Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia.

It has been suggested in the research literature that facial affect processing (FAP) and theory of mind (ToM) are both potential mediators of the well-established relationship between cognition and functional outcome among people with schizophrenia. The current project tests the mediating potency of these two domains of social cognition among deaf and hearing people with schizophrenia. Sixty-five people (34 deaf, 31 hearing) were assessed using measures of verbal and visual memory, attention, visual processing, FAP, and ToM. The results suggest that each domain of cognition, save vigilance, exerts an effect on functional outcome indirectly through its influence on social cognition. The patterns of mediation varied when the samples were broken down by hearing status and analyzed separately. Namely, the cognitive tasks directly involving linguistic ability (early visual processing [EVP] and word memory) were best mediated by social cognition for hearing subjects. For deaf subjects, the nonlinguistic cognitive tasks (e.g., visual-spatial memory-recall and copy [VSM-recall and VSM-copy]) were best mediated by social cognition. While FAP and ToM were equally effective as mediators for hearing subjects, FAP was a more potent mediator than ToM for deaf subjects. This study extends prior work in the area of social cognition and schizophrenia and indicates that the development of cognitive rehabilitation strategies should include not only interventions targeting specific cognitive abilities, such as attention and memory, but should include an emphasis on social-cognitive domains, including FAP and ToM. Further, deaf and hearing subjects may benefit from interventions addressing aspects of cognition that support linguistic ability, especially as they relate to social cognition.