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Anthony O Ahmed, Brian Kirkpatrick, Silvana Galderisi, Armida Mucci, Alessandro Rossi, Alessandro Bertolino, Paola Rocca, Mario Maj, Stefan Kaiser, Martin Bischof, Matthias N Hartmann-Riemer, Matthias Kirschner, Karoline Schneider, Maria Paz Garcia-Portilla, Anna Mane, Miguel Bernardo, Emilio Fernandez-Egea, Cui Jiefeng, Yao Jing, Tan Shuping, James M Gold, Daniel N Allen, Gregory P Strauss, Cross-cultural Validation of the 5-Factor Structure of Negative Symptoms in Schizophrenia, Schizophrenia Bulletin, Volume 45, Issue 2, March 2019, Pages 305–314, https://doi.org/10.1093/schbul/sby050
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Abstract
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.
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.
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.
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.
