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11. Investigating the impact of negative symptoms and neurocognition on prospective work functioning in psychosis: A 20-year longitudinal study
Both neurocognition and negative symptoms have demonstrated strong links to functional outcomes, such as work functioning, among those with psychosis. Several prior models have suggested that reduced neurocognition 1) precedes or predicts greater negative symptoms and 2) indirectly influences functional outcomes through its impact on negative symptoms. The current study sought to also test a divergent model: whether greater negative symptoms predicts reduced neurocognition and indirectly influences work functioning through its impact on neurocognition. We tested both models using cross-sectional and longitudinal data spanning 20-years in a sample of 277 people with psychotic disorders. Preliminary results suggest both models were supported in cross-sectional analyses. However, in longitudinal models predicting prospective work functioning, only the model examining the indirect influence of negative symptoms on work functioning through neurocognition was significant; further, higher negative symptoms significantly predicted lower prospective neurocognition, while lower neurocognition did not significantly predict greater prospective negative symptoms. Results provide some cross-sectional support for prior models but suggest that negative symptoms may also contribute to neurocognitive performance both cross-sectionally and longitudinally. These findings have implications for mechanisms contributing to longitudinal work functioning and suggest that targeting negative symptoms in addition to neurocognition may improve work functioning in psychosis.