The latent structure of negative symptoms in schizophrenia
Open accessAbstract
Importance: Negative symptoms are associated with a range of poor clinical outcomes, and currently available treatments generally do not produce a clinically meaningful response. Limited treatment progress may be owing in part to poor clarity regarding latent structure. Prior studies have inferred latent structure using exploratory factor analysis, which has led to the conclusion that there are 2 dimensions reflecting motivation and pleasure (MAP) and diminished expressivity (EXP) factors. However, whether these conclusions are statistically justified remains unclear because exploratory factor analysis does not test latent structure. Confirmatory factor analysis (CFA) is needed to test competing models regarding the latent structure of a construct. Objective: To evaluate the fit of 4 models of the latent structure of negative symptoms in schizophrenia using CFA. Design, Setting, and Participants: Three cross-sectional studies were conducted on outpatients with schizophrenia who were rated on the 3 most conceptually contemporary measures: Scale for the Assessment of Negative Symptoms (SANS), Brief Negative Symptom Scale (BNSS), and Clinical Assessment Interview for Negative Symptoms (CAINS). Confirmatory factor analysis evaluated the following 4 models: (1) a 1-factor model; (2) a 2-factor model with EXP and MAP factors; (3) a 5-factor model with separate factors for the 5 domains of the National Institute of Mental Health consensus development conference (blunted affect, alogia, anhedonia, avolition, and asociality); and (4) a hierarchical model with 2 second-order factors reflecting EXP and MAP and 5 first-order factors reflecting the 5 consensus domains. Main Outcomes and Measures: Outcomes included CFA model fit statistics derived from symptom severity scores on the SANS, BNSS, and CAINS. Results: The study population included 860 outpatients with schizophrenia (68.0% male; mean [SD] age, 43.0 [11.4] years). Confirmatory factor analysis was conducted on each scale, including 268 patients for the SANS, 192 for the BNSS, and 400 for the CAINS. The 1- and 2-factor models provided poor fit for the SANS, BNSS, and CAINS as indicated by comparative fit indexes (CFIs) and Tucker Lewis indexes (TLIs) less than 0.950, RMSEAs that exceeded the 0.080 threshold, and WRMRs greater than 1.00. The 5-factor and hierarchical models provided excellent fit, with the 5-factor model being more parsimonious. The CFIs and TLIs met the 0.95 threshold and the 1.00 threshold for both factor models with all 3 measures. Interestingly, the RMSEAs for the 5-factor model and the hierarchical model fell under the 0.08 threshold for the BNSS and the CAINS but not the SANS. Conclusions and Relevance: These findings suggest that the recent trend toward conceptualizing the latent structure of negative symptoms as 2 distinct dimensions does not adequately capture the complexity of the construct. The latent structure of negative symptoms is best conceptualized in relation to the 5 consensus domains. Implications for identifying pathophysiological mechanisms and targeted treatments are discussed.
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Anhedonia is a distinct feature of negative symptoms in schizophrenia worthy of consideration.
“When considering the clinical end point of schizophrenia, work is emerging that anhedonia is a distinct feature of negative symptoms worthy of consideration (202).”
From A transdiagnostic perspective on social anhedonia (2019) · cites this paper as [202]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
The Brief Psychiatric Rating Scale.
Overall, J. E., & Gorham, D. R. (1962) · Psychological Reports · doi:10.2466/pr0.1962.10.3.799 · Cited by 11,090 · see citing works
A very brief measure of the Big-Five personality domains
Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003) · Journal of Research in Personality · doi:10.1016/s0092-6566(03)00046-1 · Cited by 8,307 · see citing works
Structural model evaluation and modification: An interval estimation approach
Steiger, J. H. (1990) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2502_4 · Cited by 7,408 · see citing works
Sample size in factor analysis.
MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999) · Psychological Methods · doi:10.1037/1082-989x.4.1.84 · Cited by 5,497 · see citing works
Akaike, H. (1987) · Psychometrika · doi:10.1007/bf02294359 · Cited by 5,264 · see citing works
Measures of Multivariate Skewness and Kurtosis with Applications
Mardia, K. V. (1970) · Biometrika · doi:10.1093/biomet/57.3.519 · Cited by 4,859 · see citing works
Dementia Praecox or the Group of Schizophrenias
(1951) · Journal of the American Medical Association · doi:10.1001/jama.1951.02920270079043 · Cited by 4,407 · see citing works
Akaike, H. (1987) · Springer Series in Statistics · doi:10.1007/978-1-4612-1694-0_29 · Cited by 4,027 · see citing works
Dementia Praecox and Paraphrenia.
(1972) · Annals of Internal Medicine · doi:10.7326/0003-4819-76-6-1058_8 · Cited by 2,906 · see citing works
Scale for the Assessment of Negative Symptoms (SANS)*
(1989) · The British Journal of Psychiatry · doi:10.1192/s0007125000291502 · Cited by 2,706 · see citing works
Scale for the Assessment of Negative Symptoms
Andreasen, N. C. (1982) · PsycTESTS Dataset · doi:10.1037/t12696-000 · Cited by 1,878 · see citing works
The Scale for the Assessment of Negative Symptoms (SANS): Conceptual and Theoretical Foundations
Andreasen, N. C. (1989) · The British Journal of Psychiatry · doi:10.1192/s0007125000291496 · Cited by 1,532 · see citing works
The NIMH-MATRICS Consensus Statement on Negative Symptoms
Kirkpatrick, B., Fenton, W. S., Carpenter, W. T., & Marder, S. R. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj053 · Cited by 1,311 · see citing works
Self-citationThe brief negative symptom scale: Psychometric properties
Kirkpatrick, B., Strauss, G. P., Nguyen, L., Fischer, B. A., Daniel, D. G., Cienfuegos, A., & Marder, S. R. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbq059 · Cited by 895 · see citing works
Self-citationHandbook of Applied Multivariate Statistics and Mathematical Modeling
Tinsley, H. E. A., & Brown, S. D. (2000) · Elsevier eBooks · doi:10.1016/b978-0-12-691360-6.x5000-9 · Cited by 842 · see citing works
Treadway, M. T., Buckholtz, J. W., Schwartzman, A. N., Lambert, W. E., & Zald, D. H. (2009) · PLoS ONE · doi:10.1371/journal.pone.0006598 · Cited by 769 · see citing works
The clinical assessment interview for negative symptoms (CAINS): Final development and validation
Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12010109 · Cited by 726 · see citing works
An item selection procedure to maximise scale reliability and validity
Raubenheimer, J. (2004) · SA Journal of Industrial Psychology · doi:10.4102/sajip.v30i4.168 · Cited by 667 · see citing works
The Structure of Negative Symptoms Within Schizophrenia: Implications for Assessment
Blanchard, J. J., & Cohen, A. S. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj013 · Cited by 649 · see citing works
DEMENTIA PRAECOX AND PARAPHRENIA
Kraepelin, E. (1921) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-192110000-00104 · Cited by 605 · see citing works
The current conceptualization of negative symptoms in schizophrenia
Marder, S. R., & Galderisi, S. (2017) · World Psychiatry · doi:10.1002/wps.20385 · Cited by 537 · see citing works
Hayduk, L. A., & Littvay, L. (2012) · BMC Medical Research Methodology · doi:10.1186/1471-2288-12-159 · Cited by 442 · see citing works
Strauss, G. P., Horan, W. P., Kirkpatrick, B. W., Fischer, B. A., Keller, W. R., Miski, P., Buchanan, R. W., Green, M. F., & Carpenter, W. T. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.01.015 · Cited by 424 · see citing works
Self-citationBuchanan, R. W., Javitt, D. C., Marder, S. R., Schooler, N. R., Gold, J. M., McMahon, R. P., Heresco-Levy, U., & Carpenter, W. T. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.06081358 · Cited by 419 · see citing works
Self-citationThe Distinction of Positive and Negative Symptoms
Arndt, S. V., Alliger, R. J., & Andreasen, N. C. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.3.317 · Cited by 408 · see citing works
The motivation and pleasure dimension of negative symptoms: Neural substrates and behavioral outputs
Kring, A. M., & Barch, D. M. (2014) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.06.007 · Cited by 352 · see citing works
Grant, P. M. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.129 · Cited by 349 · see citing works
Hoyle, R. H. (2000) · Elsevier eBooks · doi:10.1016/b978-012691360-6/50017-3 · Cited by 346 · see citing works
LISREL Issues, Debates and Strategies
Williams, R. A., & Hayduk, L. A. (1997) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2654075 · Cited by 323 · see citing works
Horan, W. P., Kring, A. M., Gur, R. E., Reise, S. P., & Blanchard, J. J. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.06.030 · Cited by 305 · see citing works
Messinger, J. W., Trémeau, F., Antonius, D., Mendelsohn, E., Prudent, V., Stanford, A. D., & Malaspina, D. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.002 · Cited by 271 · see citing works
The SAGE Handbook of Social Science Methodology
Outhwaite, W., & Turner, S. (2007) · SAGE Publications Ltd eBooks · doi:10.4135/9781848607958 · Cited by 266 · see citing works
LISREL Issues, Debates and Strategies
Hayduk, L. A. (1996) · Johns Hopkins University Press eBooks · doi:10.56021/9780801853364 · Cited by 251 · see citing works
A Transdiagnostic Review of Negative Symptom Phenomenology and Etiology
Strauss, G. P., & Cohen, A. S. (2017) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx066 · Cited by 222 · see citing works
Self-citationFactor structure of the brief negative symptom scale
Strauss, G. P., Hong, L. E., Gold, J. M., Buchanan, R. W., McMahon, R. P., Keller, W. R., Fischer, B. A., Catalano, L. T., Culbreth, A. J., Carpenter, W. T., et al. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.09.007 · Cited by 194 · see citing works
Self-citationMeta-analysis of symptom factors in schizophrenia
Grube, B. S., Bilder, R. M., & GOLDMAN, R. S. (1998) · Schizophrenia Research · doi:10.1016/s0920-9964(98)00011-5 · Cited by 183 · see citing works
Andreasen, N. C., Arndt, S. V., Miller, D. D., Flaum, M. A., & Nopoulos, P. (2010) · Psychopathology · doi:10.1159/000284894 · Cited by 167 · see citing works
Factor structure and construct validity of the Scale for the Assessment of Negative Symptoms.
Sayers, S. L., Curran, P. J., & Mueser, K. T. (1996) · Psychological Assessment · doi:10.1037/1040-3590.8.3.269 · Cited by 151 · see citing works
The negative symptom assessment: a new instrument to assess negative symptoms of schizophrenia.
Alphs, L. D., Summerfelt, A. T., Lann, H. D., & Muller, R. J. (1989) · PubMed · Cited by 143 · see citing works
Cross-cultural Validation of the 5-Factor Structure of Negative Symptoms in Schizophrenia
Ahmed, A. O., Kirkpatrick, B., Galderisi, S., Mucci, A., Rossi, A., Bertolino, A., Rocca, P., Maj, M., Kaiser, S., Bischof, M., et al. (2019) · Schizophrenia bulletin · doi:10.1093/schbul/sby050 · Cited by 127 · see citing works
Self-citationAn overview of Markov chain methods for the study of stage-sequential developmental processes.
Kaplan, D. (2008) · Developmental Psychology · doi:10.1037/0012-1649.44.2.457 · Cited by 126 · see citing works
Kelley, M. E., van Kammen, D. P., & Allen, D. N. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.3.406 · Cited by 118 · see citing works
Self-citationThe Factorial Structure of the Schedule for the Deficit Syndrome in Schizophrenia
Kimhy, D., Yale, S. A., Goetz, R. R., McFarr, L. M., & Malaspina, D. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbi064 · Cited by 107 · see citing works
Strauss, G. P., Whearty, K. M., Morra, L. F., Sullivan, S. K., Ossenfort, K. L., & Frost, K. H. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.12.006 · Cited by 106 · see citing works
Self-citationNegative symptoms in schizophrenia: a confirmatory factor analysis of competing models
Peralta, V., & Cuesta, M. J. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.10.1450 · Cited by 95 · see citing works
Defining and measuring negative symptoms of schizophrenia in clinical trials
Marder, S. R., & Kirkpatrick, B. W. (2013) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.10.016 · Cited by 88 · see citing works
Self-citationStrauss, G. P., & Gold, J. M. (2016) · Schizophrenia Bulletin · doi:10.1093/schbul/sbw046 · Cited by 65 · see citing works
Self-citationRelationship between effortful motivation and neurocognition in schizophrenia
Bismark, A. W., Thomas, M. L., Tarasenko, M. A., Shiluk, A. L., Rackelmann, S. Y., Young, J. W., & Light, G. A. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.06.042 · Cited by 63 · see citing works
A two-factor structure for the Schedule for the Deficit Syndrome in schizophrenia
Nakaya, M., & Ohmori, K. (2008) · Psychiatry Research · doi:10.1016/j.psychres.2007.10.008 · Cited by 56 · see citing works
Shaffer, J. J., Peterson, M. J., McMahon, M. A. B., Bizzell, J., Calhoun, V. D., van Erp, T. G. M., Ford, J. M., Lauriello, J., Lim, K. O., Manoach, D. S., et al. (2015) · Complex Psychiatry · doi:10.1159/000440979 · Cited by 56 · see citing works
Preclinical Models to Investigate Mechanisms of Negative Symptoms in Schizophrenia
Barnes, S. A., Der‐Avakian, A., & Young, J. W. (2017) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx065 · Cited by 19 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Messinger JW, Trémeau F, Antonius D, et al. Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research. Clin Psychol Rev. 2011; 31(1):161-168. doi:10.1016/j.cpr.2010.09.002 · DOI · Paper page
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Barkus, E., & Badcock, J. C. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00216 · Cited by 165 · see citing works
Edwards, C. J., Garety, P., & Hardy, A. (2019) · Psychological Medicine · doi:10.1017/s0033291719002381 · Cited by 54 · see citing works
A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders
Ruiz, I., Raugh, I. M., Bartolomeo, L. A., & Strauss, G. P. (2020) · Neuropsychology Review · doi:10.1007/s11065-020-09448-2 · Cited by 34 · see citing works
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Guidara, W., Messedi, M., Naifar, M., Maalej, M., Khrouf, W., Grayaa, S., Maalej, M., Bonnefont-Rousselot, D., Lamari, F., & Ayadi, F. (2022) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2022.106123 · Cited by 11 · see citing works
- Authors
- Strauss, G. P., Nuñez, A., Ahmed, A. O., Barchard, K. A., Granholm, E., Kirkpatrick, B., Gold, J. M., & Allen, D. N.
- Affiliations
- University of Georgia (US)
- University of Nevada, Las Vegas (US)
- Weill Cornell Medicine (US)
- University of California San Diego (US)
- University of Nevada, Reno (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Strauss, Gregory P.
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-12-01
- Volume
- 75
- Issue
- 12
- Pages
- 1271
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6583036
- OpenAlex
- W2889918482
- Cited by
- 204
- References
- 56
- Citations by year
- 2026: 25 · 2025: 30 · 2024: 16 · 2023: 26 · 2022: 22 · 2021: 35 · 2020: 32 · 2019: 15 · 2018: 3
- FWCI
- 16.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh080066-10)
- National Institute of Mental Health (R61MH110019, R01-MH080066, K23MH092530)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- negative symptoms, schizophrenia, latent structure, factor structure, blunted affect, alogia, anhedonia, avolition, asociality, Scale for the Assessment of Negative Symptoms, Brief Negative Symptom Scale, model fit, hierarchical factor model, psychometric validation
- MeSH terms
- Adult, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Motivation, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Reproducibility of Results, Pleasure
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