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

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.

Cross-cultural comparisons of the effect of a schizophrenia label on stigmatizing family attitudes: A case vignette study.

It has been proposed that stigmatizing attitudes toward a family member with schizophrenia are less prevalent in low- and middle-income countries (LAMIC) than in high-income countries (HIC). Furthermore, studies from HIC have shown that labeling increases certain aspects of stigma. This raises concerns about an export of this Western psychiatric labeling practice to LAMIC. The aim of the present research was to determine (a) whether stigmatizing family attitudes are less prevalent in LAMIC than in HIC and (b) whether stigmatizing family attitudes are intensified in both country types by introducing a schizophrenia label. Adults from two HIC (n = 718) and four LAMIC (n = 763) participated in the online study by reading a vignette, which depicted a family member presenting schizophrenia symptoms. Participants were randomly allocated to receive either the label (mental illness called schizophrenia) or the no label condition. Stigma-related stereotypes, emotions, and negative family affect were measured. A two-way multivariate analysis of covariance was conducted. This analysis revealed that participants from LAMIC showed significantly less stigmatizing attitudes toward their family members compared to those from HIC. Introducing a schizophrenia label significantly increased stigmatizing family attitudes in both country types, but the association between labeling and family attitudes was stronger in HIC than in LAMIC. Our results indicate that family attitudes toward schizophrenia and associated labeling effects differ between countries with varying economic strata and cultural values. This needs to be considered in stigma research and in the tailoring of antistigma interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries.

Psychotic experiences (PEs) are common in the general population but do not necessarily reflect a risk status if they occur in relative isolation or are not distressing. Emerging evidence suggests that PEs might be experienced as more benign for individuals from collectivistic low- and middle-income countries (LAMIC) compared with individualistic high-income countries (HIC). The aim of this study was to determine whether: (1) self-reported PEs are less distressing in community samples from LAMIC than from HIC; (2) the network of PEs is significantly less connected in a sample from LAMIC than from HIC. Adults from 8 HIC (n = 4669) and 5 LAMIC (n = 2472) were compared. The lifetime frequency of PEs and related distress were assessed with the Community Assessment of Psychic Experiences. We analyzed the associations of PEs with distress and country type. The interconnection of PEs was visualized by a network analysis and tested for differences in global connection strengths. The average endorsement rates of PEs were significantly higher in LAMIC than in HIC (χ2 = 1772.87, P < .01, Φcramer = 0.50). There was a universal positive correlation between higher frequency of PEs and more distress, but the distress levels controlled for frequency were significantly higher in HIC (R2 = 0.11; b = 0.26; SE = 0.01; T = 17.68; P < .001). Moreover, the network of PEs was significantly less connected in LAMIC (S = 0.40, P < .05). The findings indicate that PEs are of less clinical relevance in LAMIC compared with HIC. The universal use of current high-risk criteria might thus not be adequate without consideration of associated distress and cultural values.

The association of family functioning and psychosis proneness in five countries that differ in cultural values and family structures.

For decades, researchers have attributed the better prognosis of psychosis in developing countries to a host of socio-cultural factors, including family functioning. Nevertheless, it is unknown whether family functioning and its association with symptoms differ across countries. This study assessed family functioning (support, satisfaction with family relations, and criticism) and psychosis proneness in community samples from Chile (n =399), Colombia (n=486), Indonesia (n=115), Germany (n=174) and the USA (n=143). Family functioning was compared between prototypical developing countries (Chile, Columbia, Indonesia) and highly industrialized countries (Germany, USA). Hierarchical regression analysis was used to test for the moderating effect of country on the associations between family functioning and psychosis proneness. Participants from developing countries perceived more support and felt more satisfied. However, they also perceived more criticism than participants from highly industrialized countries. Criticism and family satisfaction were significantly associated with psychosis proneness. Moreover, the relationship between criticism and psychosis proneness was significantly stronger in developing countries compared to highly industrialized countries. Generally, family satisfaction and criticism appear to be more relevant to psychosis proneness than the quantity of family support. Moreover, criticism seems to be more closely related to psychosis proneness in developing countries.

How to Respond to a Paranoid Thought: A Comparison of Patients With Clinically Relevant Delusions and Healthy Controls in Chile.

Although paranoid thoughts occur frequently in the population, most people do not develop clinically relevant delusions. The main purpose of the study was to explore whether participants without a mental disorder will respond in a more functional way to paranoid thoughts and be more flexible in their cognitive processes than patients with clinically relevant delusions. The Responses to Paranoid Thoughts Scale was translated into Spanish and was completed by patients (n = 36) and healthy controls (n = 39) in Chile (South America). The Beck Cognitive Insight Scale was used to assess cognitive insight. The patients responded in a more depressive, physical, and concealing way to paranoid thoughts than the healthy controls. Moreover, they showed significantly less cognitive insight and self-reflectiveness. Higher cognitive insight and self-reflectiveness were associated with more normalizing and communicative responses to paranoid thoughts.

Information and decision-making needs among people with mental disorders: a systematic review of the literature.

BACKGROUND: Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions. OBJECTIVE: To identify patients' information and decision-making needs as a pre-requisite for the development of high-quality web-based patient decision aids (PtDAs) for common mental disorders. SEARCH STRATEGY: A systematic MEDLINE search for papers published until December 2012 was conducted, and reference lists of included articles and relevant reviews were searched. INCLUSION CRITERIA: Original studies containing data on information or decision-making needs of adults with depression, anxiety disorders, somatoform disorders, alcohol-related disorders and schizophrenia were included. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed using a standardized form, and data synthesis was conducted using a theory-based deductive approach by two independent reviewers. Studies were quality assessed using the Mixed Methods Appraisal Tool. MAIN RESULTS: Twelve studies were included focusing on information needs or the identification of decisions patients with depression and schizophrenia were facing. No studies were found for the other mental disorders. Overall, seven information needs categories were identified with the topics 'basic facts', 'treatment' and 'coping' being of major relevance. Six decision categories were identified of which decisions on 'medication' and 'treatment setting' were most often classified. CONCLUSIONS: This review reveals that patients with schizophrenia and depression show extensive information and decision-making needs. The identified needs can initially inform the design of PtDAs for schizophrenia and depression. However, there is an urgent need to investigate information and decision-making needs among patients with other mental disorders.