{"paper_id":"335f34ad-2971-45ef-b27b-6405f3aec2e4","body_text":"Impact of Trauma, Urbanicity, and Paternal Age on Theory of Mind in Schizophrenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Trauma, Urbanicity, and Paternal Age on Theory of Mind in Schizophrenia Saba Cicek, Rukiye Filiz Karadag This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8615636/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study investigates the impact of specific environmental risk factors—namely childhood trauma, urbanicity, and advanced paternal age—on Theory of Mind (ToM) impairments in patients with schizophrenia. Specifically, we aimed to disentangle whether ToM deficits are solely intrinsic to the disorder or modulated by trauma history. Methods: A total of 54 patients with schizophrenia and 37 healthy controls were assessed in this cross-sectional study. Participants completed the Childhood Trauma Questionnaire (CTQ) and a battery of ToM tasks, including the Reading the Mind in the Eyes Test (RMET) and the Dokuz Eylul Theory of Mind Scale (DEZIKO). Patients were stratified into \"High Trauma\" (CTQ > 35) and \"Low Trauma\" (CTQ ≤ 35) groups to analyze the distinct contribution of trauma. Results: While patients generally exhibited poorer ToM performance compared to controls (RMET: p<0.001; DEZIKO: p<0.001), subgroup analyses revealed a crucial distinction. High-Trauma patients scored significantly lower than controls on both RMET (p=0.006) and DEZIKO Total (p=0.026). Importantly, Low-Trauma patients did not differ significantly from healthy controls (RMET: p>0.05; DEZIKO: p>0.05). Regarding specific environmental factors, patients residing in urban areas showed higher RMET scores compared to rural residents (Mean: 20.73 vs. 17.81; p=0.011). Conversely, advanced paternal age (≥35 years) was associated with significantly poorer performance on the faux pas recognition task (p=0.015). Conclusion: Our findings suggest that ToM deficits in schizophrenia may not be uniform but are significantly exacerbated by environmental insults, particularly childhood trauma. This challenges the view of ToM solely as a trait marker and highlights the importance of trauma-informed interventions. Future longitudinal studies should clarify these causal pathways to tailor cognitive remediation strategies. Psychiatry Schizophrenia Theory of Mind Childhood Trauma Urbanicity Social Cognition Paternal Age Environmental Risk Factors INTRODUCTION Schizophrenia remains one of the most debilitating psychiatric disorders, placing a substantial burden on individuals and healthcare systems due to high morbidity and mortality rates [ 1 ]. While early detection and intervention are critical public health objectives, the heterogeneous nature of the disorder complicates risk prediction and prevention strategies [ 2 ]. Consequently, there is a pressing need to identify measurable markers that can stratify risk and inform personalized treatment approaches, akin to risk calculation models used in cardiovascular medicine [ 3 ]. Social cognition, defined as the mental operations underlying social interactions—including emotion recognition, Theory of Mind (ToM), and attributional style—is a core determinant of functional outcome in schizophrenia. Deficits in social cognition are distinct from neurocognitive impairments and serve as robust predictors of real-world functioning [ 4 , 5 ]. These deficits often manifest before the onset of overt psychosis, leading some researchers to propose ToM as a potential trait marker or vulnerability indicator for the disorder [ 6 ]. However, viewing ToM deficits solely as immutable, intrinsic traits may overlook the complex developmental interplay between the individual and their environment. The etiology of schizophrenia is increasingly understood through a gene-environment interaction framework. Numerous environmental risk factors, such as childhood trauma, urbanicity, advanced paternal age, and cannabis use, have been implicated in the pathogenesis of the disorder [ 7 , 8 ]. Accumulating evidence underscores that sociodemographic factors and psychosocial stressors are not merely background variables but play a pivotal role in modulating the clinical expression and symptomatology of psychotic disorders [ 9 – 11 ]. Exposure to these risks is thought to sensitize dopaminergic pathways or disrupt neurodevelopment, thereby increasing vulnerability to psychosis [ 11 , 12 ]. This perspective aligns with recent literature suggesting that the social environment is not merely a background context, but an active force that shapes the expression and course of mental disorders [ 13 , 14 ]. Despite the established independent links between environmental risk factors and schizophrenia, and between schizophrenia and social cognitive deficits, the intersection of these domains remains under-explored. Specifically, how environmental insults—particularly childhood trauma—might modulate ToM performance in patients with schizophrenia is not fully understood. Developmental theories suggest that early adverse experiences, such as neglect or abuse, may hinder the acquisition of mentalizing capabilities by disrupting the early social learning environment [ 15 ]. Thus, the \"social cognitive deficit\" observed in schizophrenia might, in some cases, be a \"social environmental consequence\" [ 16 ]. This study aims to investigate the relationship between specific environmental risk factors (childhood trauma, urbanicity, paternal age) and ToM impairment in patients with schizophrenia. Moving beyond simple associations, we sought to disentangle whether ToM deficits are uniform across the patient population or vary as a function of environmental risk load. Our research hypotheses are as follows: 1. Patients with schizophrenia will exhibit significant deficits in ToM performance compared to healthy controls; however, this impairment will be more pronounced in patients with a history of severe childhood trauma. 2. Specific environmental risk factors will demonstrate distinct associations with social cognitive domains; specifically, childhood trauma will negatively impact ToM, whereas factors related to social complexity, such as urbanicity, may show differential or complex relationships with social sensitivity. METHODS Participants This cross-sectional study included 54 patients with schizophrenia diagnosed according to DSM-5 criteria [ 17 ] and 37 healthy controls matched for age, gender, and education. Participants were recruited from the Gazi University Hospital outpatient clinic (June–November 2020). Exclusion criteria for all participants included neurological disorders, head trauma, and active substance use. Patients with unstable clinical conditions were excluded. Controls were screened using the SCID-5-CV to ensure the absence of psychiatric disorders [ 18 ]. The study was conducted in accordance with the Declaration of Helsinki [ 19 ]. Informed consent was obtained from all individual participants included in the study. Measures Theory of Mind Assessments: Theory of Mind Assessments: Dokuz Eylul Theory of Mind Index (DEZIKO): Developed specifically for the Turkish population by Değirmencioğlu and Çorapçıoğlu [ 20 ], the DEZIKO is a comprehensive battery designed to assess multiple facets of ToM. It consists of 16 tasks (score range: 0–16) comprising story-based and picture-based vignettes. The battery evaluates distinct social cognitive domains, including first- and second-order false beliefs, irony, metaphor, faux pas, and empathy. The DEZIKO has demonstrated high validity and reliability in both healthy controls and patients with schizophrenia [ 20 ]. Reading the Mind in the Eyes Test (RMET): The Turkish version of the RMET [ 21 ] was used to assess emotion recognition. The test was originally developed by Baron-Cohen et al. [ 22 ] to evaluate the ability to attribute mental states. Participants identify the correct emotion from photographs of the eye region (Score range: 0–32). Clinical and Trauma Assessments: Childhood Trauma Questionnaire (CTQ-28): A self-report inventory assessing five domains of maltreatment: emotional/physical abuse, sexual abuse, and emotional/physical neglect. The Turkish adaptation [ 23 ] of the original scale developed by Bernstein et al. [ 24 ] was used. Positive and Negative Syndrome Scale (PANSS): Used to assess symptom severity in patients across positive, negative, and general psychopathology subscales. We used the Turkish version [ 25 ], originally developed by Kay et al. [ 26 ]. Calgary Depression Scale for Schizophrenia (CDSS): Administered to evaluate depressive symptoms independent of negative symptoms and extrapyramidal side effects. The Turkish validity study [ 27 ] based on the original scales by Addington et al. [ 28 , 29 ] was utilized. A cut-off score of 11/12 was used to detect depressive disorder. Environmental Risk Factors Risk factors were selected based on established epidemiological associations with schizophrenia. • Urbanicity: Defined as being born in a settlement with a population greater than 20,000, following the criteria of the Ninth Development Plan [ 30 ]. • Advanced Paternal Age Defined as a paternal age of ≥ 35 years at the time of the participant's birth [ 31 ]. • Season of Birth: Births occurring between January and April were categorized as the risk period [ 32 ]. • Other factors, including perinatal complications and substance use (cigarette/cannabis), were recorded based on self-reports and clinical records. Statistical Analyses Analyses were performed using IBM SPSS Statistics [ 33 ]. Normality was assessed via the Shapiro-Wilk test. Independent samples t-tests were used for normally distributed continuous variables, while the Mann-Whitney U test was employed for non-normally distributed data. Chi-Square tests were utilized for categorical comparisons. To isolate the effect of trauma: Patients were stratified into \"High Trauma\" and \"Low Trauma\" groups (CTQ cut-off: 35). We compared ToM performance across three groups: (1) High-Trauma Patients, (2) Low-Trauma Patients, and (3) Low-Trauma Controls, using the Kruskal-Wallis test followed by post-hoc comparisons. Significance was set at p < 0.05. RESULTS Sociodemographic and Clinical Characteristics The study comprised 54 patients with schizophrenia and 37 healthy controls. Detailed sociodemographic data are presented in Table 1 . Comparisons revealed no significant differences between the groups regarding age, gender, or years of education, indicating that the matching procedure was successful. Mean scores for the PANSS and CDSS are provided in Table 1 . Notably, patients reported significantly higher levels of childhood adversity across all domains of the Childhood Trauma Questionnaire (CTQ) compared to healthy controls (p < 0.001). Table 1 Sociodemographic and clinical characteristics of the participants Characteristic Patients with Schizophrenia (n = 54) Healthy Controls (n = 37) Test Statistic p-value Age (years), Mean ± SD 40.89 ± 11.43 38.76 ± 10.56 t = 0.908 0.366 Gender, n (%) χ2 = 0.586 0.444 Female 23 (42.6%) 19 (51.4%) Male 31 (57.4%) 18 (48.6%) Education (years), Mean ± SD 11.26 ± 3.54 12.57 ± 3.28 t = -1.770 0.08 Marital Status, n (%) χ2 = 11.235 0.004* Single 33 (61.1%) 11 (29.7%) Married 18 (33.3%) 25 (67.6%) Divorced/Widowed 3 (5.6%) 1 (2.7%) Clinical Measures, Mean ± SD PANSS Total 65.63 ± 17.17 - - - PANSS Positive 15.96 ± 6.56 - - - PANSS Negative 17.56 ± 7.72 - - - PANSS General 32.11 ± 8.49 - - - CDSS Total 2.85 ± 3.26 - - - Trauma Scores (CTQ), Mean ± SD CTQ Total Score 43.28 ± 15.27 31.89 ± 6.49 U = 498.0 < 0.001* Notes: SD: Standard Deviation; PANSS: Positive and Negative Syndrome Scale; CDSS: Calgary Depression Scale for Schizophrenia; CTQ: Childhood Trauma Questionnaire. *Statistically significant differences (p < 0.05). Statistical tests: Independent samples t-test, Chi-square test (χ2) or Mann-Whitney U test (U) as appropriate. Theory of Mind Performance and Clinical Correlations In the overall comparison, patients with schizophrenia demonstrated significant deficits in social cognition compared to healthy controls. Controls outperformed patients on the RMET and most DEZIKO subdomains, including false belief and irony tasks (Table 2 ). Correlation analyses revealed distinct associations between clinical symptoms and social cognitive performance. A significant negative correlation was found between negative symptom severity (PANSS-Negative) and empathy scores on the DEZIKO (r = -0.349, p < 0.01). Interestingly, positive symptom severity showed a positive correlation with physical abuse scores (r = 0.298, p < 0.05). Regarding cognitive reserve, years of education were positively correlated with RMET scores (r = 0.289, p < 0.05) and DEZIKO Total scores (r = 0.373, p < 0.01) within the patient group. Table 2 Comparison of Theory of Mind (ToM) performance between groups ToM Measure (Mean ± SD) Patients with Schizophrenia (n = 54) Healthy Controls (n = 37) p-value a RMET Total Score 19.59 ± 4.28 23.73 ± 3.52 < 0.001* DEZIKO Total Score 10.39 ± 3.54 12.92 ± 2.13 < 0.001* DEZIKO Subscales 1st Order False Belief 0.72 ± 0.45 0.92 ± 0.28 0.023* 2nd Order False Belief 0.56 ± 0.50 0.89 ± 0.31 0.001* Irony 1.41 ± 0.79 1.76 ± 0.49 0.021* Metaphor 1.48 ± 0.72 1.78 ± 0.48 0.061 Empathy 0.69 ± 0.47 0.86 ± 0.35 0.068 Faux Pas 1.20 ± 0.59 1.38 ± 0.55 0.142 Notes: RMET: Reading the Mind in the Eyes Test; DEZIKO: Dokuz Eylül Theory of Mind Index. a p-values derived from Mann-Whitney U tests due to non-normal distribution of ToM scores. *Statistically significant differences (p < 0.05). , Impact of Environmental Risk Factors on Social Cognition We examined the influence of specific environmental risk factors—urbanicity and paternal age—on ToM performance using subgroup analyses (Table 3 ). Table 3 Impact of environmental risk factors on specific ToM domains within the patient group (n = 54) Risk Factor Subgroups n ToM Measure Mean ± SD p-value a Urbanicity RMET Score Rural Residence 21 17.81 ± 4.02 Urban Residence 33 20.73 ± 4.06 0.011* Paternal Age DEZIKO Faux Pas Score Paternal Age < 35 43 1.30 ± 0.56 Paternal Age ≥ 35 11 0.82 ± 0.60 0.015* Notes: RMET: Reading the Mind in the Eyes Test a p-values derived from Mann-Whitney U tests based on mean ranks.*Statistically significant differences (p < 0.05). Urbanicity: Current residence showed a significant effect on emotion recognition. Patients residing in urban areas had significantly higher RMET scores (Mean: 20.73 ± 4.06) compared to those living in rural areas (Mean: 17.81 ± 4.02) (U = 205, p < 0.05). Paternal Age: A significant relationship was observed between paternal age and the ability to detect social faux pas. Patients with younger fathers (< 35 years) exhibited significantly higher scores on the DEZIKO-Faux Pas task (Mean: 1.30 ± 0.56) compared to those with advanced paternal age (Mean: 0.82 ± 0.60) (U = 143.5, p < 0.05). Other Factors: No significant correlations were found between ToM performance and other recorded risk factors, including season of birth, urban birth, or history of obstetric complications. The Specific Role of Childhood Trauma: A Stratified Analysis To disentangle the impact of childhood trauma from the pathophysiology of schizophrenia, we compared three groups: (1) High-Trauma Patients (CTQ > 35), (2) Low-Trauma Patients (CTQ ≤ 35), and (3) Low-Trauma Healthy Controls (Table 4 ). The analysis revealed a graded effect of trauma on social cognitive performance: Table 4 Stratified analysis of ToM performance based on trauma exposure Group 1: High-Trauma Patients (CTQ > 35) (n = 33) Group 2: Low-Trauma Patients (CTQ ≤ 35) (n = 21) Group 3: Low-Trauma Controls (CTQ ≤ 35) (n = 29) ToM Measure Mean ± SD Mean ± SD Mean ± SD Overall p-value a RMET Total 18.39 ± 4.47 21.48 ± 3.17 23.93 ± 3.70 < 0.001* DEZIKO Total 9.58 ± 3.91 11.67 ± 2.44 12.90 ± 2.23 < 0.001* 1st Order False Belief 0.61 ± 0.49 0.90 ± 0.30 0.90 ± 0.31 0.008* 2nd Order False Belief 0.39 ± 0.49 0.81 ± 0.40 0.90 ± 0.31 < 0.001* This table compares high-trauma patients, low-trauma patients, and low-trauma controls to disentangle the effects of trauma from the diagnosis. Notes: CTQ: Childhood Trauma Questionnaire; RMET: Reading the Mind in the Eyes Test; DEZIKO: Dokuz Eylül Theory of Mind Index. a p-values derived from Kruskal-Wallis tests across the three groups. Post-hoc comparisons (described in the text) revealed significant differences primarily between Group 1 vs. Group 3, and Group 1 vs. Group 2. *Statistically significant differences (p < 0.05). RMET: High-Trauma patients scored significantly lower than both the Control group (p = 0.006) and the Low-Trauma patient group (p = 0.018). Importantly, Low-Trauma patients did not differ significantly from controls. DEZIKO Total: A similar pattern was observed for global ToM performance. High-Trauma patients showed significantly poorer performance compared to controls (p = 0.026), whereas Low-Trauma patients performed comparably to controls. False Belief: In specific subdomains, High-Trauma patients performed significantly worse on first-order false belief tasks compared to both controls (p = 0.020) and low-trauma patients (p = 0.039). For second-order false belief tasks, High-Trauma patients again exhibited the poorest performance (p = 0.001 vs. controls; p = 0.021 vs. low-trauma patients). These findings indicate that while schizophrenia is associated with general social cognitive vulnerabilities, the presence of severe childhood trauma significantly exacerbates these impairments, particularly in emotion recognition and mentalizing tasks. DISCUSSION Social cognition deficits are well-established determinants of functional outcome in schizophrenia [ 4 , 5 ]. While these deficits are often considered intrinsic trait markers of the disorder, our study aimed to disentangle the contribution of environmental risk factors—specifically childhood trauma, urbanicity, and paternal age—to this impairment. The most striking finding of our study is that while patients generally performed worse than controls, patients with low childhood trauma exposure exhibited ToM performances comparable to healthy controls. This suggests that the severe social cognitive deficits frequently reported in schizophrenia literature may be partially driven, or at least significantly exacerbated, by comorbid trauma history rather than the psychotic process alone. Our results align with the growing body of literature linking childhood maltreatment to social cognitive impairment in both clinical and non-clinical populations [ 6 , 16 ]. Specifically, we found that physical neglect was a potent predictor of deficits in empathy and faux pas recognition. As suggested by attachment theory, early neglect may deprive the developing brain of the crucial social inputs required to build a robust \"mentalizing\" capacity [ 15 ]. Unlike abuse, which may trigger hyper-vigilance to threat-related cues, neglect represents an absence of social mirroring. This lack of early social scaffolding likely hinders the development of neural networks necessary for interpreting implicit emotional expressions and social interactions [ 34 , 35 ]. Consequently, the \"ToM deficit\" observed in schizophrenia might, in some cases, be a \"trauma deficit.\" Regarding specific ToM domains, high-trauma patients scored significantly lower on the DEZIKO total scores compared to low-trauma controls. The fact that low-trauma patients did not differ significantly from controls challenges the notion of ToM impairment as an immutable, uniform feature of schizophrenia. Instead, it supports a \"double-hit\" hypothesis where environmental insults during formative years compound the neurodevelopmental vulnerabilities associated with psychosis, leading to profound social cognitive failure. Interestingly, our study revealed a counter-intuitive positive correlation between urbanicity and performance on the Reading the Mind in the Eyes Test (RMET). While urban upbringing is a well-documented risk factor for the development of schizophrenia [ 36 ], our data suggest a \"social stimulation\" effect. Urban environments, characterized by higher population density and complex social networks, may force individuals to engage in more frequent and varied social processing [ 37 ]. This repeated exposure to diverse mental states may act as a form of natural cognitive training, potentially creating a \"social cognitive reserve\" [ 38 ]. Our observation that urban residence is associated with better emotion recognition provides a counter-narrative to the view of urbanicity solely as a risk factor. This finding gains critical context when considered alongside recent data from Kaminska et al., who reported that rural status is associated with a longer duration of untreated psychosis (DUP) compared to urban settings [ 39 ]. Taken together, these findings suggest that patients in rural environments may face a cumulative disadvantage: a lack of intense social cognitive stimulation combined with delayed access to early intervention, both of which may exacerbate ToM deficits. This finding warrants further investigation with larger samples to separate the effects of social drift and social causation. We also observed that advanced paternal age was associated with poorer faux pas recognition in patients. This aligns with findings suggesting that offspring of older fathers have a higher likelihood of subtle neurodevelopmental impairments, possibly due to de novo mutations or epigenetic alterations [ 40 , 41 ]. Furthermore, older parenthood might be associated with different interactional styles or reduced play-based social engagement, which are critical for the maturation of social cognition [ 42 ]. Limitations and Conclusion Several limitations should be considered when interpreting these results. First, the cross-sectional design precludes causal inferences; while we observe strong associations between trauma and ToM deficits, we cannot definitively rule out reverse causality or the influence of unmeasured confounders. Second, the sample size was relatively modest, which limited our ability to perform advanced regression models to control for all potential covariates simultaneously. Third, trauma history was obtained via retrospective self-report (CTQ), which is susceptible to recall bias, although this is a standard limitation in trauma research. Finally, the \"urbanicity\" variable requires more granular definition in future studies, considering population density and neighborhood socioeconomic status. Despite these limitations, this study provides preliminary evidence that environmental factors play a crucial, modifying role in the social cognitive profile of schizophrenia. The finding that low-trauma patients preserve relatively intact ToM abilities holds significant clinical implications. It suggests that \"one-size-fits-all\" cognitive remediation may be insufficient. Instead, trauma-informed interventions targeting emotional regulation and re-processing of early adverse experiences may be essential for improving social functioning in patients with a history of maltreatment. Future longitudinal research should focus on whether treating trauma symptoms can lead to recovery in social cognitive abilities. Declarations Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Conflicts of Interest: The authors have no relevant financial or non-financial interests to disclose. Ethical Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Gazi University (Date: 07.04.2020, No: 04). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8615636\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":575383908,\"identity\":\"0e009191-1c4e-4078-a58c-2638be6992fe\",\"order_by\":0,\"name\":\"Saba 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University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rukiye\",\"middleName\":\"Filiz\",\"lastName\":\"Karadag\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-01-16 06:20:03\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":false,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-8615636/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8615636/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":100545364,\"identity\":\"ff1bf82f-4fc8-4066-9213-77e79abe059d\",\"added_by\":\"auto\",\"created_at\":\"2026-01-19 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06:28:18\",\"extension\":\"html\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":104708,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8615636/v1/67611b705945ed2b0973685d.html\"},{\"id\":100549057,\"identity\":\"3f7db815-0980-4f58-adcb-4b2ce973fbe4\",\"added_by\":\"auto\",\"created_at\":\"2026-01-19 08:22:14\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":731639,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8615636/v1/0f959983-73d6-429c-afae-156c9b189eb0.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eImpact of Trauma, Urbanicity, and Paternal Age on Theory of Mind in Schizophrenia\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eSchizophrenia remains one of the most debilitating psychiatric disorders, placing a substantial burden on individuals and healthcare systems due to high morbidity and mortality rates [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. While early detection and intervention are critical public health objectives, the heterogeneous nature of the disorder complicates risk prediction and prevention strategies [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Consequently, there is a pressing need to identify measurable markers that can stratify risk and inform personalized treatment approaches, akin to risk calculation models used in cardiovascular medicine [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSocial cognition, defined as the mental operations underlying social interactions\\u0026mdash;including emotion recognition, Theory of Mind (ToM), and attributional style\\u0026mdash;is a core determinant of functional outcome in schizophrenia. Deficits in social cognition are distinct from neurocognitive impairments and serve as robust predictors of real-world functioning [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. These deficits often manifest before the onset of overt psychosis, leading some researchers to propose ToM as a potential trait marker or vulnerability indicator for the disorder [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. However, viewing ToM deficits solely as immutable, intrinsic traits may overlook the complex developmental interplay between the individual and their environment.\\u003c/p\\u003e \\u003cp\\u003eThe etiology of schizophrenia is increasingly understood through a gene-environment interaction framework. Numerous environmental risk factors, such as childhood trauma, urbanicity, advanced paternal age, and cannabis use, have been implicated in the pathogenesis of the disorder [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Accumulating evidence underscores that sociodemographic factors and psychosocial stressors are not merely background variables but play a pivotal role in modulating the clinical expression and symptomatology of psychotic disorders [\\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Exposure to these risks is thought to sensitize dopaminergic pathways or disrupt neurodevelopment, thereby increasing vulnerability to psychosis [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. This perspective aligns with recent literature suggesting that the social environment is not merely a background context, but an active force that shapes the expression and course of mental disorders [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDespite the established independent links between environmental risk factors and schizophrenia, and between schizophrenia and social cognitive deficits, the intersection of these domains remains under-explored. Specifically, how environmental insults\\u0026mdash;particularly childhood trauma\\u0026mdash;might modulate ToM performance in patients with schizophrenia is not fully understood. Developmental theories suggest that early adverse experiences, such as neglect or abuse, may hinder the acquisition of mentalizing capabilities by disrupting the early social learning environment [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Thus, the \\\"social cognitive deficit\\\" observed in schizophrenia might, in some cases, be a \\\"social environmental consequence\\\" [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study aims to investigate the relationship between specific environmental risk factors (childhood trauma, urbanicity, paternal age) and ToM impairment in patients with schizophrenia. Moving beyond simple associations, we sought to disentangle whether ToM deficits are uniform across the patient population or vary as a function of environmental risk load.\\u003c/p\\u003e \\u003cp\\u003eOur research hypotheses are as follows:\\u003c/p\\u003e \\u003cp\\u003e1. Patients with schizophrenia will exhibit significant deficits in ToM performance compared to healthy controls; however, this impairment will be more pronounced in patients with a history of severe childhood trauma.\\u003c/p\\u003e \\u003cp\\u003e2. Specific environmental risk factors will demonstrate distinct associations with social cognitive domains; specifically, childhood trauma will negatively impact ToM, whereas factors related to social complexity, such as urbanicity, may show differential or complex relationships with social sensitivity.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eParticipants\\u003c/h2\\u003e \\u003cp\\u003eThis cross-sectional study included 54 patients with schizophrenia diagnosed according to DSM-5 criteria [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e] and 37 healthy controls matched for age, gender, and education. Participants were recruited from the Gazi University Hospital outpatient clinic (June\\u0026ndash;November 2020). Exclusion criteria for all participants included neurological disorders, head trauma, and active substance use. Patients with unstable clinical conditions were excluded. Controls were screened using the SCID-5-CV to ensure the absence of psychiatric disorders [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. The study was conducted in accordance with the Declaration of Helsinki [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Informed consent was obtained from all individual participants included in the study.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eMeasures\\u003c/h3\\u003e\\n\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheory of Mind Assessments:\\u003c/h2\\u003e \\u003cp\\u003eTheory of Mind Assessments: Dokuz Eylul Theory of Mind Index (DEZIKO): Developed specifically for the Turkish population by Değirmencioğlu and \\u0026Ccedil;orap\\u0026ccedil;ıoğlu [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], the DEZIKO is a comprehensive battery designed to assess multiple facets of ToM. It consists of 16 tasks (score range: 0\\u0026ndash;16) comprising story-based and picture-based vignettes. The battery evaluates distinct social cognitive domains, including first- and second-order false beliefs, irony, metaphor, faux pas, and empathy. The DEZIKO has demonstrated high validity and reliability in both healthy controls and patients with schizophrenia [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eReading the Mind in the Eyes Test (RMET): The Turkish version of the RMET [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e] was used to assess emotion recognition. The test was originally developed by Baron-Cohen et al. [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e] to evaluate the ability to attribute mental states. Participants identify the correct emotion from photographs of the eye region (Score range: 0\\u0026ndash;32).\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eClinical and Trauma Assessments:\\u003c/h3\\u003e\\n\\u003cp\\u003eChildhood Trauma Questionnaire (CTQ-28): A self-report inventory assessing five domains of maltreatment: emotional/physical abuse, sexual abuse, and emotional/physical neglect. The Turkish adaptation [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e] of the original scale developed by Bernstein et al. [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e] was used. Positive and Negative Syndrome Scale (PANSS): Used to assess symptom severity in patients across positive, negative, and general psychopathology subscales. We used the Turkish version [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e], originally developed by Kay et al. [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Calgary Depression Scale for Schizophrenia (CDSS): Administered to evaluate depressive symptoms independent of negative symptoms and extrapyramidal side effects. The Turkish validity study [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e] based on the original scales by Addington et al. [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e] was utilized. A cut-off score of 11/12 was used to detect depressive disorder.\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eEnvironmental Risk Factors\\u003c/strong\\u003e \\u003cp\\u003eRisk factors were selected based on established epidemiological associations with schizophrenia.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Urbanicity: Defined as being born in a settlement with a population greater than 20,000, following the criteria of the Ninth Development Plan [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Advanced Paternal Age Defined as a paternal age of \\u0026ge;\\u0026thinsp;35 years at the time of the participant's birth [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Season of Birth: Births occurring between January and April were categorized as the risk period [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Other factors, including perinatal complications and substance use (cigarette/cannabis), were recorded based on self-reports and clinical records.\\u003c/p\\u003e\\n\\u003ch3\\u003eStatistical Analyses\\u003c/h3\\u003e\\n\\u003cp\\u003eAnalyses were performed using IBM SPSS Statistics [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Normality was assessed via the Shapiro-Wilk test. Independent samples t-tests were used for normally distributed continuous variables, while the Mann-Whitney U test was employed for non-normally distributed data. Chi-Square tests were utilized for categorical comparisons. To isolate the effect of trauma: Patients were stratified into \\\"High Trauma\\\" and \\\"Low Trauma\\\" groups (CTQ cut-off: 35). We compared ToM performance across three groups: (1) High-Trauma Patients, (2) Low-Trauma Patients, and (3) Low-Trauma Controls, using the Kruskal-Wallis test followed by post-hoc comparisons. Significance was set at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSociodemographic and Clinical Characteristics\\u003c/h2\\u003e \\u003cp\\u003eThe study comprised 54 patients with schizophrenia and 37 healthy controls. Detailed sociodemographic data are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Comparisons revealed no significant differences between the groups regarding age, gender, or years of education, indicating that the matching procedure was successful. Mean scores for the PANSS and CDSS are provided in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Notably, patients reported significantly higher levels of childhood adversity across all domains of the Childhood Trauma Questionnaire (CTQ) compared to healthy controls (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSociodemographic and clinical characteristics of the participants\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients with Schizophrenia (n\\u0026thinsp;=\\u0026thinsp;54)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHealthy Controls (n\\u0026thinsp;=\\u0026thinsp;37)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTest Statistic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years), Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40.89\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38.76\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003et\\u0026thinsp;=\\u0026thinsp;0.908\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.366\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eχ2\\u0026thinsp;=\\u0026thinsp;0.586\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.444\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23 (42.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19 (51.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e31 (57.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18 (48.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation (years), Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003et = -1.770\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarital Status, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eχ2\\u0026thinsp;=\\u0026thinsp;11.235\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.004*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33 (61.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (29.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18 (33.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25 (67.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDivorced/Widowed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (5.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (2.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical Measures, Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePANSS Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e65.63\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePANSS Positive\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15.96\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePANSS Negative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17.56\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePANSS General\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCDSS Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTrauma Scores (CTQ), Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCTQ Total Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43.28\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31.89\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eU\\u0026thinsp;=\\u0026thinsp;498.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003cem\\u003eNotes: SD: Standard Deviation; PANSS: Positive and Negative Syndrome Scale; CDSS: Calgary Depression Scale for Schizophrenia; CTQ: Childhood Trauma Questionnaire. *Statistically significant differences (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Statistical tests: Independent samples t-test, Chi-square test (χ2) or Mann-Whitney U test (U) as appropriate.\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eTheory of Mind Performance and Clinical Correlations\\u003c/h3\\u003e\\n\\u003cp\\u003eIn the overall comparison, patients with schizophrenia demonstrated significant deficits in social cognition compared to healthy controls. Controls outperformed patients on the RMET and most DEZIKO subdomains, including false belief and irony tasks (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Correlation analyses revealed distinct associations between clinical symptoms and social cognitive performance. A significant negative correlation was found between negative symptom severity (PANSS-Negative) and empathy scores on the DEZIKO (r = -0.349, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). Interestingly, positive symptom severity showed a positive correlation with physical abuse scores (r\\u0026thinsp;=\\u0026thinsp;0.298, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Regarding cognitive reserve, years of education were positively correlated with RMET scores (r\\u0026thinsp;=\\u0026thinsp;0.289, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and DEZIKO Total scores (r\\u0026thinsp;=\\u0026thinsp;0.373, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01) within the patient group.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of Theory of Mind (ToM) performance between groups\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eToM Measure (Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients with Schizophrenia (n\\u0026thinsp;=\\u0026thinsp;54)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHealthy Controls (n\\u0026thinsp;=\\u0026thinsp;37)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRMET Total Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19.59\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDEZIKO Total Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12.92\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDEZIKO Subscales\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1st Order False Belief\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.92\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.023*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2nd Order False Belief\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.56\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.89\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIrony\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.41\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.76\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.021*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMetaphor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.061\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmpathy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.69\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.068\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFaux Pas\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.38\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.142\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003cem\\u003eNotes: RMET: Reading the Mind in the Eyes Test; DEZIKO: Dokuz Eyl\\u0026uuml;l Theory of Mind Index.\\u003c/em\\u003e \\u003csup\\u003ea\\u003c/sup\\u003e\\u003cem\\u003ep-values derived from Mann-Whitney U tests due to non-normal distribution of ToM scores. *Statistically significant differences (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/em\\u003e,\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImpact of Environmental Risk Factors on Social Cognition\\u003c/h2\\u003e \\u003cp\\u003eWe examined the influence of specific environmental risk factors\\u0026mdash;urbanicity and paternal age\\u0026mdash;on ToM performance using subgroup analyses (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eImpact of environmental risk factors on specific ToM domains within the patient group (n\\u0026thinsp;=\\u0026thinsp;54)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRisk Factor Subgroups\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eToM Measure\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep-value\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUrbanicity\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRMET Score\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRural Residence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUrban Residence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.011*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePaternal Age\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDEZIKO Faux Pas Score\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePaternal Age\\u0026thinsp;\\u0026lt;\\u0026thinsp;35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePaternal Age\\u0026thinsp;\\u0026ge;\\u0026thinsp;35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.015*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003cem\\u003eNotes: RMET: Reading the Mind in the Eyes Test\\u003c/em\\u003e \\u003csup\\u003e\\u003cem\\u003ea\\u003c/em\\u003e\\u003c/sup\\u003e\\u003cem\\u003ep-values derived from Mann-Whitney U tests based on mean ranks.*Statistically significant differences (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eUrbanicity: Current residence showed a significant effect on emotion recognition. Patients residing in urban areas had significantly higher RMET scores (Mean: 20.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.06) compared to those living in rural areas (Mean: 17.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.02) (U\\u0026thinsp;=\\u0026thinsp;205, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003ePaternal Age: A significant relationship was observed between paternal age and the ability to detect social faux pas. Patients with younger fathers (\\u0026lt;\\u0026thinsp;35 years) exhibited significantly higher scores on the DEZIKO-Faux Pas task (Mean: 1.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.56) compared to those with advanced paternal age (Mean: 0.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.60) (U\\u0026thinsp;=\\u0026thinsp;143.5, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003eOther Factors: No significant correlations were found between ToM performance and other recorded risk factors, including season of birth, urban birth, or history of obstetric complications.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe Specific Role of Childhood Trauma: A Stratified Analysis\\u003c/h2\\u003e \\u003cp\\u003eTo disentangle the impact of childhood trauma from the pathophysiology of schizophrenia, we compared three groups: (1) High-Trauma Patients (CTQ\\u0026thinsp;\\u0026gt;\\u0026thinsp;35), (2) Low-Trauma Patients (CTQ\\u0026thinsp;\\u0026le;\\u0026thinsp;35), and (3) Low-Trauma Healthy Controls (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). The analysis revealed a graded effect of trauma on social cognitive performance:\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eStratified analysis of ToM performance based on trauma exposure\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup 1: High-Trauma Patients (CTQ\\u0026thinsp;\\u0026gt;\\u0026thinsp;35) (n\\u0026thinsp;=\\u0026thinsp;33)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eGroup 2: Low-Trauma Patients (CTQ\\u0026thinsp;\\u0026le;\\u0026thinsp;35) (n\\u0026thinsp;=\\u0026thinsp;21)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGroup 3: Low-Trauma Controls (CTQ\\u0026thinsp;\\u0026le;\\u0026thinsp;35) (n\\u0026thinsp;=\\u0026thinsp;29)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eToM Measure\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eOverall p-value\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRMET Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDEZIKO Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1st Order False Belief\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.008*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2nd Order False Belief\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eThis table compares high-trauma patients, low-trauma patients, and low-trauma controls to disentangle the effects of trauma from the diagnosis.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003cem\\u003eNotes: CTQ: Childhood Trauma Questionnaire; RMET: Reading the Mind in the Eyes Test; DEZIKO: Dokuz Eyl\\u0026uuml;l Theory of Mind Index.\\u003c/em\\u003e \\u003csup\\u003e\\u003cem\\u003ea\\u003c/em\\u003e\\u003c/sup\\u003e\\u003cem\\u003ep-values derived from Kruskal-Wallis tests across the three groups. Post-hoc comparisons (described in the text) revealed significant differences primarily between Group 1 vs. Group 3, and Group 1 vs. Group 2. *Statistically significant differences (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eRMET: High-Trauma patients scored significantly lower than both the Control group (p\\u0026thinsp;=\\u0026thinsp;0.006) and the Low-Trauma patient group (p\\u0026thinsp;=\\u0026thinsp;0.018). Importantly, Low-Trauma patients did not differ significantly from controls.\\u003c/p\\u003e \\u003cp\\u003eDEZIKO Total: A similar pattern was observed for global ToM performance. High-Trauma patients showed significantly poorer performance compared to controls (p\\u0026thinsp;=\\u0026thinsp;0.026), whereas Low-Trauma patients performed comparably to controls.\\u003c/p\\u003e \\u003cp\\u003eFalse Belief: In specific subdomains, High-Trauma patients performed significantly worse on first-order false belief tasks compared to both controls (p\\u0026thinsp;=\\u0026thinsp;0.020) and low-trauma patients (p\\u0026thinsp;=\\u0026thinsp;0.039). For second-order false belief tasks, High-Trauma patients again exhibited the poorest performance (p\\u0026thinsp;=\\u0026thinsp;0.001 vs. controls; p\\u0026thinsp;=\\u0026thinsp;0.021 vs. low-trauma patients). These findings indicate that while schizophrenia is associated with general social cognitive vulnerabilities, the presence of severe childhood trauma significantly exacerbates these impairments, particularly in emotion recognition and mentalizing tasks.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eSocial cognition deficits are well-established determinants of functional outcome in schizophrenia [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. While these deficits are often considered intrinsic trait markers of the disorder, our study aimed to disentangle the contribution of environmental risk factors—specifically childhood trauma, urbanicity, and paternal age—to this impairment. The most striking finding of our study is that while patients generally performed worse than controls, patients with low childhood trauma exposure exhibited ToM performances comparable to healthy controls. This suggests that the severe social cognitive deficits frequently reported in schizophrenia literature may be partially driven, or at least significantly exacerbated, by comorbid trauma history rather than the psychotic process alone.\\u003c/p\\u003e \\u003cp\\u003eOur results align with the growing body of literature linking childhood maltreatment to social cognitive impairment in both clinical and non-clinical populations [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Specifically, we found that physical neglect was a potent predictor of deficits in empathy and faux pas recognition. As suggested by attachment theory, early neglect may deprive the developing brain of the crucial social inputs required to build a robust \\\"mentalizing\\\" capacity [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Unlike abuse, which may trigger hyper-vigilance to threat-related cues, neglect represents an absence of social mirroring. This lack of early social scaffolding likely hinders the development of neural networks necessary for interpreting implicit emotional expressions and social interactions [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Consequently, the \\\"ToM deficit\\\" observed in schizophrenia might, in some cases, be a \\\"trauma deficit.\\\"\\u003c/p\\u003e \\u003cp\\u003eRegarding specific ToM domains, high-trauma patients scored significantly lower on the DEZIKO total scores compared to low-trauma controls. The fact that low-trauma patients did not differ significantly from controls challenges the notion of ToM impairment as an immutable, uniform feature of schizophrenia. Instead, it supports a \\\"double-hit\\\" hypothesis where environmental insults during formative years compound the neurodevelopmental vulnerabilities associated with psychosis, leading to profound social cognitive failure.\\u003c/p\\u003e \\u003cp\\u003eInterestingly, our study revealed a counter-intuitive positive correlation between urbanicity and performance on the Reading the Mind in the Eyes Test (RMET). While urban upbringing is a well-documented risk factor for the development of schizophrenia [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e], our data suggest a \\\"social stimulation\\\" effect. Urban environments, characterized by higher population density and complex social networks, may force individuals to engage in more frequent and varied social processing [\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. This repeated exposure to diverse mental states may act as a form of natural cognitive training, potentially creating a \\\"social cognitive reserve\\\" [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. Our observation that urban residence is associated with better emotion recognition provides a counter-narrative to the view of urbanicity solely as a risk factor. This finding gains critical context when considered alongside recent data from Kaminska et al., who reported that rural status is associated with a longer duration of untreated psychosis (DUP) compared to urban settings [\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. Taken together, these findings suggest that patients in rural environments may face a cumulative disadvantage: a lack of intense social cognitive stimulation combined with delayed access to early intervention, both of which may exacerbate ToM deficits. This finding warrants further investigation with larger samples to separate the effects of social drift and social causation.\\u003c/p\\u003e \\u003cp\\u003eWe also observed that advanced paternal age was associated with poorer faux pas recognition in patients. This aligns with findings suggesting that offspring of older fathers have a higher likelihood of subtle neurodevelopmental impairments, possibly due to de novo mutations or epigenetic alterations [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]. Furthermore, older parenthood might be associated with different interactional styles or reduced play-based social engagement, which are critical for the maturation of social cognition [\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e].\\u003c/p\\u003e \"},{\"header\":\"Limitations and Conclusion\",\"content\":\"\\u003cp\\u003eSeveral limitations should be considered when interpreting these results. First, the cross-sectional design precludes causal inferences; while we observe strong associations between trauma and ToM deficits, we cannot definitively rule out reverse causality or the influence of unmeasured confounders. Second, the sample size was relatively modest, which limited our ability to perform advanced regression models to control for all potential covariates simultaneously. Third, trauma history was obtained via retrospective self-report (CTQ), which is susceptible to recall bias, although this is a standard limitation in trauma research. Finally, the \\\"urbanicity\\\" variable requires more granular definition in future studies, considering population density and neighborhood socioeconomic status.\\u003c/p\\u003e\\u003cp\\u003eDespite these limitations, this study provides preliminary evidence that environmental factors play a crucial, modifying role in the social cognitive profile of schizophrenia. The finding that low-trauma patients preserve relatively intact ToM abilities holds significant clinical implications. It suggests that \\\"one-size-fits-all\\\" cognitive remediation may be insufficient. Instead, trauma-informed interventions targeting emotional regulation and re-processing of early adverse experiences may be essential for improving social functioning in patients with a history of maltreatment. Future longitudinal research should focus on whether treating trauma symptoms can lead to recovery in social cognitive abilities.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eFunding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eConflicts of Interest: The authors have no relevant financial or non-financial interests to disclose.\\u003c/p\\u003e\\n\\u003cp\\u003eEthical Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Gazi University (Date: 07.04.2020, No: 04).\\u003c/p\\u003e\\n\\u003cp\\u003eConsent to Participate: Informed consent was obtained from all individual participants included in the study.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthor Contributions: S.C. collected the data, performed the analysis, and wrote the main manuscript text. R.F.K. supervised the project and edited the manuscript. All authors reviewed the manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eKeepers GA, Fochtmann LJ, Anzia JM, Hilty DM (2020) The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 177:868\\u0026ndash;872\\u003c/li\\u003e\\n \\u003cli\\u003eFusar-Poli P, Salazar de Pablo G, Correll CU, Carpenter WT (2020) Prevention of psychosis: advances in detection, prognosis, and intervention. JAMA Psychiatry 77:755\\u0026ndash;765\\u003c/li\\u003e\\n \\u003cli\\u003eLloyd-Jones DM, Wilson PW, Larson MG, Levy D (2004) Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol 94:20\\u0026ndash;24\\u003c/li\\u003e\\n \\u003cli\\u003eGreen MF, Horan WP, Lee J (2015) Social cognition in schizophrenia. Nat Rev Neurosci 16:620\\u0026ndash;631\\u003c/li\\u003e\\n \\u003cli\\u003eGreen MF, Horan WP, Lee J (2019) Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry 18:146\\u0026ndash;161\\u003c/li\\u003e\\n \\u003cli\\u003eBora E, Walterfang M, Velakoulis D (2015) Theory of mind in schizophrenia: a systematic review and meta-analysis. Schizophr Res 169:493\\u0026ndash;494\\u003c/li\\u003e\\n \\u003cli\\u003eFusar-Poli P, Tantardini M, De Simone S, McGuire P (2017) Deconstructing vulnerability for psychosis: meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk. Eur Psychiatry 40:65\\u0026ndash;75\\u003c/li\\u003e\\n \\u003cli\\u003evan Os J, Kenis G, Rutten BP (2010) The environment and schizophrenia. Nature 468:203\\u0026ndash;212\\u003c/li\\u003e\\n \\u003cli\\u003eMaciukiewicz M, Pawlak J, Kapelski P, Hauser J (2016) Can psychological, social and demographical factors predict clinical characteristics symptomatology of bipolar affective disorder and schizophrenia? Psychiatr Q 87:501\\u0026ndash;513\\u003c/li\\u003e\\n \\u003cli\\u003eAlameda L, Rodriguez V, Trotta G, Mousseau P, Howard R, Quigley H, Murray RM (2021) Association of psychological and social factors with psychotic experiences and disorders: an umbrella review. Schizophr Bull 47:594\\u0026ndash;603\\u003c/li\\u003e\\n \\u003cli\\u003eMurlanova K, Pletnikov MV (2023) Modeling psychotic disorders: environment x environment interaction. Neurosci Biobehav Rev 152:105310\\u003c/li\\u003e\\n \\u003cli\\u003eHowes OD, Murray RM (2014) The integrated sociodevelopmental cognitive model of schizophrenia. Schizophr Bull 40:220\\u0026ndash;225\\u003c/li\\u003e\\n \\u003cli\\u003evan Os J, Reininghaus U (2016) Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 15:118\\u0026ndash;124\\u003c/li\\u003e\\n \\u003cli\\u003eKirmayer LJ (2025) The place of the social in psychiatry: from structural determinants to the ecology of mind. Soc Psychiatry Psychiatr Epidemiol 60:771\\u0026ndash;783\\u003c/li\\u003e\\n \\u003cli\\u003eFonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Prim Psychiatry 16:43\\u0026ndash;52\\u003c/li\\u003e\\n \\u003cli\\u003eQuid\\u0026eacute; Y, Cohen RA, Hellewell SC, Green MJ (2020) Theory of mind in schizophrenia and bipolar disorder with a history of childhood trauma. 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Noropsikiyatri Arsivi 55:303\\u003c/li\\u003e\\n \\u003cli\\u003eYıldırım EA, Kaşar M, G\\u0026uuml;d\\u0026uuml;k M, G\\u0026ouml;ka E (2011) G\\u0026ouml;zlerden Zihin Okuma Testi\\u0026rsquo;nin (GZOT) T\\u0026uuml;rk\\u0026ccedil;e g\\u0026uuml;venirlik ve ge\\u0026ccedil;erlilik \\u0026ccedil;alışması. Noropsikiyatri Arsivi 48:177\\u0026ndash;186\\u003c/li\\u003e\\n \\u003cli\\u003eBaron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I (2001) The \\u0026ldquo;Reading the Mind in the Eyes\\u0026rdquo; Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry 42:241\\u0026ndash;251\\u003c/li\\u003e\\n \\u003cli\\u003eŞar V, \\u0026Ouml;zt\\u0026uuml;rk E, İkikardeş E (2012) Validity and reliability of the Turkish version of Childhood Trauma Questionnaire. Turkiye Klinikleri J Med Sci 32:1054\\u0026ndash;1063\\u003c/li\\u003e\\n \\u003cli\\u003eBernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Zule W (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 27:169\\u0026ndash;190\\u003c/li\\u003e\\n \\u003cli\\u003eKostakoğlu AE, Batur S, Tiryaki A, G\\u0026ouml;ğ\\u0026uuml;ş A (1999) Pozitif ve negatif sendrom \\u0026ouml;l\\u0026ccedil;eğinin (PANSS) T\\u0026uuml;rk\\u0026ccedil;e uyarlamasının ge\\u0026ccedil;erlik ve g\\u0026uuml;venirliği. Turk Psikoloji Dergisi 14:23\\u0026ndash;32\\u003c/li\\u003e\\n \\u003cli\\u003eKay SR, Fiszbein A, Opler LA (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261\\u0026ndash;276\\u003c/li\\u003e\\n \\u003cli\\u003eAydemir O, Esen A, Kuey L (2000) Reliability and validity of the Turkish version of the Calgary Depression Scale for Schizophrenia. Noropsikiyatri Arsivi 37:82\\u0026ndash;86\\u003c/li\\u003e\\n \\u003cli\\u003eAddington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry 163:39\\u0026ndash;44\\u003c/li\\u003e\\n \\u003cli\\u003eAddington D, Addington J, Schissel B (1990) A depression rating scale for schizophrenics. Schizophr Res 3:247\\u0026ndash;251\\u003c/li\\u003e\\n \\u003cli\\u003ePresidency of Strategy and Budget (2018) Dokuzuncu Kalkınma Planı (2007-2013). Presidency of the Republic of T\\u0026uuml;rkiye, Ankara\\u003c/li\\u003e\\n \\u003cli\\u003eBuizer-Voskamp JE, Laan W, Staal WG, Ophoff RA (2011) Paternal age and psychiatric disorders: findings from a Dutch population-based registry. Schizophr Res 129:128\\u0026ndash;132\\u003c/li\\u003e\\n \\u003cli\\u003eSadock BJ (2011) Kaplan and Sadock\\u0026apos;s synopsis of psychiatry: behavioral sciences/clinical psychiatry. Lippincott Williams \\u0026amp; Wilkins, Philadelphia\\u003c/li\\u003e\\n \\u003cli\\u003ePallant J (2020) SPSS survival manual: a step by step guide to data analysis using IBM SPSS. McGraw-Hill Education, London\\u003c/li\\u003e\\n \\u003cli\\u003eSheridan MA, McLaughlin KA (2014) Dimensions of early experience and neural development: deprivation and threat. Trends Cogn Sci 18:580\\u0026ndash;585\\u003c/li\\u003e\\n \\u003cli\\u003eTeicher MH, Samson JA (2016) Annual research review: enduring neurobiological effects of childhood abuse and neglect. J Child Psychol Psychiatry 57:241\\u0026ndash;266\\u003c/li\\u003e\\n \\u003cli\\u003eVassos E, Pedersen CB, Murray RM, Collier DA, Lewis CM (2012) Meta-analysis of the association of urbanicity with schizophrenia. Schizophr Bull 38:1118\\u0026ndash;1123\\u003c/li\\u003e\\n \\u003cli\\u003eOlsen RK, Tyl\\u0026eacute;n K (2023) Urban living and social cognition: a systematic review. J Environ Psychol 86:101980\\u003c/li\\u003e\\n \\u003cli\\u003eImmordino-Yang MH, McColl A, Damasio H, Damasio A (2009) Neural correlates of admiration and compassion. Proc Natl Acad Sci U S A 106:8021\\u0026ndash;8026\\u003c/li\\u003e\\n \\u003cli\\u003eKaminska K, Hodgekins J, Lewis JR, Cardinal RN, Oduola S (2025) Associations between rural/urban status, duration of untreated psychosis and mode of onset of psychosis: a mental health electronic clinical records analysis in the East of England, UK. Soc Psychiatry Psychiatr Epidemiol 60:1323\\u0026ndash;1334\\u003c/li\\u003e\\n \\u003cli\\u003eKong A, Frigge ML, Masson G, Stefansson K (2012) Rate of de novo mutations and the importance of father\\u0026rsquo;s age to disease risk. Nature 488:471\\u0026ndash;475\\u003c/li\\u003e\\n \\u003cli\\u003eJanecka M, Rijsdijk F, Rai D, Modabbernia A, Reichenberg A (2017) Paternal age and child behavior and cognitive development. Pediatrics 139:e20163622\\u003c/li\\u003e\\n \\u003cli\\u003eLanjekar PD, Wagh VV, Lanjekar DP (2022) The effect of advanced paternal age on the wellbeing of children. Cureus 14:e29255\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Schizophrenia, Theory of Mind, Childhood Trauma, Urbanicity, Social Cognition, Paternal Age, Environmental Risk Factors\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8615636/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8615636/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eObjective: This study investigates the impact of specific environmental risk factors—namely childhood trauma, urbanicity, and advanced paternal age—on Theory of Mind (ToM) impairments in patients with schizophrenia. Specifically, we aimed to disentangle whether ToM deficits are solely intrinsic to the disorder or modulated by trauma history.\\u003c/p\\u003e\\n\\u003cp\\u003eMethods: A total of 54 patients with schizophrenia and 37 healthy controls were assessed in this cross-sectional study. Participants completed the Childhood Trauma Questionnaire (CTQ) and a battery of ToM tasks, including the Reading the Mind in the Eyes Test (RMET) and the Dokuz Eylul Theory of Mind Scale (DEZIKO). Patients were stratified into \\\"High Trauma\\\" (CTQ \\u0026gt; 35) and \\\"Low Trauma\\\" (CTQ ≤ 35) groups to analyze the distinct contribution of trauma.\\u003c/p\\u003e\\n\\u003cp\\u003eResults: While patients generally exhibited poorer ToM performance compared to controls (RMET: p\\u0026lt;0.001; DEZIKO: p\\u0026lt;0.001), subgroup analyses revealed a crucial distinction. High-Trauma patients scored significantly lower than controls on both RMET (p=0.006) and DEZIKO Total (p=0.026). Importantly, Low-Trauma patients did not differ significantly from healthy controls (RMET: p\\u0026gt;0.05; DEZIKO: p\\u0026gt;0.05). Regarding specific environmental factors, patients residing in urban areas showed higher RMET scores compared to rural residents (Mean: 20.73 vs. 17.81; p=0.011). Conversely, advanced paternal age (≥35 years) was associated with significantly poorer performance on the faux pas recognition task (p=0.015).\\u003c/p\\u003e\\n\\u003cp\\u003eConclusion: Our findings suggest that ToM deficits in schizophrenia may not be uniform but are significantly exacerbated by environmental insults, particularly childhood trauma. This challenges the view of ToM solely as a trait marker and highlights the importance of trauma-informed interventions. Future longitudinal studies should clarify these causal pathways to tailor cognitive remediation strategies.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Impact of Trauma, Urbanicity, and Paternal Age on Theory of Mind in Schizophrenia\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-01-19 06:28:08\",\"doi\":\"10.21203/rs.3.rs-8615636/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"459f5b6e-a162-4afc-9bb8-3e30e37c6025\",\"owner\":[],\"postedDate\":\"January 19th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":61339977,\"name\":\"Psychiatry\"}],\"tags\":[],\"updatedAt\":\"2026-01-19T06:28:08+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-01-19 06:28:08\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8615636\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8615636\",\"identity\":\"rs-8615636\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}