Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach
Abstract
Background Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM). Method Three hundred and twenty-one Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms. Results An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation Conclusion Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.
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Self-perception factors such as self-esteem, self-efficacy and internalised stigma are associated with poor social functioning in psychosis.
“Self‐perception factors included self‐esteem (Lysaker et al. 2007), self‐efficacy (Chang et al. 2017) and internalised stigma (Hill and Startup 2013; Lysaker et al. 2007).”
From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Chang et al. 2017
Deficits in social cognition, theory of mind (ToM) and neurocognition are associated with poor social functioning in psychosis.
“the factors that were associated with poor social functioning (see Table 5) included deficits in social cognition (Addington et al. 2006; García‐López et al. 2022; Woolverton et al. 2018), ToM (Sullivan et al. 2013, 2014) and neurocognition (Chang et al. 2017)”
From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Chang et al. 2017
Behavioural factors such as poor motivation, social relatedness and avoidance of goal-directed activity are associated with poor social functioning in psychosis.
“Behavioural factors included poor motivation (Chang et al. 2017; Moe et al. 2021), social relatedness (González‐Blanch et al. 2020) and avoidance of goal‐directed activity (Schlosser et al. 2015).”
From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Chang et al. 2017
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Fett, A.-K. J., Viechtbauer, W., Dominguez, M.-D.-G., Penn, D. L., van Os, J., & Krabbendam, L. (2011) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.07.001 · Cited by 1,833 · see citing works
Neurocognition in first-episode schizophrenia: a meta-analytic review.
Mesholam-Gately, R. I., Giuliano, A. J., Goff, K. P., Faraone, S. V., & Seidman, L. J. (2009) · Neuropsychology · doi:10.1037/a0014708 · Cited by 1,130 · see citing works
The clinical assessment interview for negative symptoms (CAINS): Final development and validation
Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12010109 · Cited by 726 · see citing works
Symptomatic and functional remission in patients with first-episode psychosis
Verma, S., Subramaniam, M., Abdin, E., Poon, L. Y., & Chong, S. A. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01883.x · Cited by 149 · cited 1× · see citing works
“It is well recognized that a significant proportion of first-episode psychosis (FEP) patients exhibit persistent functional impairment even in the presence of clinical remission (Chang et al. 2012; Verma et al. 2012).”
BackgroundSellwood, W., Morrison, A. P., Beck, R., Heffernan, S., Law, H., & Bentall, R. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0083774 · Cited by 46 · see citing works
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Recovery from schizophrenia: is it possible?
Vita, A., & Barlati, S. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000407 · Cited by 187 · see citing works
Social Functioning Interventions in Psychosis: A Systematic Review.
Vinu, M., & Georgiades, A. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70090 · Cited by 9 · see citing works
- Authors
- Chang, W. C., Kwong, V. W. Y., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., & Chen, E. Y. H.
- Affiliations
- Queen Mary Hospital (CN)
- Corresponding author
- Chang, W. C.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2016-11-21
- Volume
- 47
- Issue
- 4
- Pages
- 755-765
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2551401227
- Cited by
- 46
- References
- 7
- Citations by year
- 2026: 2 · 2025: 7 · 2023: 5 · 2022: 2 · 2021: 10 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 3
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- Eli Lilly and Company
- AstraZeneca
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- amotivation, first-episode psychosis, neurocognitive function, general self-efficacy, global functioning, negative symptoms, mediation, functional outcome, early intervention, motivational deficits
- MeSH terms
- Adult, Female, Hong Kong, Humans, Male, Middle Aged, Motivation, Psychotic Disorders, Models, Statistical, Self Efficacy, Apathy
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