Comparing psychotic experiences in low-and-middle-income-countries and high-income-countries with a focus on measurement invariance

Abstract

Background The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias. Methods A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses. Results MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = −0.42) and underestimation (e.g. magical thinking, d = −0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition. Conclusion Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.

The Community Assessment of Psychic Experiences: Optimal cut‐off scores for detecting individuals with a psychotic disorder

“…The original factorial structure of the CAPE includes three dimensions (positive symptoms, negative symptoms, and depressive symptoms (Stefanis et al., 2002 )). However, the most recent psychometric examination of the CAPE shows that a nine‐cluster factorial structure has better model fit (Jaya et al., 2020 ; Schlier et al., 2015 ). This structure consists of a positive symptom dimension with five subdimensions (bizarre experiences, hallucinations, grandiosity, magical thinking, and paranoia), a negative symptom dimension with three subdimensions (affective flattening, avolition, and social withdrawal), and a depressive symptom dimension.…”

“…This structure consists of a positive symptom dimension with five subdimensions (bizarre experiences, hallucinations, grandiosity, magical thinking, and paranoia), a negative symptom dimension with three subdimensions (affective flattening, avolition, and social withdrawal), and a depressive symptom dimension. The nine‐cluster factorial structure has been shown to have partial scalar measurement invariance between participants from low‐and‐middle‐income countries and high‐income countries (Jaya et al., 2020 ), and the binary version of the three‐dimensional factorial structure has been shown to have partial scalar measurement invariance too in Brazil, France, the Netherlands, Italy, Spain, and the UK participants (Pignon et al., 2019 ).…”

Cognitive Patterns and Conversion in a Representative Sample of Individuals at Risk for Psychosis

“…This finding could possibly elucidate the psychosis continuum as it manifests in the general population, and its relation to CHR, help-seeking behavior, and conversion (Falkenberg et al, 2015). In addition, in our low- and middle-income setting, we consider this might also be the result of cultural adaptation of psychotic phenomena (Jaya et al, 2020; Loch, 2019), of the low availability of mental health services in the country (Loch et al, 2016), or a mixture of both. Nevertheless, these speculations demand further investigations to account for their accuracy.…”

Indonesian Longitudinal Survey on Mental Health and Social Factors (INDOLUMEN): Early Findings and Protocol

“…Psychotic symptoms were measured using the CAPE (Jaya et al, 2020;Schlier et al, 2015;Stefanis et al, 2002). CAPE was an instrument that consists of a total of forty-two items-twenty positive symptom items, fourteen negative symptom items, and eight depression symptom items.…”