Anthony O Ahmed1, Brian Kirkpatrick2, Silvana Galderisi3, Armida Mucci3, Alessandro Rossi4, Alessandro Bertolino5, Paola Rocca6, Mario Maj3, Stefan Kaiser7, Martin Bischof8, Matthias N Hartmann-Riemer8, Matthias Kirschner8, Karoline Schneider8, Maria Paz Garcia-Portilla9,10, Anna Mane10,11,12, Miguel Bernardo10,13,14,15, Emilio Fernandez-Egea10,14,16,17, Cui Jiefeng18, Yao Jing18, Tan Shuping18, James M Gold19, Daniel N Allen20, Gregory P Strauss21. 1. Department of Psychiatry, Weill Cornell Medicine, White Plains, NY. 2. Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV. 3. Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy. 4. Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy. 5. Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy. 6. Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy. 7. Division of Adult Psychiatry, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland. 8. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. 9. Department of Psychiatry, University of Oviedo, Oviedo, Spain. 10. Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain. 11. Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain. 12. Fundació IMIM, Barcelona, Spain. 13. Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain. 14. Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 15. Psychiatry Unit, Department of Medicine, University of Barcelona, Barcelona, Spain. 16. Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK. 17. Clozapine Clinic. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. 18. Psychiatry Research Center, Beijing Huilongguan Hospital, Peking University Huilongguan Clinical College, Beijing, China. 19. Department of Psychiatry, University of Maryland School of Medicine and Maryland Psychiatric Research Center, Baltimore, MD. 20. Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV. 21. Department of Psychology, University of Georgia, Athens, GA.
Abstract
OBJECTIVE: Negative symptoms are currently viewed as having a 2-dimensional structure, with factors reflecting diminished expression (EXP) and motivation and pleasure (MAP). However, several factor-analytic studies suggest that the consensus around a 2-dimensional model is premature. The current study investigated and cross-culturally validated the factorial structure of BNSS-rated negative symptoms across a range of cultures and languages. METHOD: Participants included individuals diagnosed with a psychotic disorder who had been rated on the Brief Negative Symptom Scale (BNSS) from 5 cross-cultural samples, with a total N = 1691. First, exploratory factor analysis was used to extract up to 6 factors from the data. Next, confirmatory factor analysis evaluated the fit of 5 models: (1) a 1-factor model, 2) a 2-factor model with factors of MAP and EXP, 3) a 3-factor model with inner world, external, and alogia factors; 4) a 5-factor model with separate factors for blunted affect, alogia, anhedonia, avolition, and asociality, and 5) a hierarchical model with 2 second-order factors reflecting EXP and MAP, as well as 5 first-order factors reflecting the 5 aforementioned domains. RESULTS: Models with 4 factors or less were mediocre fits to the data. The 5-factor, 6-factor, and the hierarchical second-order 5-factor models provided excellent fit with an edge to the 5-factor model. The 5-factor structure demonstrated invariance across study samples. CONCLUSIONS: Findings support the validity of the 5-factor structure of BNSS-rated negative symptoms across diverse cultures and languages. These findings have important implications for the diagnosis, assessment, and treatment of negative symptoms.
OBJECTIVE: Negative symptoms are currently viewed as having a 2-dimensional structure, with factors reflecting diminished expression (EXP) and motivation and pleasure (MAP). However, several factor-analytic studies suggest that the consensus around a 2-dimensional model is premature. The current study investigated and cross-culturally validated the factorial structure of BNSS-rated negative symptoms across a range of cultures and languages. METHOD:Participants included individuals diagnosed with a psychotic disorder who had been rated on the Brief Negative Symptom Scale (BNSS) from 5 cross-cultural samples, with a total N = 1691. First, exploratory factor analysis was used to extract up to 6 factors from the data. Next, confirmatory factor analysis evaluated the fit of 5 models: (1) a 1-factor model, 2) a 2-factor model with factors of MAP and EXP, 3) a 3-factor model with inner world, external, and alogia factors; 4) a 5-factor model with separate factors for blunted affect, alogia, anhedonia, avolition, and asociality, and 5) a hierarchical model with 2 second-order factors reflecting EXP and MAP, as well as 5 first-order factors reflecting the 5 aforementioned domains. RESULTS: Models with 4 factors or less were mediocre fits to the data. The 5-factor, 6-factor, and the hierarchical second-order 5-factor models provided excellent fit with an edge to the 5-factor model. The 5-factor structure demonstrated invariance across study samples. CONCLUSIONS: Findings support the validity of the 5-factor structure of BNSS-rated negative symptoms across diverse cultures and languages. These findings have important implications for the diagnosis, assessment, and treatment of negative symptoms.
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