Metacognitive ability and its mediation effect on the relationship between the theory of mind and social function in schizophrenia

Abstract

Objective To explore the role of the metacognitive ability in the relationship between theory of mind and social function in patients with schizophrenia. Methods 74 patients with schizophrenia in stable stage and 73 patients with neurosis in stable stage were evaluated by the revised Metacognitive Assessment Scale (MAS-A) and the Theory of Mind-Picture Sequencing Task(ToM-PST). In addition, schizophrenia patients were assessed with the Personal and Social Performance Scale (PSP). The metacognitive ability were compared between the two groups and the relationships among metacognitive ability, theory of mind and social function was also studied. Results Compared with neurosis patients, the total score(8.5(4.25) vs 13.0(4.0), P<0.01), and the subscores of self-reflectivity (3.0(1.5) vs 5.0(2.0), P<0.01), understanding of others (2.5(1.0) vs 3.0(1.0), P<0.01), decentration (0.5(1.0) vs 1.0(1.0), P<0.01) and mastery (2.5(1.25) vs 3.5(1.75), P<0.01) of the MAS-A, and the ToM-PST total score (48(12.25) vs 56(7.5), P<0.01)were significantly lower in schizophrenia patients. MAS-A total score was significantly positively correlated with ToM-PST total score(r=0.524, P<0.01)and PSP total score(r=0.521, P<0.01) .The ToM-PST total score also positively correlated with PSP total score (r=0.619, P<0.01) in schizophrenia patients. Regression analysis indicated that metacognitive level predicted social function in schizophrenia (β=0.374, P<0.01) and partially mediated the relationship between theory of mind and social function. Conclusion Schizophrenic patients have deficits of metacognition which partially mediates the influence of theory of mind on social function. Key words: Schizophrenia; Metacognition; Theory of mind; Social function; Mental Symptom