The causal relationship between social cognition and psychosocial functional outcome over time in bipolar disorder: A latent change score model approach

INTRODUCTION: Impairments in social cognition are associated with poor functional outcomes, but their temporal dynamics and causal pathways remain unclear. This study aimed to investigate the causal relationship between social cognition, specifically Theory of Mind (ToM) and emotion recognition (ER), and psychosocial functioning in individuals with bipolar disorder (BD).

METHODS: We used a latent change score model to analyze data from a randomized controlled trial comparing metacognitive training to treatment as usual. The study investigated the causal direction among ToM, ER, and psychosocial functioning, including baseline correlations and associations between changes over time. Fifty-five euthymic patients with BD were assessed at baseline and after 10 weeks using the Reading the Mind in the Eyes Test (ToM), the CANTAB Emotion Recognition Task (ER), and the Functioning Assessment Short Test (FAST).

RESULTS: Better baseline ToM performance was associated with smaller improvements in ER over time (B = -0.23, p = 0.062). No significant correlation was found between ToM and ER at baseline. ToM and ER scores were stable over time, with strong test-retest correlations (ToM: ρ = 0.712; ER: ρ = 0.728; both p < 0.001). Within-domain changes for ToM and psychosocial functioning were influenced by respective baseline scores. Cross-domain associations showed small effect sizes, with no significant associations between baseline scores in one domain and change in another.

CONCLUSIONS: ToM and ER appear stable over short intervals and may function independently from psychosocial functioning. Findings support domain-specific interventions and suggest a potential ceiling effect for individuals with higher baseline ToM.