Abstract
Background
The conceptualization of negative symptoms has been refined in the past decades. Two-factor model comprising Motivation and Pleasure (MAP) and Emotional Expressivity (EE), five-factor model representing five domains of negative symptoms and second-order five-factor model incorporating the two-factor and five-factor models (Anhedonia, Asociality and Avolition regressed on MAP; Blunted Affect and Alogia regressed on EE) have been suggested as latent structure of negative symptoms. In most studies, the item “Lack of Normal Distress” in the Brief Negative Symptom Scale (BNSS) did not fit well in factor models. Nevertheless, the reported correlation and item-total correlation of Distress with other negative symptom domains and BNSS items were not negligible. Emotion deficit was also discussed as a part of negative symptoms conceptualization. As a single item may not be sufficient to represent an underlying construct that is potentially abstract and complex, the Schedule for the Deficit Syndrome (SDS) which comprises “Diminished Emotional Range” that is conceptually relevant to the BNSS Distress was employed. The study aimed to reexamine the conceptualization of negative symptoms by examining the model fit of several models when BNSS Distress and SDS Emotion (EMO) were included in the models using confirmatory factor analyses (CFA).
Methods
Two-hundred and seventy-four schizophrenia outpatients aged 21–65 were assessed on the BNSS and SDS. In the two-factor models, Restricted Affect, Diminished Emotional Range and Poverty of Speech in SDS and all items in BNSS Blunted Affect and Alogia subscales were regressed on EE, Curbing of Interests, Diminished Sense of Purpose and Diminished Social Drive in SDS and all items in BNSS Anhedonia, Asociality and Avolition subscales were regressed on MAP, without EMO, or with EMO regressed on either EE or MAP. Five-factor models and second-order five-factor models were examined, with or without EMO. Lastly, a six-factor model with EMO manifested by the sixth factor and second-order six-factor models in which EMO was regressed on either EE or MAP were tested. Root mean square error of approximation (RMSEA) <0.08, comparative fit index (CFI) >0.95, the Tucker-Lewis Index (TLI) >0.95, and weighted root-mean-square residual (WRMR) <1.0 indicate good model fit. CFAs were conducted using Mplus version 7.4.
Results
The two-factor models did not yield adequate fit indices. Five-factor model and second-order five-factor model without EMO had good model fit; five-factor model: RMSEA=0.056 (0.044–0.068), CFI=0.996, TFI=0.995, WRMR=0.718; second-order five-factor model: RMSEA=0.049 (0.036–0.061), CFI=0.997, TFI=0.996, WRMR=0.758. When EMO was included as indicator in one of the factors in the five-factor models, only the model in which EMO was regressed on Alogia yielded adequate fit. Similarly, in the second-order five-factor models, adequate fit indices were observed only when EMO was regressed on Alogia and Blunted Affect. The six-factor model fitted the data well, RMSEA=0.053 (0.042–0.064), CFI=0.996, TFI=0.995, WRMR=0.711. Second-order six-factor model with EMO regressed on EE yielded better model fit than MAP, RMSEA=0.050 (0.039–0.061), CFI=0.996, TFI=0.995, WRMR=0.849.
Discussion
In line with previous studies, five-factor and second-order five-factor models without EMO fitted the data well. When EMO was included, a six-factor model and a second-order six-factor model in which the sixth factor was regressed on EE showed good model fit. Emotion, motivation and behavior are intertwined. Our results showed that diminished emotion may also be one of the components of negative symptoms, which had higher association with EE than MAP.
Large-Scale Evaluation of the Positive and Negative Syndrome Scale (PANSS) Symptom Architecture in Schizophrenia
