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<p>Cognitive dysfunction is a common feature of schizophrenia and is crucial to long-term prognosis. Loneliness may be associated with poorer cognitive function, potentially through sleep quality and anxiety, but the pathways underlying these associations remain unclear. In this study, we aimed to explore the relationship between loneliness and cognitive function using a clinical cohort from China and to examine the mediating roles of sleep quality and anxiety. Using cross-sectional data from a Chinese clinical cohort, we recruited 299 patients with schizophrenia who met DSM-5 diagnostic criteria. Participants completed the University of California Los Angeles (UCLA) Loneliness Scale, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Pittsburgh Sleep Quality Index (PSQI), and the Hamilton Anxiety Rating (HAMA) Scale. We first conducted univariable analyses to identify demographic and clinical correlates of cognitive performance to be included as covariates. To examine the robustness of the findings, we further performed subgroup analyses by age (18–44, 45–59, ≥ 60&#xa0;years), sex (male/female), and education level (≤ 9&#xa0;years/ &gt; 9&#xa0;years). We then tested a serial mediation model of “UCLA → PSQI → HAMA → RBANS” using structural equation modelling while adjusting for the identified covariates. The significance of indirect effects was evaluated using bootstrapping with 5,000 resamples. After adjustment for age, sex, and years of education, the structural equation model showed a good fit (χ<sup>2</sup>/df = 1.287, CFI = 0.996, RMSEA = 0.031). Path analyses indicated that the association between UCLA scores and RBANS scores was partially explained by significant indirect pathways comprising two components. First, anxiety acted as an independent mediator. Higher UCLA scores were associated with higher HAMA scores (β = 0.135, P &lt; 0.001), which in turn were associated with lower RBANS scores (β = −0.710, P &lt; 0.001). Higher UCLA scores were also associated with higher PSQI scores (β = 0.068, P &lt; 0.001), which were associated with higher HAMA scores (β = 0.283, P &lt; 0.001). Bootstrapping confirmed a significant total indirect effect (effect = −0.109, 95% CI [−0.179, −0.055]). The anxiety-only pathway accounted for 13.7% of the total effect and the sleep–anxiety serial pathway for 2.0%. Subgroup analyses revealed that the anxiety-mediated pathway was significant across most strata, with larger effect sizes in males, older adults (≥ 60&#xa0;years), and individuals with lower education (≤ 9&#xa0;years), while the serial pathway was uniquely significant in the 45–59&#xa0;years age group. These findings indicate that anxiety accounted for a larger proportion of the observed indirect association, whereas the contribution of the sleep–anxiety serial pathway was relatively modest. Nevertheless, given the cross-sectional design, the findings should be interpreted cautiously with respect to causality, and the observed relationships among loneliness, sleep quality, anxiety, and cognitive function may reflect clinically relevant interrelated processes in patients with schizophrenia.</p>

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Loneliness is associated with cognitive impairment in patients with schizophrenia: the mediating roles of sleep quality and anxiety

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Wenqing Zhou,
  • Zixi Zhu,
  • Jian Zhang,
  • Yifei Zhu,
  • Jingyi Lu,
  • Xiaomin Luo,
  • Huiying Zhang,
  • Weiye Cao,
  • Yingyi Wang,
  • Xinyu Zhang,
  • Shen Li,
  • Zezhi Li

摘要

Cognitive dysfunction is a common feature of schizophrenia and is crucial to long-term prognosis. Loneliness may be associated with poorer cognitive function, potentially through sleep quality and anxiety, but the pathways underlying these associations remain unclear. In this study, we aimed to explore the relationship between loneliness and cognitive function using a clinical cohort from China and to examine the mediating roles of sleep quality and anxiety. Using cross-sectional data from a Chinese clinical cohort, we recruited 299 patients with schizophrenia who met DSM-5 diagnostic criteria. Participants completed the University of California Los Angeles (UCLA) Loneliness Scale, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Pittsburgh Sleep Quality Index (PSQI), and the Hamilton Anxiety Rating (HAMA) Scale. We first conducted univariable analyses to identify demographic and clinical correlates of cognitive performance to be included as covariates. To examine the robustness of the findings, we further performed subgroup analyses by age (18–44, 45–59, ≥ 60 years), sex (male/female), and education level (≤ 9 years/ > 9 years). We then tested a serial mediation model of “UCLA → PSQI → HAMA → RBANS” using structural equation modelling while adjusting for the identified covariates. The significance of indirect effects was evaluated using bootstrapping with 5,000 resamples. After adjustment for age, sex, and years of education, the structural equation model showed a good fit (χ2/df = 1.287, CFI = 0.996, RMSEA = 0.031). Path analyses indicated that the association between UCLA scores and RBANS scores was partially explained by significant indirect pathways comprising two components. First, anxiety acted as an independent mediator. Higher UCLA scores were associated with higher HAMA scores (β = 0.135, P < 0.001), which in turn were associated with lower RBANS scores (β = −0.710, P < 0.001). Higher UCLA scores were also associated with higher PSQI scores (β = 0.068, P < 0.001), which were associated with higher HAMA scores (β = 0.283, P < 0.001). Bootstrapping confirmed a significant total indirect effect (effect = −0.109, 95% CI [−0.179, −0.055]). The anxiety-only pathway accounted for 13.7% of the total effect and the sleep–anxiety serial pathway for 2.0%. Subgroup analyses revealed that the anxiety-mediated pathway was significant across most strata, with larger effect sizes in males, older adults (≥ 60 years), and individuals with lower education (≤ 9 years), while the serial pathway was uniquely significant in the 45–59 years age group. These findings indicate that anxiety accounted for a larger proportion of the observed indirect association, whereas the contribution of the sleep–anxiety serial pathway was relatively modest. Nevertheless, given the cross-sectional design, the findings should be interpreted cautiously with respect to causality, and the observed relationships among loneliness, sleep quality, anxiety, and cognitive function may reflect clinically relevant interrelated processes in patients with schizophrenia.