Subjective and objective assessment of negative symptoms in patients with schizophrenia and their clinical and functional associations

Negative symptoms significantly affect psychosocial functioning and prognosis in schizophrenia. While clinician-rated scales are standard practice, the clinical value of patient-reported subjective assessments remains underexplored. This study investigated associations between subjective (Self-evaluation of Negative Symptoms, SNS) and objective clinician-rated (modified Short Assessment of Negative Domain-negative subscale, m-SAND-N) assessments, their predictive relationships, and links with psychosocial functioning (Personal and Social Performance, PSP). This cross-sectional analysis included 188 outpatients with schizophrenia from 20 psychiatric clinics in Slovakia. Participants completed the SNS, followed by structured clinical interviews assessing negative symptoms (m-SAND), clinical severity (CGI-S), PSP, insight, and adherence. Correlation analyses and hierarchical multiple regressions examined the relationships among demographic, clinical, subjective/objective negative symptoms, as well as psychosocial functioning. Clinician-rated negative symptoms (m-SAND-N) showed significant correlations with patient-reported negative symptoms (SNS; r = 0.38, p < 0.001) and with poorer psychosocial functioning (PSP; r = 0.68, p < 0.001). In hierarchical regression, objective negative symptoms were the principal factor associated with higher subjective ratings (β = 0.332, p < 0.001). Conversely, higher SNS scores (β = 0.179, p < 0.001), greater overall illness severity (CGI-S; β = 0.156, p < 0.05) and poorer psychosocial functioning (PSP; β = 0.583, p < 0.001) were jointly related to more severe clinician-rated negative symptoms, together accounting for 50.7 % of their variance. Subjective ratings of affective blunting did not correlate significantly with clinician assessments, highlighting a divergence between patient- and clinician-reported measures. Integrating subjective patient assessments with objective clinician ratings provides a comprehensive understanding of negative symptoms, facilitating improved treatment approaches and psychosocial outcomes in schizophrenia. Clinicians should consider patient insight when interpreting discrepancies, especially in affective blunting.