Reducing psychiatric symptoms particularly negative symptoms is also

Reducing psychiatric symptoms, particularly negative symptoms, is also considered to improve QOL, thus enhancing therapeutic alliance and treatment satisfaction (Karow et al., 2012a). Although negative symptoms have been shown to affect QOL in patients with schizophrenia (Brissos et al., 2011; Woon et al., 2010), only a minority of patients exhibit substantial improvement in QOL, even after achieving symptom remission (Karadayi et al., 2011; Schennach-Wolff et al., 2009). QOL has also been associated with functional outcomes, including employment status, independent living, engagement in daily activities, and maintaining personal relationships (Galuppi et al., 2010; Karadayi et al., 2011). In sum, cognitive function and psychiatric symptoms are considered to play a major role in social functioning in patients with schizophrenia (Bowie et al., 2008).
General cognitive function is assessed by performance on neuropsychological tests of most cognitive domains (Dickinson et al., 2004) and has been shown to correlate with everyday functioning (Green et al., 2000). However, a conceptual model of the link between cognitive function and social functioning suggests a discrepancy between cognitive performance in the laboratory setting and phosphodiesterase inhibitors outcomes (Bowie and Harvey, 2006; Green et al., 2004). Therefore, it is reasonable to assume that functional abilities/capacity, as evaluated by co-primary measures (e.g., UPSA-B), mediates cognitive function and social functioning (Bowie et al., 2006; Green et al., 2012). Previous studies have shown a role of functional capacity as a mediator of cognitive dysfunctions on employment status (Bowie et al., 2006; Bowie et al., 2010).
Although statistical modeling has been employed to examine the relationships among cognitive function, functional abilities, and social functioning (interpersonal skills, community activities, and work skills) (Bowie et al., 2006), there is little information on specifying a model to include pathways to QOL (Hwang et al., 2009; Savilla et al., 2008). We seek to extend understandings on pathways to QOL by developing a comprehensive model of the relationships among cognitive function, functional capacity, employment status, psychiatric symptoms, and QOL.



The employment/occupation model met the criteria for a good fit, whereas the other model predicting overall social functioning showed slightly larger RMSEA than those required for good fit criteria. The former model successfully explained variables in a manner consistent with a previous study (Bowie et al., 2006). The role of functional capacity, as measured by the UPSA-B, may be important for the employment/occupation domain of social functioning in patients with schizophrenia, as poor cognitive abilities may underlie the deficit patients present in their ability to perform daily activities, which leads to inefficiency in work life (Ho et al., 2013). These findings suggest an important role of functional capacity as a link between cognitive improvement and employment outcomes (Bowie and Harvey, 2006). Consistent with previous studies (Bowie et al., 2006; Fujino et al., 2014; Tas et al., 2013), negative symptoms were found to be moderately associated with cognitive function, social functioning, and QOL. Our model, which included a measure of subjective QOL, indicated elongation part of QOL may be explained by real-world functioning, which is consistent with previous results (Galuppi et al., 2010). These findings suggest that better social functioning (e.g., having a job), is associated with improved subjective QOL in patients with schizophrenia, via increased motivation and energy.
The link between functional capacity and social functioning may be affected by the degree of social support and other environmental factors. While employment status, measured by the SFS, was predicted by performance on the UPSA-B, other components of social functioning (e.g., interpersonal communication and pro-social activities) were not. Enhancement of additional abilities, such as social cognition and adaptive beliefs, may be required for the latter aspects of social functioning to be improved (Addington et al., 2010; Green et al., 2012). Moreover, social support, familial resources, financial disadvantage, and previous work history have been reported to affect real-world functioning (Gould et al., 2012; Marwaha and Johnson, 2004). Inclusion of these factors may have increased the explanatory power of our model.