title: Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives.
abstract: Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives.
  
  
  
  The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs.
  
  
  
  Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization.
  
  
  
  Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy. Electronic address: silvana.galderisi@gmail.com.
authors.forename: Silvana
authors.initials: S
authors.lastname: Galderisi
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rocca
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bertolino
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
authors.forename: Armida
authors.initials: A
authors.lastname: Mucci
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bucci
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Dino
authors.initials: D
authors.lastname: Gibertoni
authors.affiliation: Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Aguglia
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Blasi
authors.affiliation: Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Comparelli
authors.affiliation: Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio University, Chieti, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Giannantonio
authors.affiliation: Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Goracci
authors.affiliation: Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Marchesi
authors.affiliation: Department of Medicine and Surgery, Chair of Psychiatry, University of Salerno, Salerno, Italy.
authors.forename: Palmiero
authors.initials: P
authors.lastname: Monteleone
authors.affiliation: Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Montemagni
authors.affiliation: Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of Cagliari, Cagliari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Pinna
authors.affiliation: Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Roncone
authors.affiliation: Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Siracusano
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Stratta
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Torti
authors.affiliation: Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental Health, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vita
authors.affiliation: Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zeppegno
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Chieffi
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maj
mesh_terms: D000328:Adult; D003071:Cognition; D004522:Educational Status; D004651:Employment / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000235:genetics; D012565:Schizophrenic Psychology; D057545:Social Stigma
keywords: Avolition; Cognition; Interpersonal relationships; Schizophrenia first-degree relatives; Structural equation model; Work skills