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70. The impact of theory of mind deficits on functioning in schizophrenia: a meta-analysis of the associations
Schizophrenia is associated with major functioning difficulties. Theory of mind (ToM), the ability to infer the mental state of others, is an important predictor of functioning. The objective of this meta-analysis was to determine and compare the magnitude of the associations between ToM and different domains of functioning in schizophrenia, targeting both performance-based assessments and community functioning.
Articles reporting correlations between a ToM task and a measure of functioning in people with schizophrenia or schizoaffective disorder (age 18-65) were identified. Correlations were transformed into effect sizes Zr, pooled as weighted means and compared between measures of community functioning and performance-based measures, as well as between domains of functioning.
Fifty-six studies (N=4180) were included. ToM was more strongly associated with overall functioning as assessed with performance-based tasks (Zr=0.36) than to measures of everyday functioning (Zr=0.24;χ2(1)=14.49,p<0.001). For the performance-based tasks and the measures of everyday functioning, ToM was moderately associated with activities of daily living (Zr=0.20 and 0.28, respectively), productive activities (Zr=0.20 and 0.30) and social functioning (Zr=0.25 and 0.34), with no significant difference between the three domains (χ2(2)=4.29,p=0.117;χ2(2)=4.29,p=0.117).
Given the moderate associations between ToM and all domains of functioning, ToM represents an important treatment target in schizophrenia to improve functional recovery.