Autobiographical memory in schizophrenia: The role of metacognition

Background: Autobiographical memory is an important component of declarative memory, which refers to the ability to recall personal events that happened in the past. This requires that the person senses or experiences himself/herself in the past (i.e., conscious recollection). For people with schizophrenia, conscious recollection can be particularly difficult, resulting in difficulty accessing detailed, specific autobiographical information. Our hypothesis is that the ability to monitor and think about one's cognitive processes (metacognition) is a requisite for conscious recollection, and that it mediates the association between having schizophrenia and recalling fewer specific, personal memories. Methods: Participants were 30 adults with schizophrenia and 30 matched healthy controls. The main assessment instruments were the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Autobiographical Memory Test (AMT). Severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Cognitive performance was measured with the Screen for Cognitive Impairment in Psychiatry (SCIP). Mediation analysis was conducted following Baron and Kenny's procedure. Results: People with schizophrenia had more semantic associations and fewer specific memories than controls in the AMT. Metacognition (MAS-A total score) partially mediated the association between having schizophrenia and recalling fewer specific past events, even after controlling for cognitive impairment as a potential confounding source. Conclusions: Metacognitive ability, which can be improved with available programs, intervenes in the process of accessing autobiographical memories in people with schizophrenia. Practical implications of this finding are discussed