Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF.

Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is effective for addressing depression and anxiety in adults with various mental disorders. Motivational interviewing (MI) has been successfully applied to address ambivalence or lack of motivation toward treatment. Motivational and behavioral activation (mBA) has been developed by incorporating the core principles from BA and MI with recent findings on the negative symptoms of schizophrenia. In this study, we aimed to examine the feasibility and preliminary efficacy of mBA in a non-randomized controlled pilot study that included individuals with schizophrenia with mild to moderate negative symptoms receiving psychiatric rehabilitation. A total of 73 individuals with schizophrenia were recruited. Forty-seven of the participants who met the study inclusion and exclusion criteria were assigned to either an mBA + usual psychiatric rehabilitation group (mBA) or a usual psychiatric rehabilitation only group (treatment as usual, TAU). Administering mBA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, mBA was associated with large effects in reducing negative symptoms measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). However, after considering PANSS cognitive deficits and marital status as covariates due to significant differences in their baseline levels, the treatment effects on the BNSS were partially observed. In addition, participants in the mBA group showed improved verbal learning and memory compared with those in the TAU group. In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, mBA appears to offer a promising adjunctive approach for addressing mild to moderate negative symptoms. Further investigations are needed to replicate the current findings in a randomized controlled trial.

The Beck Depression Inventory-II (BDI-II) is one of the most widely used depression assessment tools in Korea. However, the psychometric properties and diagnostic cutoff point of the official Korean version of the BDI-II have not yet been reported. This study aims to clarify the psychometric properties and diagnostic utility of the Korean BDI-II. A total of 1,145 clinical and non-clinical Korean adults participated in this study. The BDI-II showed a high level of internal consistency and high correlations with other depression-related measures. Confirmatory factor analysis (CFA) was performed, and a 3-factor model showed the best model fit. To identify the diagnostic utility of the BDI-II, the Quality Assessment of Diagnostic Accuracy Studies 2nd Edition (QUADAS-2) methodology was applied in participant recruitment and research design. Results of ROC curve analysis suggested two optimal cutoff scores, 23 points for detecting major depressive disorder (MDD) (83.3% sensitivity, 86.8% specificity) and 17 points for depressive-related disorder (80.9% sensitivity, 76.4% specificity). To identify the usefulness of the BDI-II as a severity assessment tool or screening tool, a test information curve (TIC) was generated with an Item Response Theory (IRT) analysis. The TIC was flat and plateau-like, indicating its appropriateness as a severity rating tool. Research data supports the BDI-II as a reliable and valid screening tool as well as a severity rating tool in the Korean adult population.

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