Abstract

Background: Social isolation and social cognition (SC) have been linked to symptom severity in schizophrenia, yet their joint mediational pathways have not been tested in a Chilean clinical sample. Methods: A total of 175 clinically stable patients with schizophrenia completed the Social Isolation subscale of the Internalized Stigma of Mental Illness Scale (ISMI), the Social Cognition subscale of the GEOPTE, and the Positive and Negative Syndrome Scale (PANSS). Descriptive statistics, internal consistency, Spearman correlations, confirmatory factor analysis (CFA), a mediational structural-equation model (SEM), and multiple regression were performed. Results: All scales showed acceptable-to-excellent reliability (alpha = .72-.92; omega = .72-.92). CFA indicated excellent fit (CFI = .98; TLI = .98; RMSEA = .06). Isolation was strongly associated with SC (rho = .54, p < .001). In SEM, isolation was significantly associated with SC (beta = .64, p < .001) but had no direct effect on positive symptoms. For negative symptoms, both SC (beta = .26, p = .040) and isolation (beta = .48, p < .001) exerted significant direct effects. SC mediated the relationship between isolation and positive symptoms (indirect beta = .38, p < .001) but not negative symptoms. Multiple regression confirmed SC as the sole significant associated of positive symptoms (beta = .24, p = .007). Conclusions: Findings support a model in which SC mediates the impact of social isolation on positive symptom severity, while isolation exerts an independent direct effect on negative symptoms.