A multilayered model of work outcome in patients with schizophrenia: Examination of the relationships among positive symptoms, cognition, and daily living skills

Patients with schizophrenia often show impairments in work functioning, yet the precise relationships among positive symptoms, cognition, daily living skills, and work outcome remain to be elucidated. We analyzed data from 396 patients with schizophrenia and 1109 healthy individuals. Work outcome was quantified as the mean weekly working hours. Cognitive decline was defined as the difference between current and premorbid IQ, while social function was evaluated by the Social Functioning Scale. We also conducted group comparisons and correlational analyses among the clinical variables. Using structural equation modeling (SEM), we further examined pathways from positive symptoms through cognitive decline, and determined whether daily living skills account for work outcome. Patients showed impairments in work outcome, cognitive decline, and social function, including daily living skills, as represented by Independence–Performance subscale of the Social Functioning Scale. Consistent with previous studies, cognitive decline and social function were correlated with weekly working hours among patients. SEM revealed several pathways from positive symptoms to working hours via daily living skills with or without a mediational effect of cognitive decline. The findings suggest that work outcome is influenced by multiple clinical symptom domains, including positive symptoms, cognitive decline, and daily living skills. The observed relationships among these features may aid in the development of effective interventions for occupational function in patients with schizophrenia.