Validity and Reliability of the Staden Schizophrenia Anxiety Rating Scale

Fear and Anxiety in Schizophrenia: A Focus on Development, Assessment, and Mechanisms

In people with schizophrenia, anxiety is highly prevalent and related to numerous negative outcomes; unfortunately, anxiety is both underreported and understudied in schizophrenia. The current review highlights the importance and utility of assessing anxiety in schizophrenia by addressing four main questions: (1) What does anxiety look like throughout the development of schizophrenia?; (2) How do we measure anxiety in schizophrenia?; (3) What are the mechanisms underlying anxiety in schizophrenia; (4) How do we treat anxiety in schizophrenia? We also provide take-home points and propose future directions for the field. We hope this emphasis on the critical role of anxiety in schizophrenia will help researchers appropriately identify the presence of anxiety, better address these symptoms, and improve the lives of people at risk for or experiencing psychosis.

Arabic translation and validation of the clinician administered Staden schizophrenia anxiety rating scale (S-SARS)

Background

Research on anxiety in patients with schizophrenia of Arab origin is surprisingly scarce, particularly given that expressions of both psychotic disorders and anxiety disorders can be largely shaped by cultural factors. This study proposes to complement previous research by exploring the psychometric characteristics of an Arabic translation of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) in chronic, remitted patients diagnosed with schizophrenia. As the Arabic version of the Generalized Anxiety Disorder 7-Item Scale (GAD-7) has not been previously validated in Arabic in patients with schizophrenia, this study had as a secondary aim to investigate the psychometric properties of this scale before its use.

Method

This cross-sectional study was performed over a period of three months (August-October 2023). A total of 177 chronic inpatients diagnosed with schizophrenia (63.3 % males) who were remitted and clinically stable participated in the study.

Results

Confirmatory factor analyses showed that all 10 items loaded onto a single factor and had high factor loading values between .53 and .81. The reliability of the S-SARS in its Arabic version was excellent as attested by a McDonald's omega and a Cronbach's alpha coefficients of .90 and .89, respectively. The score of Arabic S-SARS correlated positively with the GAD-7 scores (r = .55; p < .001), thus supporting good convergent validity. As for discriminant validity, findings showed positive correlations between S-SARS and depression scores as assessed using the Calgary Depressive Symptoms Scale. In addition, the Arabic S-SARS correlated negatively with general functioning, further supporting the good validity and clinical relevance of the scale. Finally, measurement invariance was established in the sex subsamples (males vs. females) at the scalar, metric and configural levels, with females showing more anxiety than males.

Conclusion

Findings suggest that the Arabic S-SARS holds good psychometric properties, and is suitable for use among Arabic-speaking people diagnosed with schizophrenia in both research and clinical practice. The Arabic version of S-SARS will hopefully be widely applied to provide useful and timely clinical information for monitoring and adequately treating patients with schizophrenia, in order to improve the course and prognosis of the disease.

Vigour as a marker of positive mental health among social media respondents

BACKGROUND

Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population.

METHOD

Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue.

RESULTS

Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = -0.593) and fatigue (r = -0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure.

LIMITATIONS

Results are limited to willing participants who responded through social media.

CONCLUSIONS

Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.

Agentive steadfastness as trait marker in relation to temperament and character

BACKGROUND

Agentive steadfastness was identified as a potential trait marker with which to anticipate prognostically that a patient will persevere steadfastly and take congruent action in facing the demands of living. Taken as an enduring expression of personality, this study investigated agentive steadfastness among adult social media respondents (n = 511) in relation to temperament and character as captured in Cloninger's psychobiological model of personality.

METHODS

Participants recruited though snowball sampling on social media platforms, applied the 27-item Agentive Steadfastness Index (ASI) and the 240-item Temperament and Character Inventory (TCI-R-240).

RESULTS

Agentive steadfastness was statistically predicted by the Self-directedness (β = 0.634), Self-transcendence (β = 0.119), Harm Avoidance (β = -0.142) and the Reward Dependence (β = 0.071) scales, accounting for 63.3 % of the variance in one stepwise regression model. In another stepwise model for the TCI-R-240 subscales, the Purposeful (β = 0.359), Anticipatory Worry (β = -0.353), and the Responsibility (β = 0.259) subscales accounted for respectively 56.8 %, 11.2 % and 2.8 % of the variance in ASI scores.

LIMITATIONS

Results are limited to adult social media respondents who were willing to participate.

CONCLUSIONS

Agentive steadfastness may serve as a trait marker of well-being and the good prognostic associations that have been established for high self-directedness, low harm avoidance, as well as resilience, and character strengths. It may be assessed clinically to anticipate prognostically the extent to which a patient will persevere steadfastly and take congruent action in facing the demands of living and adversity.

Validity and reliability of the agentive steadfastness index

Agentive steadfastness is a hitherto unarticulated and unmeasured construct, although clinicians may have drawn intuitively on it in anticipating clients' prognosis and anticipated responsiveness to adverse events. Following the conceptualisation and articulation of the agentive steadfastness construct and a measure thereof, the current study examined the validity and reliability of the agentive steadfastness index (ASI) among responding adult social media users (n = 511). Results confirmed convergent validity between agentive steadfastness and closest related psychological constructs, which were resilience (r = .715) and character strength (r = .704). Its discriminant validity was observed with other related but notably distinct psychological constructs, which were anxiety (r = -.599) and ego-strength (r = -.244). Temporal stability was confirmed over a period of 6 months (r = .763). The ASI showed good internal (Cronbach alpha = .937) and split-half reliability (r = .838) and a low standard error of measurement of 7.57 points within a theoretical range of 190 points. These results suggest that the ASI is a valid and a reliable measure of agentive steadfastness. Equipped with the ASI, further research is enabled on agentive steadfastness as a psychotherapeutic target and its relations with various aspects of personality, prognosis and adversity.

Validation and optimal cut-off score of the World Health Organization Well-being Index (WHO-5) as a screening tool for depression among patients with schizophrenia

BACKGROUND

The utility of the World Health Organization Wellbeing Index (WHO-5) as rapid screening tool for depression has not yet been researched in the context of schizophrenia. The goals of this study were twofold: (1) to test the psychometric properties of the WHO-5 in a sample of Arabic-speaking patients with schizophrenia from Lebanon, with particular emphasis on validating the WHO-5 as a screening tool for wellbeing and depression in patients with schizophrenia; and (2) to determine the optimal cut-off point to identify schizophrenia patients with depression.

METHODS

Chronic, remitted patients with schizophrenia took part in this cross-sectional study between August and October 2023 (n = 117; mean age of 57.86 ± 10.88 years and 63.3% males). The Calgary Depression Scale for Schizophrenia (CDSS) was included as index of validity. For the validation of the WHO-5 scale, we performed a confirmatory factor analysis (CFA) using the original structure of the scale. To assess the discriminatory validity of the Arabic version of the WHO-5 as a screening tool for depression, we conducted a Receiver operating characteristic (ROC) curve analysis, taking the WHO-5 reversed score against the dichotomized CDSS score at a cut off value of 6.

RESULTS

The results of CFA supported the originally proposed unidimensional structure of the measure, with good internal consistency reliability (α = 0.80), concurrent validity, and cross-sex measurement invariance. The WHO-5 showed a sensitivity of 0.8 and a specificity of 0.7 in the detection of depression with a cut-off point of 9.5. The validity of the WHO-5 as a screening tool for depression was supported by the excellent discrimination AUC value of 0.838. Based on this WHO-5 cut-off value, 42.6% of the patients were screened as having a depression.

CONCLUSION

The study contributes to the field by showing that the WHO-5 is a concise and convenient self-report measure for quickly screening and monitoring depressive symptoms in patients with schizophrenia. It is therefore highly recommended to apply this cut-off point for screening and follow-up assessments. The current findings will hopefully encourage clinicians and researchers working in Arab settings, who are often confronted with significant time and resource constraints, to start using the WHO-5 to aid their efforts in mitigating depression in this vulnerable population and fostering research in this under-researched area.

Advances in the Diagnosis and Management of Psychosis

Psychosis research in the contemporary sense of scientific inquiry may be traced as far as the formulation of the "unitary psychosis" concept, or Einheitpsychose, which is usually attributed to Wilhelm Griesinger, Ernst von Zeller, and Heinrich Neumann [...].

Testing the validity and reliability of the Chinese version of the Staden schizophrenia anxiety rating scale

Accurate assessment of anxiety disorders and their symptomatology in schizophrenic patients is important for prognosis and treatment. Measuring anxiety on the traditional anxiety assessment scales such as the Hamilton Anxiety Rating (HAMA) Scale or the self-rating depression scale (SAS) is challenging and often considered unsuitable for assessing anxiety symptoms in patients with schizophrenia. The Staden schizophrenia anxiety rating scale (S-SARS) has been shown to reliably measure specified and undifferentiated anxiety in schizophrenia. The present study aims to test the reliability and validity of the S-SARS version, thereby facilitating Chinese psychiatrists in assessing anxiety symptoms in schizophrenic patients. A total of 300 patients meeting ICD-10 diagnostic criteria of schizophrenia were recruited by convenience sampling. We used the exploratory factor analysis (EFA) to evaluate the structural validity of S-SARS and receiver operating characteristic (ROC) curves to acquire the cutoff point of S-SARS to define the severity of anxiety. Internal consistency was assessed using Cronbach's and Krippendorff's α scores. 1-week test-retest reliability was assessed using the intra-class correlation coefficient (ICC). Correlation analysis with HAMA was used to determine the Chinese version of S-SARS criterion validity. We have the following results: Our version of S-SARS showed Cronbach's α score as 0.899, Krippendorff's α as 0.874, and a correlation coefficient of 0.852 between S-SARS and HAMA. The EPA demonstrated that the contribution rate of major factors was 69.45%. All the items of S-SARS were located in one factor and showed a high factor load (0.415-0.837). The correlation coefficient of S-SARS and HAMA was 0.852. Our results indicated that Chinese version of S-SARS showed good constructive validity and reliability. It also showed better criterion validity compared to HAMA. The S-SARS and its Chinese version can thus serve as an effective tool for assessing anxiety symptoms in patients with schizophrenia.