Abstract
Abstract
Background
Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that metacognitive awareness of performance may underlie other symptoms such as delusions and disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on social cognitive tests, confidence in performance, effort allocated to the task, and other aspects of self-assessment in patients with schizophrenia and healthy controls.
Methods
Participants were stable outpatients with diagnoses of schizophrenia or schizoaffective disorder (n=218) and healthy controls (n=154). Measures included self-reported depression (BDI-2), interpersonal sensitivity (Persecution and Deservedness Scale; PADS), social cognitive ability (Observable Social Cognition Rating Scale; OSCARS), and social functioning (Specific Level of Functioning Scale; SLOF). A performance-based emotion recognition test (Bell Lysaker Emotion Recognition Test; BLERT) assessed social cognitive performance and provided the basis for confidence judgments.
Results
Confidence was higher when correct for both healthy controls t(150)=5.87, p<.001 and patients with schizophrenia, t(214)=5.44, p<.001. However, the effect size for controls was d=0.7 and d=0.3 for the patients. We found that healthy controls responded significantly more rapidly when correct than incorrect, t(150)=4.92, p<.001; d=0.37. Patients with schizophrenia, in contrast, did not significantly differ in their response times to items when they were correct or incorrect, t(214)=1.89, p=.06; d=.13.
Schizophrenia patients reported more depression, more interpersonal sensitivity, poorer social cognitive ability, and poorer everyday functioning than the healthy controls (all p<.001). Interestingly, 28 schizophrenia patients (13%) provided confidence scores of 100% on every item, while only 3 healthy controls (1.4%) provided these 100% confidence scores. Healthy controls who were 100% confident did not perform differently from those who were not, M=76.8%, vs. M= 75.7%. However, the schizophrenia patients who were 100% confident performed significantly more poorly than those who were not, M=57.5 % (SD=21.5) vs. 67.2 % (SD=18.4) respectively, t(214)=2.56, p=.011. Those patients who believed that their performance was perfect also had significantly lower scores on the BDI than those who believed that they had made some errors, M=10.8 (SD=11.9) vs. M=15.8 (SD=12.5) respectively, t(214)=2.04, p=.048.
Discussion
Self-assessment of everyday social functioning in healthy people was associated with confidence and impressions of social cognitive competence and, to a lesser extent, depression. In contrast, the self-assessments of schizophrenia patients were correlated only with depression in a regression analysis. Confidence that one is correct when performing social cognitive tests was not associated with actual performance to a notable extent in either group, and confidence in healthy people was associated with a test-taking style that included more rapid responses both when correct and incorrect. These data are consistent with previous studies of confidence and self-assessment in both healthy people and people with schizophrenia, again suggesting that patients are largely relying on their current mood state as an index of their global everyday functioning.
