Flowers for Algernon: How metacognition affects quality of life in schizophrenia. Structural equation modeling with...

We examined the association between metacognitive performance, functioning, and quality of life (QoL) in schizophrenia using structural equation model analyses.

A sample of 249 participants was assessed for symptoms, functioning, QoL, and both objective and subjective cognitive performance. Metacognitive performance was defined as the adequation between objective and subjective measures of cognitive performance.

Our model showed an excellent fit (CFI = 0.981; RMSEA = 0.014-0.081) and explained 53.3 % of the variance in functioning and 50.3 % in QoL. Metacognitive performance was not significantly associated with functioning but showed a negative association with QoL (β = -0.383, p < 0.001). Thus, a greater underestimation of one's cognitive abilities was linked with lower QoL, potentially reflecting heightened awareness of deficits that affect well-being. Depression, also negatively associated with QoL (β = -0.359, p < 0.001), was linked to the underestimation of cognitive abilities, whereas symptom severity was associated with their overestimation (β = -0.296, p < 0.001). Complementary analyses suggest that the subjective cognition model closely mirrors that of metacognitive performance, questioning the distinctiveness of metacognition as an explanatory factor in schizophrenia outcomes.

Our findings imply that interventions that boost confidence in cognitive abilities, such as cognitive remediation, may improve QoL. Future research should investigate the causal pathways between these factors and explore the role of social cognition, often impaired in schizophrenia, as another mediator. Comprehensive treatment that addresses clinical symptoms, depression, and subjective cognition challenges appear essential to improve outcomes in schizophrenia.