What is the Best Latent Structure of Negative Symptoms in Schizophrenia? A Systematic Review

Abstract

Background Determining the best latent structure of negative symptoms in schizophrenia could benefit assessment tools, neurobiological research, and targeted interventions. However, no review systematically evaluated studies that assessed and validated latent models of negative symptoms. Objective To identify and evaluate existing latent structure models in the literature of negative symptoms and to determine the best model. Method Systematic search of MEDLINE, EMBASE, and Scopus on July 19, 2020, for confirmatory factor analysis models of negative symptoms in patients with schizophrenia. The available evidence was assessed through 2 sets of criteria: (1) study design quality—based on negative symptoms assessment and modeling strategy and (2) psychometric quality and model fit—based on fit indices and factor definition quality. Results In total, 22 studies (n = 17 086) from 9 countries were included. Studies differed greatly regarding symptom scales, setting, and sample size (range = 86–6889). Dimensional models included 2–6 factors (median = 4). Twelve studies evaluated competing models and adopted appropriate instruments to assess the latent structure of negative symptoms. The 5-factor and hierarchical models outperformed unitary, 2-factor, and 3-factor models on all direct comparisons, and most of the analyses derived from the Brief Negative Symptom Scale. Considering the quality criteria proposed, 5-factor and hierarchical models achieved excellent fit in just one study. Conclusions Our review points out that the 5-factor and hierarchical models represent the best latent structure of negative symptoms, but the immaturity of the relevant current literature may affect the robustness of this conclusion. Future studies should address current limitations regarding psychometric properties and also address biological and clinical validity to refine available models.

Treating negative symptoms of schizophrenia: current approaches and future perspectives

“…4 However, this approach is based on exploratory factor analysis studies, which are hypothesis generating and not designed to specify an underlying factor structure; confirmatory factor analysis studies show that a five-factor model consisting of the five consensus symptoms of avolition, asociality, anhedonia, alogia and blunted affect represents the best fit. 4…”

“…1,3 These are commonly grouped into two domains, one representing reduced motivation and pleasure (comprising asociality, avolition and anhedonia) and another representing reduced expressivity (comprising blunted affect and alogia). 4 However, this approach is based on exploratory factor analysis studies, which are hypothesis generating and not designed to specify an underlying factor structure; confirmatory factor analysis studies show that a fivefactor model consisting of the five consensus symptoms of avolition, asociality, anhedonia, alogia and blunted affect represents the best fit. 4 Prevalence and relevance A large proportion of people with schizophrenia, around 50%, experience negative symptoms in the prodromal phase, prior to the onset of the first episode of psychosis (FEP).…”

“…4 However, this approach is based on exploratory factor analysis studies, which are hypothesis generating and not designed to specify an underlying factor structure; confirmatory factor analysis studies show that a fivefactor model consisting of the five consensus symptoms of avolition, asociality, anhedonia, alogia and blunted affect represents the best fit. 4 Prevalence and relevance A large proportion of people with schizophrenia, around 50%, experience negative symptoms in the prodromal phase, prior to the onset of the first episode of psychosis (FEP). 5 Negative symptoms often persist into the first episode and continue to be common throughout the course of schizophrenia.…”