From Patients to Caregivers: Indirect Associations between Social Cognition, Patient Distress, and Caregiver Quality of Life in Schizophrenia.

OBJECTIVE: To examine whether patients' social cognition (SC) is indirectly associated with caregivers' quality of life (S-CGQoL) through patients' psychological distress (PD), using a cross-sectional structural equation model (SEM). METHODS: Cross-sectional study of 175 outpatients with schizophrenia-spectrum disorders and their primary family caregivers, recruited from three public community mental-health centers in Chile. Patients completed the GEOPTE SC subscale and the Kessler-10 (PD); caregivers completed the S-CGQoL-25. A cross-sectional SEM with WLSMV tested the indirect association SC→PD→S-CGQoL, reporting standardized coefficients (STDYX), global fit indices, and R². RESULTS: Poorer SC was strongly associated with higher PD (β ≈ 0.79; p < .001). In turn, higher PD was associated with poorer S-CGQoL across all domains (β = -0.55 to -0.82; all p < .001). Indirect effects of SC on each S-CGQoL domain were significant (all p < .001). Model fit was acceptable (χ²/df ≈ 1.6; RMSEA ≈ 0.05; CFI ≈ 0.91; SRMR ≈ 0.06). The model explained 62% of PD variance and 30%-68% of S-CGQoL variance by domain. CONCLUSIONS: Patients' SC difficulties were indirectly associated with poorer caregiver quality of life through increased patient distress. These findings are clinically actionable: brief screening and reduction of distress, alongside social-cognitive rehabilitation, may mitigate family impact.