Self-report Assessment of Metacognition Among Schizophrenia Patients: A Systematic Review

Metacognition is the ability to reflect on and regulate one's own cognitive processes. It is increasingly recognized as a critical factor in schizophrenia, influencing insight, treatment adherence, and functional outcomes. Self-report tools are widely used to assess metacognition, but their reliability, validity, and clinical applicability remain debated.

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with International Prospective Register of Systematic Reviews (PROSPERO). A total of five electronic databases (PubMed, PsycINFO, Embase, Web of Science, and Scopus) were searched for studies published between 2014 and 2024. Eligibility was defined by the Population, Intervention, Comparison, Design (PICO-D) framework, focusing on adults with schizophrenia or schizoaffective disorder assessed with self-report metacognition measures. Study quality was appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. Of 2,437 records screened, 36 studies were included. Data were narratively synthesized, with statistical properties such as internal consistency (Cronbach's α), test-retest reliability, and factor structures summarized. Most tools, including the Beck Cognitive Insight Scale (BCIS), Metacognition Assessment Scale (MAS), and Metacognitions Questionnaire (MCQ-30), demonstrated high internal consistency (α = 0.70-0.95) and satisfactory construct validity. Findings consistently linked metacognitive deficits to greater symptom severity, poor social functioning, and reduced treatment response, while higher self-reflection and cognitive flexibility predicted improved clinical and vocational outcomes. However, limitations included reliance on self-report accuracy, limited longitudinal validation, and inadequate cross-cultural adaptation.

Self-report measures of metacognition in schizophrenia exhibit strong psychometric support and clear clinical utility for diagnosis, symptom monitoring, and rehabilitation planning.