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Social functioning and formal thought disorder in schizophrenia: A Bayesian meta-analysis
Clara Benedetta Caterina Soldovieri1, Dalia Elleuch2, Jessica Ahrens3
1School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Schizophrenia Research
|August 7, 2026
Summary
Formal thought disorder (FTD) negatively impacts social functioning in schizophrenia. Positive FTD shows a stronger association with poorer social functioning than negative FTD, suggesting a need for communication-focused interventions.
Area of Science:
- Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Formal thought disorder (FTD) significantly affects social functioning in schizophrenia.
- Existing research has not adequately distinguished between positive and negative FTD dimensions.
- These dimensions have unique developmental paths, underlying mechanisms, and treatment considerations.
Purpose of the Study:
- To investigate the distinct associations of positive and negative FTD dimensions with social functioning in individuals with schizophrenia.
- To update existing meta-analyses by employing stricter inclusion criteria and robust statistical methods.
Main Methods:
- A systematic literature review and meta-analysis were conducted, searching Scopus and PubMed for studies up to January 31, 2026.
- Bayesian random-effects meta-analyses were performed separately for positive FTD (24 studies, N=4072) and negative FTD (7 studies, N=1226).
- Study bias was evaluated using the Newcastle-Ottawa Scale, and publication bias was assessed using Bayesian methods. The protocol was pre-registered on OSF.
Main Results:
- Both positive and negative FTD dimensions were negatively associated with social functioning.
- Positive FTD exhibited a robust pooled effect size (r=-0.31) with strong statistical evidence.
- Negative FTD showed a smaller effect size (r=-0.21) with moderate evidence. High heterogeneity was observed across studies, unexplained by known moderators.
Conclusions:
- Both positive and negative FTD dimensions are linked to diminished social functioning in schizophrenia.
- Positive FTD demonstrates a stronger association with poorer social functioning, supported by a larger body of evidence.
- Interventions targeting communication deficits may be beneficial for individuals with positive FTD, addressing its impact on social interaction.
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