Exploratory factor analysis of variables from five tests covering a wide range of social cognitive processes yielded three interpretable and weakly intercorrelated factors in outpatients with psychosis. The factors demonstrated evidence of external validity in their differential patterns of correlation with neurocognitive, clinical symptom, and functional outcome measures. The Hostile attributional style factor significantly correlated with clinical symptoms (positive, depression/anxiety, agitation) but not functional outcome, whereas The Lower-level social cue detection and Higher-level inferential and regulatory processes factors significantly correlated with functional outcome (functional capacity and real-world social and work functioning) but not clinical symptoms. Furthermore, aspects of social cognition had added value in predicting functional capacity above and beyond non-social neurocognition and symptoms. A multidimensional conceptualization of social cognition can provide a useful organizational and guiding framework for this rapidly growing area of research in psychosis.
This is the first study, to our knowledge, to conduct an exploratory factor analysis on social cognitive domains that are commonly studied in major psychopathology. The three Hostile attributional style indexes (AIHQ Hostility, Aggression and Blame) loaded on the first factor, which showed little to no correlation with the other social cognitive variables. The second factor was labeled “Lower-level social cue detection” reflecting basic emotion detection skills (recognition of emotions in faces), low level of cognitive processing (interpretation of non-verbal information transmitted by others), and first order mental representation (detection of lies) (Peskin et al., 1996
; Sullivan et al., 1995
). This factor showed the highest correction with neurocognition. The third factor was labeled “Higher-level inferential and regulatory processing” and was reflected in more refined emotional skills (ability to manage subjective emotional states), higher social cognitive functions and second order mental representation (detection of sarcasm) (Winner and Leekam, 1991
; Happe, 1993
). These findings support the value of considering social cognition as a multidimensional construct with hierarchically distinct lower-level and higher-level abilities (Ochsner, 2008
Our results also showed that detection of lies and sarcasm loaded on separate factors. Several studies of school-age children have demonstrated that comprehension of deceit and irony (e.g., sarcasm) are qualitatively distinct abilities (Bara et al., 1999
; Bosco and Bucciarelli, 2008
; Lee and Katz, 1998
). Comprehension of lies/deceit is acquired before sarcasm/irony and is based on a less complex inferential chain (Bucciarelli et al., 2003
; Winner et al., 1988
). We found that detection of sarcasm and managing emotions loaded on the same factor, suggesting that comprehension of sarcasm requires refined emotional skills such as empathic appreciation of the listener's emotional state (Shamay-Tsoory et al., 2005
). This distinction between lies and sarcasm may have been enhanced by the way that the TASIT evaluates detection of lies – it provides all of the information about deceit in the scene and does not require much inference. A more subtle test of lie detection may have yielded a different factor structure.
In the current study, only certain aspects of social cognition showed significant relationships with clinical symptoms. No correlations were found between the three social cognitive factors and negative symptoms suggesting that social cognition and negative symptoms are largely separate constructs (Rassovsky et al., in press
; Sergi et al., 2007
). Also, some authors have demonstrated that the correlations between social cognition and negative symptoms can be attributed to confounding variables such as intellectual deficits or duration of illness (Langdon 2002
; Pousa et al., 2008
). Only the Hostile attributional style factor showed significant relations to other types of symptoms. Similar to other studies, higher tendencies to blame and respond with hostility in ambiguous social situations significantly correlated with positive symptoms (e.g., An et al., 2010
; Combs et al., 2009
; Janssen et al., 2006
). These attributional tendencies also showed more general linkages to higher levels of depression/anxiety and agitation. Thus, the social cognitive domain of Hostile attributional style was more closely tied to indicators of clinical symptom state than the other factors and showed no significant relations to any aspect of functional outcome.
The Lower-level social cue detection and Higher-level inferential and regulatory processes factors were distinguished from the Hostile attributional style factor by a different pattern of external correlates, namely, significant relations with both functional capacity and real-world functioning but no significant relations to positive, depression/anxiety, or agitation. These findings converge with growing evidence that various aspects of social cognition show meaningful relations to both competence and performance measures of functional outcome (Couture et al., 2006
; Horan et al., in press
). This study also explored the associations between functional outcome and social cognition versus neurocognition, another key correlate of functional outcome. Notably, Lower-level social cue detection factor demonstrated a significantly larger correlation with neurocognition than did Higher-level inferential and regulatory processes factor, providing some evidence of differential relations between these social cognitive factors and external variables. In line with prior studies (e.g., Couture et al., 2006
; Pan et al., 2009
), the Lower-level social cue detection factor accounted for additional variance in functional capacity above and beyond neurocognition and negative symptoms (8% for UPSA and 9% for MASC), demonstrating the “added value” of social cognition. However, we did not find evidence for incremental validity in real-world functioning, although other studies have (Brekke et al., 2005
; Poole et al, 2000
; Vauth et al., 2004
). As discussed in recent integrative models of functional outcome (Bowie et al., 2008
, Horan et al., 2010
, Rassovsky et al., in press
), neurocognitive and social cognitive competence appear more proximal to functional capacity than to real-world functioning, rendering unique relations to functional capacity simpler to demonstrate. Relations to the more distal outcome of real-world functioning can be more challenging to detect due to the various personal (e.g., motivation, self-efficacy) and socio-environmental (e.g., disability policies, cultural factors) variables that impact how one performs in the community.
The current study provides evidence for the multidimensional structure of social cognition in outpatients with psychosis. These findings should be considered in the context of several methodological factors that may limit generalizability, including a largely VA-based sample (mostly older male patients with a slightly skewed ethnic distribution), enrolling patients with three different clinically-determined psychotic diagnoses, and a lack of control for medication effects. Also, the generally low to moderate level of symptoms in our sample may have limited our ability to detect significant relations to symptoms. Nevertheless, a better understanding of the factor structure of social cognition in schizophrenia was a stated goal of a NIMH consensus meeting on this topic (Green et al., 2008
) and has implications for how we interpret findings in this area. As mentioned above, social cognition has been studied in schizophrenia to better understand clinical symptoms and to better understand daily functioning. The results of these analyses suggest that social cognition in general serves both of these purposes, but specific factors serve one or the other. Even the well-documented relationships between social cognition and neurocognition are more characteristic of one factor (lower-level processes) than others, suggesting that Hostile attributional style and Higher-level inferential and regulatory processes factors involve other types of determinants. Hence, these results provide an initial step to help parse and organize this complex and rapidly-developing area.