Assessing Social Functioning in Individuals with Schizophrenia with the Brief Impression Questionnaire (BIQ)
Isabelle Lanser
University of North Carolina at Chapel Hill Spring 2016
A thesis presented to the faculty of The University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the Bachelor of Arts degree with Honors in Psychology.
Acknowledgments
Abstract
Assessing Social Functioning in Patients with Schizophrenia with the Brief Impression Questionnaire (BIQ)
One of the key targets of schizophrenia treatment is community reintegration following the onset of psychosis (Melle et al., 2014). However, deficits in social functioning prevent many of the 2.6 million Americans affected by this disorder from achieving this goal (Kennedy et al., 2014). Social functioning is one’s ability to engage with the environment and fulfill various social roles within one’s social network (Bosc et al., 2000). Decreased social functioning significantly influences subjective quality of life, defined as one’s evaluation of physical health, feelings, interpersonal relationships, school/occupation, household responsibilities, leisure, overall satisfaction, and enjoyment (Ritsner et al. 2012). For example, in a ten-year quality of life outcomes study of individuals with schizophrenia and schizoaffective disorder, Ritsner et al. (2012) found that psychosocial factors, like social support and social functioning, were better predictors of quality of life than symptom-related factors. Moreover, social functioning deficits contribute to an economic burden on society and high relapse rates in this population. Since 1998, the World Health Organization has ranked schizophrenia among the top 10 causes of disability among people in developed countries, and, in 2014, individuals with psychosis received about 20% of all social security dollars for healthcare related costs (Kennedy et al., 2014; Lopez et al., 2006).
expressed emotion, a critical or over-involved attitude, tend to have poorer levels of social functioning compared to patients whose families are less hostile (Barrowclough & Tarrier, 1990). In turn, increased hostility among family members may stem from the consequences of social functioning impairments, such as the inability to secure a job or fully engage with other family members (Sczufca & Kuipers 1998). The quality of family relationships is particularly important for this population, as 50-80% of individuals with schizophrenia either live with family members or have regular contact with them (Sharif, Shayagan, & Mani, 2012). Further, perceptions of improvement in a patient’s social functioning is associated with the reduction of expressed emotion in families that originally displayed high levels of hostility, transforming the family from a source of stress to one of social support (Sczufca & Kuipers 1998; Tempier et al., 2013). Expressed emotion in families is one type of social stressor individuals with psychosis may be ill-equipped to handle due to their social functioning deficits (Koujalgi et al., 2014). Thus, high levels of social stressors may contribute to an individual’s relapse, even with adherence to medication regimens (Bustillo et al. 2001; Butzlaff & Hooley, 1998).
(Burns & Patrick, 2007), thus underscoring the importance of social functioning as a key target in schizophrenia research.
Global social functioning is often targeted through social skills training interventions (Bellack & Mueser, 1993). Social skills are the building blocks of social functioning and include the skills needed to perform daily life tasks, acquire and maintain employment, and build
effective relationships (Bustillo, 2001). These skills can be categorized into three groups:
receiving, processing, and sending skills (Ikebuchi, 2009). Receiving skills are those necessary to decode social cues such as tone and facial displays. Processing skills (also known as social problem solving skills) involve assessing the social situation and integrating this information with prior knowledge to generate a response. The ability to reciprocate communication through verbal and nonverbal displays falls under the sending skills domain (Ikebuchi, 2009). These skills are taught using highly structured interventions that utilize modeling, role-playing, and social reinforcement procedures to teach and shape appropriate social behavior (Bellack & Mueser, 1993). For example, a receiving skill may be taught by training individuals to focus on the center region of the face, the eyes, nose, and mouth, when attempting to identify someone’s emotion (Penn et al., 2005). Moreover, following the principles of behavior therapy and social learning theory, these interventions use goal setting, corrective feedback, and homework assignments to facilitate the adoption of social skills (Kopelowicz, Liberman, & Zarate, 2006).
Mueser, 1993). The integration of these steps occurs during the role-play portion of the
intervention (Bellack & Mueser, 1993). Randomized controlled trials of standalone social skills training interventions have demonstrated moderate to large effect sizes on domains beyond skill mastery, such as social adjustment, independent living, and negative symptoms (Kurtz & Mueser, 2008; Kern et al., 2009). Increasingly, these interventions have been incorporated into multidimensional interventions, such as supported employment programs (Nuechterlein,
Subotnik, & Ventura, 2005). Moreover, these interventions have shifted from teaching formulaic, general skills to targeting the individual needs of the group members (Kern et al., 2009). Social skills interventions have preserved their impact even as the flexibility of their implementation has increased (Kern et al., 2009).
Given the importance of social functioning in schizophrenia and the efficacy of social skills training, there has been an increased focus on developing valid assessment tools
(Kopelowicz et al., 2006). Social functioning assessments generally fall into two categories: indirect assessment (e.g. self and informant reports) and direct assessment (e.g. role-play tasks) (Patterson et al., 2001a). The ultimate goal of these assessments is to evaluate and predict real-world outcomes. In 2009, researchers from the Validation of Everyday Real-World Outcomes Study (VALERO) asked 48 experts to nominate social functioning assessments that measured social, residential, and vocational domains, to identify the best self or informant report
instruments and recommend them to the field (Leifker et al., 2011). A total of 59 measures were nominated, highlighting the heterogeneity of methods used at that time (Leifker et al., 2011). Based on the available published data, number of nominations, and match to the aforementioned domains of interest, six scales were selected for further study: the Quality of Life Scale
1983), Independent Living Skills Survey (Wallace et al., 2000), Social Behavior Schedule (Wykes & Sturt, 1986), Social Functioning Scale (Birchwood et al., 1990), and Life Skills Profile (Rosen et al., 1989) (Leifker et al., 2011). Notably, only one self-report measure, the Social Functioning Scale, was selected for potential inclusion in the assessment battery, suggesting that other self-report measures had less than desirable psychometric properties (Leifker et al., 2011). All other measures included in the VALERO study were either semi-structured interviews or informant reports (Leifker et al., 2011).
The phase I trial of the VALERO study assessed the predictive utility of the six scales on neurocognitive and functional capacity assessment performance (Harvey et al., 2011). Functional capacity measures the potential of an individual’s functioning outside of the laboratory setting. The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and the advanced finances subscale of the Everyday Functioning Battery were used to assess functional capacity directly, and these scores were correlated with ratings from the six social functioning measures (Harvey et al., 2011). Previously, there had been little evidence that indirect measures of real-world functioning were related to performance-based assessments of functioning, thus, the identification of the SLOF as a robust predictor of performance-based functional ability was an important finding (Harvey et al., 2011; Leifker et al., 2011). The SLOF asks either the patient or the patient’s caseworker, caregiver, or clinician to rate the patient’s behavior and functioning in the following domains: physical functioning, interpersonal relationships, social acceptability, personal care skills, work skills, and community living skills (Leifker et al. 2011).
video recorded and later scored by assessing the participant on domains such as interest, fluency, affect, and social appropriateness. These types of assessments allow researchers to directly observe behavior, and they often help reconcile disparities between informant and self-reports (Patterson et al., 2001a). Despite its significance, the field has yet to reach a consensus on whether direct or indirect assessment of social functioning should be considered the standard practice (Burns & Patrick, 2007; Patterson et al. 2001a). Results from the VALERO study have helped identify the best indirect assessments of functional capacity, namely the SLOF, however, more investigation is needed for direct assessments (Harvey et al., 2011; Leifker et al., 2009; Leifker et al., 2011).
Informant reports also exhibit several limitations. For example, the type of informant completing the assessment (e.g. family member, clinician, friend, etc.) may vary between participants. Such discrepancies make it difficult to compare reports between subjects because different informants may be evaluating the subject based on experiences in differing contexts, such as social, vocational, or residential (Beck et al., 1991; Sabbag et al., 2011). Additionally, the amount of time each type of informant spends with the individual may affect their ratings (Harvey et al., 2007). Clinicians who frequently meet with the patient may provide more accurate ratings of everyday functioning than informants who are relatives or friends of the patient (Sabbag et al. 2011). As a result, high-contact informants, or those who have consistent contact with the client, are often preferred. Yet, the specific definition of a high-contact
informant is not standardized, and may vary between studies. Previously, healthcare professionals working with an individual in a highly structured living environment were
considered “high-contact” informants, but often these ratings did not correlate with performance on functional capacity assessments (Harvey et al., 2007). These informants were found to only interact with patients in brief, highly structured contexts, resulting in a limited view of their overall functioning (Harvey et al., 2007). Moreover, it may be difficult to recruit a large enough sample size of individuals with high-contact informants willing to participate in a study. Over one-third of individuals cannot name anyone able to fill out these reports (Harvey et al., 2007).
administer, and while this time is available in the laboratory setting, it is unclear whether these tasks can be successfully integrated into an intake assessment (Bellack et al., 1993; Mausbach et al., 2009; Patterson et al., 2001b). Additionally, the UPSA requires several props, which may make administration challenging (Mausbach et al., 2009). Further, to ensure adherence to coding and scoring protocols for many of the direct assessment measures, multiple independent raters are required. Each rater must be trained to meet reliability standards with the other raters, which can be a lengthy process (Harvey et al., 2007, Mausbach et al., 2009). Thus, while these
assessments may provide clinicians with important information that can aid in designing a treatment course for patients, several factors limit their adoption in the clinical setting. Although the present study does not formally assess clinical utility, we believe it is important to keep these challenges in mind when evaluating measures.
Spontaneous trait inference is an underutilized construct in the field of schizophrenia research, but has long been a popular domain of study among social psychologists, beginning with the study of forming impressions on personality (Asch, 1946). These inferences, developed in a three stage process, are those made about an individual’s disposition based on either
Ingrid as “funny.” The spontaneity of these inferences suggests that these attributions are a part of the natural processing and comprehension of social events (Winter & Uleman, 1984).
Faces provide a copious amount of social information that can then be used to make inferences about an individual’s dispositions (Willis & Todorov, 2006). The accuracy of these spontaneous impressions of others has been established in the general population (Carney, Colvin, & Hall, 2007; Uleman, Saribay, & Gonzalez, 2008). Specifically, accuracy is indicated by the agreement or match between the judgment content and the direct measurement of that content, and the predictive validity of those judgments, the extent to which a judgment made in one context is indicative of future behavior (Carney, Colvin, & Hall, 2007). For example, imagine that when meeting a new acquaintance, you observe that she is introverted. After talking to her, you find that she agrees that she is introverted, which suggests a match between the judgment and a measurement of that trait. You can now use this introversion judgment to predict that she will stay with her friends and only talk to new people when they come up to her, which demonstrates the predictive nature of impressions. High levels of judgment accuracy have been demonstrated in studies asking nonclinical samples to assess constructs such as personality and competence (Ambady, Hallahan, & Conner, 1999; Carney, Colvin, & Hall, 2007).
expressions), rigidity (posture and body movement), and verbal fluency (way of speaking) (Miers et al., 2010). These findings shed light on the utility of impression formation as an assessment tool for evaluating social skill and social functioning. Impressions following short periods of interactions or observed behaviors may mitigate some of the challenges associated with social skills assessment because they require little to no training, as demonstrated by the use of untrained adolescents in the aforementioned study. Furthermore, the ease at which these adolescents formed these impressions provides evidence of both the automaticity and accuracy of social inferences. Additionally, thin slicing research has demonstrated that facial inferences are the most rapidly formed inferences, suggesting that these inferences are rooted in survival-related abilities, such as threat judgments (Bar, Neta, & Linz, 2006). As a result, obtaining impressions through thin slicing may also be a valuable tool for assessing an individual’s social functioning.
The purpose of this study is to conduct an initial evaluation of the Brief Impression Questionnaire (BIQ). The BIQ is a novel impression formation measure that asks research assistants to quantify their impressions of an individual after completing a research study
assessment. It requires the research assistants to consider participants’ facial displays, affect, and general demeanor, features commonly used to generate impressions (Uleman, Saribay, &
Method Participants
This study took place at three sites, University of Miami (UM), University of North Carolina at Chapel Hill (UNC), and University of Texas at Dallas (UTD). Patients at the UNC and UTD sites were primarily recruited from local mental health services clinics. Patient recruitment at the UM site occurred at the Miami VA Center and the Jackson Memorial Hospital-University of Miami Center. Community advertisements were used to recruit healthy controls at all sites. For inclusion and exclusion criteria, please refer to Pinkham et al. (2015).
A total of 104 individuals (47 HC) participated in this study. The demographic
information for the individuals with schizophrenia (SCZ) and HC is presented in Table 1. Group composition was matched on age, race, ethnicity, and gender during the recruitment process. In addition to the traditional demographic information, data on highest level of education,
employment status, and residential status is presented, as these are indicators of real world functioning.
A total of 18 research assistants from the three testing sites completed the BIQ after each participant visit. Demographic information for all the research assistants can also be found in Table 1.
INSERT TABLE 1 Social Cognition Measures
Observational Ratings of Social Cognition. The Observable Social Cognition- a Rating Scale (OSCARS) is an 8-item interview designed to assess the four domains of social cognition —emotion perception, theory of mind, attributional style/bias, and social perception—in
scale. The total score received on the OSCARS was used in analyses. Higher scores on this measure indicate impaired social cognitive performance.
Emotion Perception. The Penn Emotion Recognition Task (ER-40) and the Bell-Lysaker Emotion Recognition Task (BLERT) were used to assess emotion perception. The ER-40 asks participants to correctly identify one of six emotions (happy, sad, anger, fear, disgust, and neutral) for 40 photographs (Kohler et al., 2003). Performance is evaluated by totaling the number of correct items. The BLERT asks participants to view 21 brief videos of an actor saying phrases while displaying emotionally salient facial expressions and vocal prosody (Bryson, Bell, & Lysaker, 1997). A total score is calculated by summing the number of correctly identified emotions.
Theory of Mind. The Hinting Task, Reading the Mind in the Eyes Task (Eyes), and The Awareness of Social Inference Test (TASIT) were used to assess theory of mind (ToM). The Hinting Task assesses ToM using ten short stories, each presenting an interaction between two characters (Corcoran, 2003). At the end of each story, one of the characters makes an allusion and participants are asked to make an inference regarding what the character is intimating by this allusion. Better performance on this task is indicated by a greater number of correct responses. The total number of correct responses was used in analyses.
The TASIT (McDonald et al., 2003) is a 16-item assessment, during which participants view 16 brief videotaped social interactions that depict sarcasm and “white lies.” Then, they are asked four Yes/No questions about each video clip. Performance is indexed by the total correct responses to the Yes/No questions.
identify the emotion that describes what the person is thinking and/or feeling from four response choices. Performance is evaluated by summing the correct responses.
Social Functioning Measures
The Specific Levels of Functioning (SLOF), Social Skills Performance Assessment (SSPA), and UCSD Performance-based Skills Assessment (UPSA) were used to assess social functioning.
The SLOF is a 43-item questionnaire designed to rate a participant’s performance in six real-world domains (Schneider & Struenig, 1983). Healthy controls completed the self-report version of the SLOF and informants of the patient group completed the informant-report version. Patients selected an informant of their choosing and research assistants contacted the individual. The SLOF domains are: physical functioning, personal care skills, interpersonal relationships, social acceptability, activities, and work skills. Each item is rated on a 5-point scale.
Additionally, the informant report asks the informant to rate how familiar they are with the patient on a 5-point scale. Averaging the ratings on the individual items creates a composite score for each version of the SLOF. The present study uses this total score in data analyses.
affect, negotiation ability, submission/persistence, overall argument, and social appropriateness. Each item is rated on a scale from 1 to 5. An average rating is computed for each scene. Data analyses used the average of the two scene scores.
The UPSA was only administered to patients because it is designed to assess everyday functioning in people with severe mental illness using props and standardized role-plays
(Patterson et al., 2001a). The UPSA is segmented into three domains, however, only the finance and communication domains were administered in this study. The finance domain asks
participants to count out amounts of real U.S. currency, make change, and write a check to pay a utility bill. The communication domain requires a patient to read an appointment reminder notice from a medical provider and call to reschedule the appointment. A total score was computed after assigning a score of 0-20 to each domain.
Symptom Measures
Symptoms. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), a 30-item inventory designed to assess symptomatology in a schizophrenia population on a continuum (Kay, Opler, & Lindenmayer, 1988). Each item is rated from 1 to 7 (higher scores indicating more severe symptoms) yielding three subscales: positive symptoms, negative symptoms, and general psychopathology.
Brief Impression Questionnaire (BIQ)
delusions can often be unusual, resulting in odd behavior, and as a result, the term “strange” was added to the questionnaire. The two items regarding whether the research assistant would like to socialize with or retest the participant were adapted from the Impression Questionnaire (Murphy-Berman & (Murphy-Berman, 1978). All items are rated on a 6-point Likert Scale (anchors: strongly disagree to strongly agree). Research assistants completed the BIQ immediately after each visit. Procedure
Participation took place over two study visits at one of three study sites as a part of the SCOPE study (Pinkham et al., 2015). For the initial exploration of this measure, only visit 1 is necessary. Both participant groups completed the BLERT, ER-40, TASIT, Eyes, and Hinting Task, SSPA, OSCARS, and SLOF at visit 1. The informant report version of the SLOF was filled out by the subjects’ designated informant and returned directly to the research assistant (Note: the SLOF informant report was only completed for the SCZ group). The SCZ group also completed the PANSS and the UPSA. The research assistants completed the BIQ after each visit; however, for the purposes of the present study, BIQ ratings of visit 1 were utilized in all
analyses. The BIQ was rated twice because it followed the same protocol as the SCOPE study (2 visits with a primary aim to test-retest reliability). For a full description of study procedures, please see Pinkham et al., 2015.
Results Data Analytic plan
the study (Smilde, 2003). The average rating of each research assistant, on each item, for each visit, and for each subject type was calculated. This average was then subtracted from the corresponding raw rating. A higher rating on the BIQ indicates better performance on this measure.
Descriptive Statistics
Descriptive data for item ratings on the BIQ, social cognition, social functioning, and PANSS ratings (for both groups) are summarized in Table 2.
INSERT TABLE 2 Exploratory factor analysis
The primary aim of the present study was to investigate the factor structure of the BIQ for healthy controls and individuals with schizophrenia. Initially we examined the suitability of the six BIQ items for a factor analysis. First, we observed that all of the items correlated at least 0.3 with at least one other item. Second, the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.823 for the SCZ data and 0.881 for the HC data, which is above the recommended value of 0.6, and Bartlett’s Test of Sphericity was significant for both samples. Lastly, the communalities for both analyses were above 0.3, confirming that each item shared common variance with each other item. Therefore, an exploratory factor analysis was deemed suitable for all six items of the BIQ.
extracting too few or too many factors (Costello & Osborne, 2005). Because a one-factor model was the best solution for the HC group, rotation was not necessary to generate the factor loadings (Table 3). Due to the high between-item correlations, we used an oblimin rotation to generate the factor loadings for the SCZ model (Table 3). Following convention, the cutoff for item loading was 0.3 (Costello & Osborne, 2005).
Results from these analyses revealed separate factor structures for the HC and SCZ data. For the HC data, the one-factor solution explained 72% of the variance (See Table 3 for factor loadings and Figure 1 for scree plot). All of the items loaded quite strongly onto one factor as evidenced by factor loadings above 0.5. The likability, easygoing, and retest items had the strongest loadings (0.8 or higher). The strangeness item had the lowest loading of 0.69, indicating that this item is moderately correlated with the Composite factor. This factor is conceptualized as a composite score on the BIQ because it contained all items, and will be referred to as the “Composite factor” after this point.
For the SCZ data, the two-factor solution explained 72% of the variance within the data, with the first factor explaining 56% of the variance (See Table 3). The factor loadings for the SCZ model were all over 0.5. The retest item exhibited a cross-loading above 0.3, however, this item had a primary loading of 0.626, and was thus grouped with the first factor. The likability and friendliness items had the highest factor loadings (above 0.8 on the first factor). The likelihood to socialize item had the lowest factor loading (0.53 on the second factor).
INSERT TABLE 3
participant was (Appendix, Items 1-3). In order for all of the tasks to be completed, a degree of agreeableness and cooperation was required from each participant, particularly because of the duration of the study visit (2 to 4 hours). Therefore, the loading of the retest item (Appendix, Item 5) onto the Agreeableness factor can be understood as a characterization of the working relationship between the research assistants and the participants.
The second factor, comprised of the strangeness item (Appendix, Item 4) and the
likelihood to socialize item (Appendix, Item 6), was labeled “Willingness to Engage” because of the likelihood to socialize item. This item asks research assistants to gauge the likelihood of whether they would engage with the participant if they were not in the laboratory environment. The likelihood to socialize item is a social rejection question because research assistants are required to assess whether they would include the participant in their social group. Social rejection is related to the feeling of disgust, which is triggered by strangeness, among other factors (Lindner et al., 2014). We interpret the loading of the strangeness item onto this factor as consistent with this understanding of the relationship between social rejection and strangeness. Social Cognition and Social Functioning Bivariate Correlations
Using the factor scores generated by the principal axis factoring extraction, a series of bivariate correlations were conducted to assess the relationship between the factors of the BIQ and the social cognition and social functioning assessments. Additionally, we computed correlations between the factor scores and PANSS ratings for the SCZ group (see Table 4).
For HC, the Composite factor was moderately negatively correlated with social cognitive impairment, such that higher scores on the BIQ were associated with less social cognitive
For SCZ, in terms of social cognition, higher ratings on the Agreeableness factor was associated with better performance on the ToM task, the Hinting task, and associated with less impairment on the real-world social cognition task, the OSCARS-Informant report. Finally, higher ratings on the Willingness to Engage factor were associated with better performance on the two ToM tasks, the Hinting task and the TASIT.
In terms of social functioning, higher ratings on the Agreeableness and Willingness to Engage factors were associated with better role functioning, as measured by the UPSA, and better social functioning, as measured by the SLOF-Informant task.
Finally, in terms of symptoms, higher ratings on the Agreeableness factor was associated with lower negative symptoms, while higher ratings on the Willingness to Engage factor were associated with lower positive symptoms.
INSERT TABLE 4 Discussion
The primary aims of this study were to examine the factor structure of the BIQ for HC and SCZ groups and to examine the relationship between the extracted factors with current measures of social cognition and social functioning. Results from the exploratory factor analysis revealed that the structure of the BIQ varied between subject groups. Specifically, a single factor solution was present in the HC sample and a two-factor solution was present in the SCZ sample. In addition, there were differences in the number and strength of associations between the BIQ and social cognition and social functioning in both groups.
studies have indicated variability in social cognitive factor structures across schizophrenia and control samples (Buck, Healey, Gagen, Roberts, & Penn, 2015). Given that assessors were not blind to condition, it is possible that the differing factor solutions observed in HC versus SCZ groups may result from the assessors’ knowledge of the group (e.g. whether he/she had a mental illness or not). It is also possible that forming impressions of individuals with schizophrenia are a function of general likeability, which pertains to all people (regardless of diagnosis), and symptom related factors, which are unique to people with psychosis.
The finding that the Composite factor for the HC group was correlated with only one of the social cognition assessments, the OSCARS-self-report, and none of the social functioning assessments is consistent with prior research (Couture et al., 2011). While healthy controls systematically outperform patient groups on measures of both social cognition and social
functioning, these domains are not typically correlated for this group (Addington et al., 2006). In healthy control groups, social cognition is more closely related to general neurocognitive
abilities than social functioning abilities (Addington et al., 2006). Therefore, this finding is consistent with prior models of social cognition in individuals without severe mental illness.
supported by its consistent association with the OSCARS, which is strongly correlated with direct measures of social functioning (Healey et al., 2015).
Established social cognition and social functioning measures are often correlated, because social cognition explains a significant portion of the variance in social functioning (Addington et al., 2006; Couture et al., 2011). This relationship may provide insight as to why the two factors for the SCZ group were also correlated with the Hinting Task and the TASIT. Specifically, both of these assessments measure higher order social cognition skills, which are more closely related to social functioning than measures that examine lower level emotion recognition (Addington et al., 2006; Couture et al., 2011). In conceptual frameworks modeling the relationship between social cognition and social functioning, emotion perception occurs shortly after the social stimulus, while ToM judgments are thought to occur closer to the attribution and social behavior stages (Couture, Penn, & Roberts, 2006). Thus, the BIQ may be tapping into social cognitive processes most proximal to actual social behavior.
The Agreeableness and Willingness to Engage factors in the SCZ sample showed unique patterns of correlations with the different symptom types (positive and negative). The
and social distance were predicted by perceived strangeness resulting from the presence of positive symptoms (Penn, Kohlmaier, & Corrigan, 2003; Schumacher, Corrigan, & Dejong, 2003). Therefore, it is possible that the content of hallucinations and delusions could have led to the judgment of “strange” on the BIQ and subsequently resulted in decreased motivation to include the participant in a social group.
There are several limitations associated with this study. First, the research assistants to participants ratio was rather small (18:104). As a result, there is a concern for the nesting of BIQ ratings within each research assistant (see Meirs et al, 2010, for similar concerns). The mean centering conducted prior to data analysis may not have been sufficient to reduce this effect. Additionally, the strangeness item was not clearly defined, which may have impacted assessors’ ratings. This issue is related to the aforementioned nesting problem because some research assistants may have a higher or lower threshold for what they consider strange. Lastly, it is likely that the impressions captured by the BIQ were informed by the performance on other social cognition and functioning measures, as observed by the research assistants given that they completed the BIQ after the entire testing session.
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Table 1
Demographic Characteristics of SCZ, HC, and Research Assistants (RA)
SCZ (n= 57) HC (n= 47) RAs (n = 18)
Age M= 43.02 (SD
= 10.23) M= 42.62(SD = 9.61)
M= 25.83 (SD = 3.98)
Gender
Male 31 (54.4%) 28 (59.6%) 4 (22.2%)
Female 26 (45.6%) 19 (40.4%) 14 (77.8%)
Race
Asian 2 (3.5%) 2 (4.3%) 2 (11.1%)
Black or African American 32 (56.1%) 28 (59.6%) 2 (11.1%)
White 20 (35.1%) 17 (36.2%) 11 (61.1%)
Other 3 (5.3%) N/A 3 (16.7%)
Ethnicity
Hispanic or Latino 11 (19.3%) 13 (27.7%) 3 (16.7%)
Not Hispanic or Latino 46 (80.7%) 34 (72.3%) 15 (83.3%) Highest Level of Education
Higher than College 5 (8.8%) 2 (4.3%) N/A
Completed College, 4 year Degree 5 (8.8%) 15 (31.9%) N/A Some Post-Secondary School, No Degree 18 (31.6%) 20 (42.6%) N/A Completed High School, Diploma 18 (31.6%) 9 (19.1%) N/A Attended High School, No Diploma 8 (14.0%) 1 (2.1%) N/A
Middle School or Less 3 (5.3%) N/A N/A
Primary Diagnosis
Schizophrenia 27 (47.4%) N/A N/A
Schizoaffective Disorder 29 (50.9%) N/A N/A
First Episode Schizophrenia Spectrum Disorder 1 (1.8%) N/A N/A Secondary Diagnosis
Depression 10 (17.5%) N/A N/A
Bipolar Disorder 4 (7.0%) N/A N/A
Other 4 (7.0%) N/A N/A
N/A 39 (68.4%) N/A N/A
Current Employment Status
Unemployed 18 (31.6%) 7 (14.9%) N/A
Disability/Unemployed 29 (50.9%) N/A N/A
Disability/Part-Time Employment 5 (8.8%) N/A N/A
Full-Time Student N/A 3 (6.4%)
Employed Part Time 2 (3.5%) 6 (12.8%) N/A
Employed Full Time 1 (1.8%) 28 (59.6%) N/A
Retired/Unemployed 2 (3.5%) 2 (4.3%) N/A
Residential Status
Independent and Not Financially Responsible 9 (15.8%) 1 (2.1%) N/A Unsupervised Residential Facility 4 (7.0%) 2 (4.3%) N/A Supervised Residential Facility 4 (7.0%) N/A N/A
Table 2
Descriptive Statistics for BIQ Items and SCOPE Outcome Measures HC
(n = 47)
SCZ (n = 57)
BIQ M(SD) M(SD)
Likability 5.25(0.97) 4.80(1.12) Friendliness 5.40(0.89) 4.91(1.04) Easygoing 5.33(0.90) 4.77(1.11) Likelihood to Retest the Participant 4.93(1.19) 4.36(1.45) Likelihood to Socialize with the Participant 3.92(1.35) 2.30(1.33) Strangeness 5.18(1.22) 3.45(1.54) Social Cognition
BLERT Total Correct 15.32(3.07) 13.37(4.40) ER40 Total Correct 33.36(3.45) 30.93(5.13) Eyes Total Correct 24.04(4.45) 21.93(3.32) Hinting Total Correct 16.43(2.09) 13.46(3.32) TASIT Total Correct 52.70(5.22) 45.02(7.89)
OSCARS Self-Report 1.82(1.56) N/A
OSCARS Informant-Report N/A 4.09(2.61)
Symptom Ratings
PANSS Positive Factor N/A 16.05(4.97)
PANSS Negative Factor N/A 12.86(3.56)
PANSS General Factor N/A 31.14(7.87)
Social Functioning
SSPA Average 4.58(0.34) 4.26(0.45)
UPSA Total Score N/A 72.23(14.43)
SLOF Informant-Report N/A 4.16(0.57)
SLOF Self-Report 4.74(0.25) N/A
Note. BLERT= Bell-Lysaker Emotion Recognition Task; ER-40= Penn Emotion Recognition Task; Eyes= Reading the Mind in the Eyes Task; Hinting= Hinting Task; TASIT= The
Table 3
Factor Loadings of BIQ
HC SCZ
Item Factor 1:
Composite AgreeablenessFactor 1: Willingness toFactor 2: Engage
Likability .949 .801 .109
Friendliness .776 .853 -.139
Easygoing .862 .658 .029
Willingness to Retest Participant .832 .626 .355
Willingness to Socialize with Participant .784 .247 .531
Strangeness .690 -.055 .684
Table 4
Bivariate Correlations among SCOPE Measures and BIQ Factors: HC and SCZ
HC SCZ
Composite Factor Agreeableness
Factor Willingness toEngage Factor Social Cognition
BLERT Total Correct .061 .151 .262
ER40 Total Correct .309 .138 .248
Eyes Total Correct .230 .139 .209
Hinting Total Correct .055 .438* .479*
TASIT Total Correct .089 .251 .348*
OSCARS Self-Report -.409*** -.125 -.184
OSCARS Informant-Report N/A -.337* -.328
Symptom Ratings
PANSS Positive Factor N/A -.184 -.421*
PANSS Negative Factor N/A -.416* -.263
PANSS General Factor N/A -.081 -.088
Social Functioning
SSPA Average .261 .096 .244
UPSA Total Score N/A .365* .444*
SLOF Informant-Report N/A .552** .478*
SLOF Self-Report .252 N/A N/A
Note. BLERT= Bell-Lysaker Emotion Recognition Task; ER-40= Penn Emotion Recognition Task; Eyes= Reading the Mind in the Eyes Task; Hinting= Hinting Task; TASIT= The
Awareness of Social Inference Test; OSCARS= Observational Social Cognition, A Rating Scale; PANSS= Positive and Negative Syndrome Scale; SSPA= Social Skills Performance Assessment; UPSA= UCSD Performance-based Skills Assessment; SLOF= Specific Levels of Functioning, Self-Report.
Correlations marked with an asterisk (*) were significant at p < .05
Figure 1
Figure 2
Appendix Brief Impression Questionnaire
1. The participant was likable.
1 2 3 4 5 6
Strongly Disagree Strongly Agree 2. The participant was friendly.
1 2 3 4 5 6
Strongly Disagree Strongly Agree 3. The participant was easy to get along with.
1 2 3 4 5 6
Strongly Disagree Strongly Agree 4. The participant was strange.
1 2 3 4 5 6
Strongly Disagree Strongly Agree 5. I would look forward to testing this participant again.
1 2 3 4 5 6
Strongly Disagree Strongly Agree 6. The participant is someone I could socialize with outside of the research setting.
1 2 3 4 5 6
