Factor structure of the brief psychiatric rating scale-expanded among outpatients with psychotic disorders in five Southeast European countries: evidence for five factors

Stojan Bajraktarov; Biljana Blazhevska Stoilkovska; Manuela Russo; Selman Repišti; Nadja P Maric; Alma Dzubur Kulenovic; Aliriza Arënliu; Lidija Injac Stevovic; Ljubisha Novotni; Emina Ribic; Jon Konjufca; Ivan Ristic; Antoni Novotni; Nikolina Jovanovic

doi:10.3389/fpsyt.2023.1207577

Factor structure of the brief psychiatric rating scale-expanded among outpatients with psychotic disorders in five Southeast European countries: evidence for five factors

Front Psychiatry. 2023 Oct 25:14:1207577. doi: 10.3389/fpsyt.2023.1207577. eCollection 2023.

Affiliations

¹ University Clinic of Psychiatry, Ss. Cyril in Methodius University in Skopje, Skopje, North Macedonia.
² Department of Psychology, Faculty of Philosophy, Ss. Cyril in Methodius University in Skopje, Skopje, North Macedonia.
³ Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁴ Faculty of Applied Sciences, University of Donja Gorica, Podgorica, Montenegro.
⁵ Faculty of Medicine, Institute of Mental Health, University of Belgrade, Belgrade, Serbia.
⁶ Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁷ Department of Psychology, Faculty of Philosophy, University of Prishtina, Prishtina, Kosovo.
⁸ Psychiatric Clinic, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.
⁹ Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.

Abstract

The Brief Psychiatric Rating Scale (BPRS) is a useful tool for measuring the severity of psychopathological symptoms among patients with psychosis. Many studies, predominantly in Western countries, have investigated its factor structure. This study has the following aims: (a) to further explore the factor structure of the BPRS-Expanded version (BPRS-E, 24 items) among outpatients with psychotic disorders in Southeast European countries; (b) to confirm the identified model; and (c) to investigate the goodness-of-fit of the three competing BPRS-E factor models derived from previous studies. The exploratory factor analysis (EFA) produced a solution with 21 items grouped into five factors, thus supporting the existence of a fifth factor, i.e., Disorganization. A follow-up confirmatory factor analysis (CFA) revealed a 19-item model (with two items removed) that fit the data well. In addition, the stability of two out of three competing factor models was confirmed. Finally, the BPRS-E model with 5 factors developed in this cross-national study was found to include a greater number of items compared to competing models.

Keywords: BPRS-E scale; confirmatory factor analysis; cross-national study; factor structure; outpatients with psychotic disorders; principal axis factoring.

Grants and funding

This manuscript was prepared as a part of the research project titled Implementation of an effective and cost-effective intervention for patients with psychotic disorders in low- and middle-income countries in South Eastern Europe (IMPULSE) funded by European Commission, Directorate-General Research and Innovation, Grant number 779334.