Predictions of different elements of everyday functional outcomes in bipolar disorder and schizophrenia: Cognition, social cognition, clinical symptoms, and mood states as predictors.

BACKGROUND Disability is common in serious mental illnesses across employment, everyday activities, and social outcomes. Although cognition and social cognition are known to predict disability, the level of influence across elements of functioning and condition and is not certain. We examined the correlations between cognition and social cognition, measured with observer ratings and performance, with ratings of performance in employment, everyday activities, and social outcomes in a transdiagnostic sample.

METHODS Participants with bipolar disorder (BD; n = 114) and SZ (SZ; n = 126) were studied. Everyday functioning was indexed with observer ratings of functioning, consolidating self and informant reports. In order to evaluate the usefulness of additional information sources, predictors also included clinical symptoms in domains of psychosis, negative symptoms, and depression, and momentary data on moods, location, and social context collected over 30 days of Ecological Momentary Assessment (EMA).

RESULTS Observer ratings of neurocognition and social cognition were uniformly correlated with functioning across diagnoses, with performance-based tests less strongly correlated with outcomes. Negative symptoms were the best predictor of interpersonal functioning, with mood symptoms also predictive in BD.

IMPLICATIONS Observer-rated social cognition emerged as the most consistent predictor of disability across all domains and diagnoses. Negative symptoms had a relatively specific contribution to interpersonal outcomes, with sadness also contributing in BD. As observer ratings of social cognition and cognition were better predictors of outcomes than performance based tests, this may suggest a practical assessment strategy in general clinical settings with limited access to testing specialists.