Murrihy Sean, Filia Kate, Cotton Sue, Phillips Lisa, Youn Sarah, Jayasinghe Anuradhi, Wrobel Anna, Bastawy Eslam M, Allott Kelly, Watson Amity
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne 3052, Australia.
Orygen, Melbourne 3052, Australia.
Schizophr Bull. 2025 Jul 7;51(4):1054-1071. doi: 10.1093/schbul/sbae167.
Emotion processing (EP) is impaired in individuals with psychosis and associated with social functioning; however, it is unclear how symptoms fit into this relationship. The aim of this systematic review and meta-analysis was to examine interrelationships between EP, symptoms, and social functioning, test whether different symptom domains mediate the relationship between EP and social functioning, and examine the moderating effects of illness stage and EP task type.
MEDLINE, Embase, and PsycINFO databases were searched for studies that included individuals with psychosis and reported correlations between EP, symptom domains (positive, negative, depressive, and disorganization), and social functioning. Random effects meta-analyses determined the strength of correlations, and subgroup analyses included illness stage and EP task type (lower- vs higher-level processing). Meta-analytic structural equation models tested whether symptom domains mediated the relationship between EP and social functioning.
There was a small relationship (r = .18) between EP and social functioning. Positive, negative, and disorganization symptoms mediated this relationship, although indirect effects were small. Higher-level EP tasks were more strongly associated with negative symptoms than lower-level tasks. Relationships between EP and both social functioning and positive symptoms were smaller in the first episode of psychosis than in established illness.
The mediating relationship suggests that EP not only influences social dysfunction directly but contributes to negative and disorganization symptoms, which in turn impair social functioning. This pathway suggests that targeting negative and disorganization symptoms may ultimately improve social outcomes for individuals with psychosis. Future research, particularly in early psychosis, is needed to determine other factors impacting these interrelationships.
精神病患者的情绪加工（EP）受损，且与社会功能相关；然而，尚不清楚症状如何融入这种关系。本系统评价和荟萃分析的目的是研究EP、症状和社会功能之间的相互关系，检验不同症状领域是否介导EP与社会功能之间的关系，并考察疾病阶段和EP任务类型的调节作用。
检索MEDLINE、Embase和PsycINFO数据库，查找纳入精神病患者并报告EP、症状领域（阳性、阴性、抑郁和紊乱）与社会功能之间相关性的研究。随机效应荟萃分析确定相关性强度，亚组分析包括疾病阶段和EP任务类型（低级与高级加工）。荟萃分析结构方程模型检验症状领域是否介导EP与社会功能之间的关系。
EP与社会功能之间存在较小的关系（r = 0.18）。阳性、阴性和紊乱症状介导了这种关系，尽管间接效应较小。与低级任务相比，高级EP任务与阴性症状的关联更强。在精神病的首发期，EP与社会功能及阳性症状之间的关系比在病程较长的疾病中更小。
这种中介关系表明，EP不仅直接影响社会功能障碍，还导致阴性和紊乱症状，进而损害社会功能。这一途径表明，针对阴性和紊乱症状可能最终改善精神病患者的社会结局。需要未来的研究，特别是在早期精神病方面的研究，以确定影响这些相互关系的其他因素。
