Is emotion recognition a possible mediator between basic neurocognition and psychosocial functioning in schizophrenia?

Nuno Rocha ab, Cristina Queirós b& Susana Aguiar b Purpose Purpose Social cognition has been proposed as one possible mediator between neurocognition and functional outcome in Schizophrenia (Green, Kern, Braff & Mintz, 2000). Social cognition is a broad construct including different domains such as emotion processing, social perception and theory of mind. In this study we will focus on emotion recognition in order to analyze the associations between cognitive skills, facial emotion recognition and psychosocial functioning, and to determine if emotion recognition mediated the relationship between cognition and psychosocial functioning. aSchool of Allied Health Sciences, Porto Polytechnic Institute b Faculty of Psychology and Educational Sciences, University of Porto [email protected]; [email protected]; susana.[email protected] XIV XIV World World Congress Congress of of Psychiatry Psychiatry Prague, Czech Republic, September 2008 Is emotion recognition a possible mediator between basic neurocognition and psychosocial functioning in schizophrenia? Condition 2: The independent variable predicts the mediator Regression analysis: Independent variable: Neurocognition Dependent Variable: Emotion recognition Bibliography F PCE U P FACULDADE DE PSICOLOGIA E DE CIÊNCIAS DA EDUCAÇÃO UNIVERSIDADE DO PORTO Model 1: Emotion Recognition as a mediator of the relationship between Neurocognition and General Psychosocial Functioning VI r raw correlation β Tsig. Neurocognition 0.428* 0.428 2.509 0.018 * p<0.050 ** p<0.010 Conditions 3 and 4: The mediator predicts the dependent variable (when the effects of the independent variable are controlled) and the independent variable does not predict the dependent variable (when controlling for the effects of the mediator) Regression analysis: Independent variables: Neurocognition and Emotion Recognition Dependent variable: General psychosocial functioning VI r raw correlation β Tsig.SobelTest sig. Neurocognition 0.597** 0.481 2.953 0.006 Emotionrecognition 0.476** 0.270 1.661 0.108 1.38 0.17 Condition 1: The independent variable predicts the outcome variable Regression analysis: Independent variable: Neurocognition Dependent variable: General Psychosocial Functioning VI r raw correlation β Tsig. Neurocognition 0.597** 0.597 3.934 0.001 0.428* 0.476** (0.270) 0.597** (0.481**) Model 2: Emotion recognition as a mediator of the relationship between Neurocognition and Communication Skills Condition 1: The independent variable predicts the outcome variable Regression analysis: Independent variable: Neurocognition Dependent variable: Communication Skills VI r raw correlation β Tsig. Neurocognition 0.497** 0.497 3.028 0.005 Condition 2: The independent variable predicts the mediator Regression analysis: Independent variable: Neurocognition Dependent Variable: Emotion recognition VI r raw correlation β Tsig. Neurocognition 0.428* 0.428 2.509 0.018 Conditions 3 and 4: The mediator predicts the dependent variable (when the effects of the independent variable are controlled) and the independent variable does not predict the dependent variable (when controlling for the effects of the mediator) Regression analysis: Independent variables: Neurocognition and Emotion Recognition Dependent variable: Communication Skills VI r raw correlation β Tsig.SobelTest sig. Neurocognition 0.497** 0.291 1.817 0.080 Emotionrecognition 0.605** 0.480 2.998 0.006 1.993 0.04 0.428* 0.605** (0.480**) 0.497** (0.291) Participants: 30 Portuguese patients diagnosed with Schizophrenia (Age Md = 41.47, SD = 8.78; 90% males). Instruments: Neurocognition: Battery comprised by the subtests derived from the Working Memory and Processing Speed indexes of WAIS-III (Digit Span; Letter-Number Sequencing; Arithmetic; Symbol Search and Digit Symbol — Coding). Emotion recognition: 30 morphed faces with different 6 emotional intensities of happiness, sadness, anger, fear and disgust . For each morph, participants had to decide which of the 5 emotions was being expressed (Aguiar, Queirós & Rocha, 2006; Aguiar, 2008) Psychosocial Functioning and Communication Skills: Life Skills Profile – Portuguese Version (Rocha et al., 2006) was used to determine psychosocial functioning. This scale was completed by psychologists and occupational therapists who follow their patients over the years and have ample opportunity to observe and assess patient functioning in different community settings. The Life Skills Profile comprises 39 items, which can measure five key dimensions: self-care, nonturbulence, social contact, communication and responsibility . The General Psychosocial Functioning score was obtained by the sum of all dimensions and the Communication skills were measured through the Communication dimension of the scale. Data Analysis: Given the large number of parameters to be estimated we created a composite score of neurocognition based on the mean z-transformed scores of the cognitive measures (for that purpose we obtained the scores of 37 control subjects in the different cognitive tasks used in the study). To determine whether emotion recognition mediates the relationship between neurocognition and psychosocial functioning, a series of analyses were performed according to the method outlined by Baron and Kenny (1986). The conditions to establish mediation are: (1) the independent variable is correlated with the outcome; (2) the independent variable is correlated with the mediator; (3) the mediator affects the outcome variable; and (4) when the effects of the mediator are controlled for, a previously significant correlation between the independent and dependent variables is greatly attenuated . Sobel test was used to test for mediation, by computing the raw regression coefficient and the standard error for this regression coefficient for the association between the independent variable and the mediator, and the association between the mediator and the outcome variable (adjusting for the independent variable). * p<0.050 ** p<0.010 Aguiar, S. (2008). [Facial Emotional Recognition in Schizophrenia]. Master Thesis in Health Psychology. Porto: Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto (Portuguese); Aguiar, S., Queirós, C. & Rocha, N. (2006). Facial Emotional Recognition Test. Porto: Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto; Baron, R. & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51 (6), 1173-1182; Bellack, A. (2004). Skills Training for People with Severe Mental Illness. Psychiatric Rehabilitation Journal, 27 (4), 375-391; Green, M., Kern, R., Braff, D. & Mintz, J. (2000). Neurocognitive Deficits and Functional Outcome in Schizophrenia: Are we Measuring the "Right Stuff"? Schizophrenia Bulletin, 26 (1), 119-136; Rocha, N., Queirós, C., Aguiar, S. & Marques, A. (2006). [Life Skills Profile (LSP – 39): Portuguese Authorized Version]. Porto: Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto (Portuguese). Through the causal steps method developed by Baron and Kenny we observed that controlling for the mediator (emotion recognition) the association between neurocognition and psychosocial functioning decreased. Sobel test revealed that emotional recognition was a better mediator of the Communication dimension of the Life Skills Profile rather than of the Life Skills Profile total score. There was found some evidence to support emotion recognition as a mediator of psychosocial functioning. Communication was better mediated by emotional recognition than general psychosocial function, since the latter include other areas of function such as self-care skills, which are not dependent of social interaction (Bellack, 2004). Methods Methods Results Results and and Conclusions Conclusions Supported by a FACC Grant