Novel determinants of introspective accuracy and confidence in schizophrenia-spectrum disorders: a mixed methods investigation

The National Institute of Mental Health awarded The University of Southern Mississippi $194,697 on October 5, 2025, under the Mental Health Research Grants program (CFDA 93.242) to investigate introspective accuracy and confidence in schizophrenia-spectrum disorders through a mixed-methods study examining the role of sleep quality.

The study will assess relationships between objective sleep quality, introspective accuracy, and task performance confidence; document participants' perceptions of factors impacting their introspective accuracy and confidence; and compare these relationships between individuals with schizophrenia-spectrum disorders and healthy controls. Sixty participants—40 with schizophrenia-spectrum disorders and 20 healthy controls—will complete comprehensive assessments using objective sleep monitoring, cognitive testing, and qualitative interviews to identify determinants of introspective accuracy and confidence that have not been previously explored through quantitative methods.

Work is performed in Hattiesburg, Mississippi. The award period runs from October 5, 2025, through June 14, 2027. This is a project grant, a non-renewable assistance type supporting basic research as defined under NIMH's mission to transform understanding and treatment of mental illnesses through research.

Abstract

Introspective accuracy (IA; i.e., how individuals estimate their abilities and skills) and confidence about performance are promising determinants of real-world functional outcomes for people with schizophrenia-spectrum disorders (ssds). Yet, the mechanisms underlying IA and confidence are currently unclear. One area with promise as a potential determinant of IA and confidence is sleep. Sleep difficulties are highly prevalent in people with ssds, and early work suggests that self-reported sleep quality may be related to IA and confidence about task performance among those with ssds. No studies to date have examined these relationships using objective sleep assessments, and IT is unclear how sleep may impact IA and confidence day- to-day. While existing work points to sleep as one possible determinant of IA and confidence, there may be additional factors related to IA and confidence in this group that have not been previously explored. No research to date has assessed participants' perceptions of factors impacting their IA and confidence, or their understanding of why they might over or underestimate their abilities. The current study will address this question using qualitative interviewing. This data may have important implications for current mechanistic models of IA and confidence, as factors may be identified through qualitative methods that have not been previously considered. This study aims to fill these gaps in the literature by assessing 1) relationships between objective sleep quality, IA, and confidence, 2) participants' understanding of factors impacting their IA and confidence, and 3) whether relationships between sleep, IA, and confidence are stronger among SSD participants as compared to healthy control (HC) participants. Sixty participants (40 people with ssds and 20 HCS) will complete comprehensive assessments of IA and confidence for social cognition and neurocognition. After this visit, ecological momentary assessment (EMA) via a smartphone APP will be used to assess IA and confidence 7 times per day over a one-week period. Fitbits will also be provided to participants, which will be used to collect objective sleep data during the one-week period of EMA data collection. Following this one-week sleep and EMA period, a subset of SSD participants (n = 25) will answer qualitative questions about their perception of factors influencing their IA and confidence ratings. This proposed project aligns closely with nimh 2024 strategic plan, strategy 2.2.a (determining early risk and protective factors, and related mechanisms, to serve as novel intervention targets). Results from this study will aid in understanding the mechanisms underlying IA and confidence about performance among people with ssds, which will inform intervention efforts aimed at improving everyday functioning in this population.