Relationship between cognitive reserve (education), social cognition and negative symptoms

Background: Negative symptoms (NS) are a core feature of schizophrenia spectrum disorders, yet their relationship with cognitive reserve (defined by educational attainment) and social cognition remains underexplored. This study examined whether education predicts NS and whether this relationship is mediated by social cognition, specifically emotional or inferential theory of mind Reading the Mind in the Eyes Test (RMET) vs. the Hinting Test. Methods: A mediation model and multiple regression analysis were conducted within an ex-post-facto, crosssectional design. The sample included 144 participants: 69 diagnosed with schizophrenia spectrum disorders and 75 healthy controls. Women comprised 52.8 % of the sample, with a mean age of 42.67 years (SD = 15.88). The average years of formal education were 8.37 (SD = 2.77) in the patient group and 8.62 (SD = 3.66) in the control group. Results: The mediation model explained 67.57 % of the variance in NS, with age as a covariate. RMET showed a significant indirect effect (d = -0.22) in predicting NS, while HT did not (d = -0.12). In the patient group, multiple regression analysis explained 69.2 % of the variance, with education emerging as a significant predictor of NS. Conclusions: Education, as an indicator of cognitive reserve, significantly predicts NS. This relationship is mediated by social cognition, with differential effects depending on the specific type of social cognition, either within the patient group or across the entire sample. These findings highlight the importance of cognitive reserve and social cognition in understanding and potentially mitigating NS in schizophrenia.