Configurational patterns associated with psychiatric disability among patients with schizophrenia: A fuzzy-set...

Psychiatric disability in schizophrenia may reflect the combined effects of clinical symptoms, cognitive impairment, individual resources, and environmental support rather than the influence of a single risk factor. This study used fuzzy-set qualitative comparative analysis to identify configurations associated with higher and lower psychiatric disability states among patients with stable-phase schizophrenia. A cross-sectional study was conducted among 482 patients with stable-phase schizophrenia. Psychiatric disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Seven conditions were examined: negative symptoms, depressive symptoms, neurocognition, social cognition, psychological resilience, family functioning, and social support. Necessary condition analysis showed that no single condition reached the necessity consistency threshold. Sufficiency analysis identified five configurations associated with higher psychiatric disability and five configurations associated with lower psychiatric disability. For higher psychiatric disability, the overall solution consistency was 0.935 and coverage was 0.724; for lower psychiatric disability, the overall solution consistency was 0.932 and coverage was 0.695. Low social cognitive functioning appeared in all higher-disability configurations, whereas the absence of negative symptoms and the presence of social cognitive ability appeared in all lower-disability configurations. These findings indicate equifinality and configurational asymmetry, suggesting that psychiatric disability in schizophrenia should be assessed and addressed through combined consideration of symptoms, cognition, especially social cognition, and resource conditions.