcome. This secondary analysis utilized baseline cognitive and functional outcome data from a cognitive remediation trial for outpatients with early course schizophrenia (N = 102). A path analysis approach was used to compute mediation of social cognition (mediator; composite index and subdomain scores) on the relationship between neurocognition (predictor; composite index) and functional outcome (outcome; composite index). Significant positive associations were observed between neurocognition, social cognition, and functional outcome. As previously observed, the mediation effect of the social cognition composite was significant (p = 0.042). Of the seven social cognitive subdomains, only social inference (p < 0.001) emerged as a significant mediator. Reverse mediation models (mediator; neurocognition) were non-significant. Results suggest that the impact of cognition on functional outcome in the early course occurs, in part, through the impact of neurocognition on social cognition, which subsequently influences functional outcome. In addition, social inference is possibly an important treatment target of functional recovery in the early course of the condition, highlighting a potential future research direction. These findings further support the provision of comprehensive cognitive remediation approaches to facilitate functional recovery.