Residual experiential symptoms mediate the effect of expressive symptoms over the social functioning in remitted schizophrenia.

Context: Impairment in social functioning had been consistently found in remitted schizophrenia; yet, predictors of social dysfunction had been hardly explored and intervention trials had rarely included remitted schizophrenia.

Methods: 60 subjects with schizophrenia (diagnosed based on DSM5), currently in remission (SAPS and SANS global rating ≤2, for a minimum period of 12 weeks) and 46 age and gender-matched healthy controls were recruited after obtaining informed consent. The socio-demographic details, illness characteristics, depressive symptoms, positive and negative symptoms [using Scale for assessment of positive symptoms (SAPS), and scale for assessment of negative symptoms (SANS)] were assessed. The Theory of Mind (ToM) score was derived from the ToM tasks of a culturally validated tool, Social Cognition Rating Tools in Indian Setting. The social functioning was assessed using Groningen social disabilities schedule II (GSDSSII).

Results: The mean SAPS summary and SANS summary scores were 3.01 ± 2.99 and 4.32 ± 2.94, respectively. The social functioning was significantly impaired in remitted schizophrenia when compared to healthy controls. In the hierarchical regression, experiential dimension ( =1.941, t = 6.097, P < 0.001), followed by expressive dimension predicted social functioning (explained 70.5% of variance) after controlling for confounders. On mediation analysis, the effect of expressive dimension over the social functioning was significantly mediated by experiential dimension (E = 1.1821, Boot SE = 0.2895, C.I: 0.6934 to 1.7862).

Conclusion: The experiential dimension mediates the effect of expressive dimension over the social dysfunction in remitted schizophrenia. Future studies should focus on targeting the experiential dimension and thereby social functioning.