A rasch model to test the cross-cultural validity in the positive and negative syndrome scale (PANSS) across six geo-cultural groups

Abstract

BackgroundThe objective of this study was to examine the cross-cultural differences of the PANSS across six geo-cultural regions. The specific aims are (1) to examine measurement properties of the PANSS; and (2) to examine how each of the 30 items function across geo-cultural regions.MethodsData was obtained for 1,169 raters from 6 different regions: Eastern Asia (n = 202), India (n = 185), Northern Europe (n = 126), Russia & Ukraine (n = 197), Southern Europe (n = 162), United States (n = 297). A principle components analysis assessed unidimensionality of the subscales. Rasch rating scale analysis examined cross-cultural differences among each item of the PANSS.ResultsLower item values reflects items in which raters often showed less variation in the scores; higher item values reflects items with more variation in the scores. Positive Subscale: Most regions found item P5 (Excitement) to be the most difficult item to score. Items varied in severity from −0.93 [item P6. Suspiciousness/persecution (USA) to 0.69 item P4. Excitement (Eastern Asia)]. Item P3 (Hallucinatory Behavior) was the easiest item to score for all geographical regions. Negative Subscale: The most difficult item to score for all regions is N7 (Stereotyped Thinking) with India showing the most difficulty Δ = 0.69, and Northern Europe and the United States showing the least difficulty Δ = 0.21, each. The second most difficult item for raters to score was N1 (Blunted Affect) for most countries including Southern Europe (Δ = 0.30), Eastern Asia (Δ = 0.28), Russia & Ukraine (Δ = 0.22) and India (Δ = 0.10). General Psychopathology: The most difficult item for raters to score for all regions is G4 (Tension) with difficulty levels ranging from Δ = 1.38 (India) to Δ = 0.72.ConclusionsThere were significant differences in response to a number of items on the PANSS, possibly caused by a lack of equivalence between the original and translated versions, cultural differences among interpretation of items or scoring parameters. Knowing which items are problematic for various cultures can help guide PANSS training and make training specialized for specific geographical regions.

Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study

“…The strengths of the current study include the large study sample, which is the largest so far in the literature investigating the factor structure of the PANSS as well as efforts to clinically stage schizophrenia. In contrast to other studies, we did not exclude any basic component of the disease’s symptomatology (Kelley et al, 2013; Khan et al, 2013a, 2013b; Fong et al, 2015; Wu et al, 2015). An additional strength is the multi-center and multinational characteristic of the sample.…”

“…A number of studies have reported the presence of significant associations of stage of illness with course, outcome, prognosis, and treatment response (Nakaya et al, 1999a, 1999b; Emsley et al, 2007; Cuesta et al, 2012; Hill et al, 2012). The effect of socio-cultural factors as well as intrinsic factors pertaining to the specific diagnostic and conceptual approaches of individual researchers and research centers could exert a major contributing effect towards significant heterogeneity of the results (Khan et al, 2013a, 2013b), but these issues are not adequately studied (Dollfus and Petit, 1995; Nakaya et al, 1999a, 1999b; Hayashi et al, 2002; Walsh-Messinger et al, 2018).…”

Validation of the Five-Factor Model of the Arabic Version of the Positive and Negative Syndrome Scale in Schizophrenia

“…However, it is also plausible that the translation of these items into Arabic did not capture the same construct provided in English versions or the raters showed variability on some of these items. In a study on crosscultural validity of the PANSS [41] among different countries, the authors suggested that differences in scoring, in addition to culture and translation, could also contribute to the differences in factor structures among cultures. Schizophrenia has been viewed initially to be very similar across cultures where the degree of the overlap in the illness definition and symptoms in many countries increases with the illness severity [6] .…”

PANSS‐6: a brief rating scale for the measurement of severity in schizophrenia

“…As outlined above, to obtain valid measures of illness severity, it is essential that rating scales are both scalable and transferable. Although prior studies have evaluated some psychometric properties of the PANSS , the scalability and transferability of the full PANSS‐30 and the proposed PANSS‐14 and PANSS‐8 subscales have never been tested by means of the Rasch rating scale model.…”