Theory of mind impairment in schizophrenia: meta-analysis

Emre Bora, Murat Yucel, Christos Pantelis

Research output: Contribution to journalArticleResearchpeer-review

456 Citations (Scopus)


There is now substantial evidence for Theory of mind (ToM) impairment in schizophrenia. Despite this, we know little about how dynamic (state) variables and broad clinical, cognitive and medication characteristics moderate the precise magnitude of the observed ToM deficit during task performance. Meta-analyses were conducted using 36 studies that reported continuous data regarding ToM performances of schizophrenia patients and healthy control subjects. These 36 studies included 1,181 (67 male) patients with schizophrenia and 936 (58.3 male) healthy control subjects. Individual analyses were also conducted for the Hinting and the Eyes tasks. The effects of moderator variables were studied by both subgroup and meta-regression analyses. The effect sizes (Cohen s d) for overall ToM performance and the individual tasks were large (d = 0.90-1.08). In remitted patients, the degree of ToM impairment was less pronounced than non-remitted patients (d = 1.21) but it was still significant (d = 0.80). Moreover, the distribution of effect sizes was more homogeneous for the individual tasks, especially in remitted patients. General intellectual deficits observed in schizophrenia patients contributed to their ToM impairment only in the remission phase of the illness. While state variables and task specific differences explain a large degree of the heterogeneity of the ToM findings observed in previous studies, the persistence of ToM deficits in remitted patients suggests there are trait related mentalising impairments in schizophrenia. Our review also suggests that future research should consider the potential moderating influence of IQ deficits on ToM performance in remitted patients, as well as the potential effects of residual symptoms.
Original languageEnglish
Pages (from-to)1 - 9
Number of pages9
JournalSchizophrenia Research
Issue number1-3
Publication statusPublished - 2009
Externally publishedYes

Cite this