ArticleEuropean archives of psychiatry and clinical neuroscience2026
Loneliness is associated with cognitive impairment in patients with schizophrenia: the mediating roles of sleep quality and anxiety.
Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 (χ
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