Personal Beliefs about Illness Questionnaire-Revised (PBIQ-R): Spanish adaptation in a clinical sample with psychotic disorders

MAIN Pe sonal Belie s abou Illness Ques ionnai e-Re ised (PBIQ-R): Spanish adap a ion in a clinical sample wi h psycho ic diso de s An onio J. Vázquez Mo ej´on1,Ch isJackson 2, Raquel Vázquez-Mo ej´on3* and Jose M. Leon-Pe ez3 1Unidad de Salud Men al Comuni a ia Guadalqui i , Hospi al Uni e si a io Vi gen del Rocío, Se ille, Spain and Uni e si y o Se ille, Spain, 2Bi mingham Women’s and Child en’s NHS Founda ion T us , Bi mingham, UK and 3G upo de In es igaci´on Compo amien os Sociales y Salud, Uni e si y o Se ille, Spain *Co esponding au ho . Email: [email p o ec ed] (Recei ed 12 Augus 2021; e ised 18 Ap il 2022; accep ed 27 Ap il 2022; i s published online 15 June 2022) Abs ac Backg ound: The way people wi h psychosis psychologically adap and manage he diagnosis o such a men al diso de has been conside ed a key ac o ha con ibu es o he eme gence and agg a a ion o emo ional p oblems. These belie s abou illness can be e y impo an due o hei possible associa ion wi h s igma and i s implica ions in e ms o loss o oles and social s a us. Gi en he impo ance o hese pe sonal belie s abou he speci ic diagnosis o psychosis, he Pe sonal Belie s abou Illness Ques ionnai e (PBIQ) and PBIQ-R ha e been de eloped. Aims: The p esen s udy aims o explo e he psychome ic cha ac e is ics o he Spanish e sion o he PBIQ-R in a sample o pa ien s wi h a diagnosis o psychosis- ela ed diso de s. Me hod: Pa icipan s we e 155 pa ien s (54.8% male) o he Public Heal h Se ice in Andalusia (Spain). Those who consen ed o pa icipa e illed in he PBIQ-R, he Social Compa ison Scale, and he PHQ-9 and GAD-7 o measu e emo ional symp oms. Resul s: All dimensions showed adequa e in e nal consis ency alues: C onbach’s alpha ex ends be ween .81 and .88; and McDonald’s omega anges be ween .87 and .92. The empo al eliabili y o an in e al o 3–4 weeks was high. The co ela ions be ween he PBIQ-R dimensions and he o he a iables included in he s udy we e signi ican and in he expec ed di ec ion. The ac o analysis o he p incipal componen s o he PBIQ-R dimensions e ealed a single ac o in each o he dimensions ha explained 64–74%. Conclusions: The esul s suppo he eliabili y and alidi y o he Spanish e sion o he PBIQ-R. Keywo ds: Assessmen ; Pe sonal Belie s abou Illness Ques ionnai e; psychome ic cha ac e is ics; psycho ic diso de s In oduc ion Se e al s udies ha e shown he impo ance o emo ional dis ess in people diagnosed wi h psycho ic diso de s and i s co-mo bidi y wi h anxie y diso de s (Achim e al., 2011; Pa lo a e al., 2015), dep essi e diso de s (Acos a e al., 2013; Bi chwood e al., 1993,2005,2007; Buckley e al., 2009), and pos - auma ic diso de s (McGo y, 1991). This symp oma ology d ama ically a ec s hese pa ien s’quali y o li e, and he e o e i is o g ea in e es o in es iga e he ac o s ha may be in ol ed in he eme gence and cou se o his © The Au ho (s), 2022. Published by Camb idge Uni e si y P ess on behal o he B i ish Associa ion o Beha iou al and Cogni i e Psycho he apies. This is an Open Access a icle, dis ibu ed unde he e ms o he C ea i e Commons A ibu ion licence (h ps:// c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed e-use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Beha iou al and Cogni i e Psycho he apy, 2022, 50, 528–537 doi:10.1017/S1352465822000248 h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess symp oma ology. Belie s ega ding he diagnoses and hei possible implica ions o loss o social oles and s a us can also be c i ical o he e olu ion and eco e y o people a ec ed. P e ious s udies ha e sugges ed ha one pi o al ac o ha con ibu es o he eme gence and agg a a ion o emo ional p oblems in people wi h psychosis is how hey psychologically adap and manage he diagnosis o such a men al diso de (Bi chwood e al., 1998,2007; Jackson and Ikbal, 2000; Jackson e al., 2009; Ropaj e al., 2021). Indeed, he psychological adap a ion and managemen o he diagnosis plays an impo an ole in se e al models aimed a explaining psycho ic diso de s and hei associa ed s igma, as in some cases he disease has ele an nega i e implica ions in e ms o loss o oles and social s a us (Bi chwood e al., 2005; Pyle e al., 2015; Rooke and Bi chwood, 1998). Among hese explica i e models, he social compa ison heo y (SCT; Fes inge , 1954; see also Gilbe , 1992) cons i u es a heo e ical amewo k o in e es o unde s anding he p ocesses ha explain he impac o he psychosis diagnosis on one’s iden i y and he pe cep ion o one’s social s a us. Acco ding o he SCT, people e alua e hei abili ies and de e mine hei own social s a us by compa ing hemsel es wi h o he s. P e ious s udies and clinical obse a ion sugges ha he common social compa isons psycho ic people make a e eeling no being like o he s and he e o e no i ing in o g oups in which hey ha e p e iously been in eg a ed, which is associa ed wi h dis ancing om social g oups and loss o suppo , inc easing he likelihood o ma ginaliza ion (Bi chwood e al., 2007; McCa hy and Mo ina, 2020). Gi en he impo ance o hese pe sonal belie s abou he speci ic diagnosis o psychosis, Bi chwood and colleagues (1993) de eloped he Pe sonal Belie s abou Illness Ques ionnai e (PBIQ). This ins umen has ecen ly been e ised and e ined ollowing he SCT amewo k o assess i e dimensions o hese pe sonal belie s ha a e associa ed wi h bo h s igma and social ank: loss, en apmen , con ol, social ma ginaliza ion, and shame (PBIQ-R: Bi chwood e al., 2012). Unlike he IPQ, which is based on he Sel Regula ion Model (Le en hal e al., 1984) and ocuses on belie s abou nega i e consequences and he pe cep ion o con ol, he PBIQ-R is mo e based on he heo y o s igma (Es o , 1989) and places he emphasis, a he han on con ol o he diso de pe se, on he pe cei ed implica ion o a s igma izing diso de on a pe son’s social ank and s a us. Howe e , al hough he psychome ic cha ac e is ics o he PBIQ-R o iginal English e sion show adequa e eliabili y and alidi y in pa ien s wi h a i s episode o psychosis, con i ming he ac o ial s uc u e o he p oposed dimensions, he e is no p e ious esea ch on i s use in he Spanish con ex . In esponse, he p esen s udy aims o explo e he psychome ic cha ac e is ics o he Spanish e sion o he PBIQ-R in a sample o pa ien s wi h a diagnosis o psychosis- ela ed diso de s ea ed in he acili ies o he Andalusian Public Heal h Se ice. In addi ion, his s udy ex ends he o iginal alida ion o he ins umen by p o iding new da a on i s psychome ic p ope ies in a mo e di e se sample in e ms o age and e olu ion o hei men al diso de s. The inclusion o a sample wi h a wide age ange was conside ed o in e es o p o ide a alida ed ins umen ha can explo e how changes in belie s e ol e o e ime. The s igma izing iew e alua ed in he PBIQ-R, which can a ec social ank and s a us, is associa ed wi h highe le els o dep ession and anxie y. The e o e, a posi i e signi ican ela ionship be ween he sco es on he PBIQ-R and hose on he dep ession (PHQ9) and anxie y (GAD-7) scales can be expec ed. Howe e , as hey a e di e en cons uc s, co ela ions will be mode a e, as obse ed in he s udy by Bi chwood e al.(2012), whe e signi ican co ela ions obse ed we e be ween .34 and .61. The s igma izing iew e alua ed by he PBIQ-R assumes a nega i e impac on he pe cep ion o one’s own s a us and ank, and he e o e, mode a ely signi ican nega i e co ela ions on he Social Compa ison Scale (SCS) can be expec ed, as hey a e also di e en cons uc s. This, oo, is shown by he esul s o Bi chwood e al.(2012), wi h co ela ions anging be ween .47 and .59. Beha iou al and Cogni i e Psycho he apy 529 h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess Me hod Pa icipan s Pa icipan s we e 155 ou -pa ien s (54.8% male) o he Public Heal h Se ice in Andalusia wi h a diagnosis o schizoph enia o ela ed diso de acco ding o he ICD-10 c i e ia (WHO, 1992): 48 wi h schizoph enia (F20), 32 wi h o he psycho ic diso de (F28), 30 wi h bipola diso de (F31), 16 wi h delusional diso de s (F22), 14 wi h schizoa ec i e diso de s (F25), 10 wi h b ie psycho ic diso de (F23), and i e wi h schizo ypal diso de (F21). Thei age anged be ween 18 and 65 yea s old (M=43.51; SD=12.48), and be ween 13 and 48 yea s old o age a diagnosis (M=25.75; SD=7.77). Thei yea s o e olu ion anged be ween 0 and 47 (M=17.77; SD=12.51). Mos o hem we e single (75.5% s 15.5% ma ied s 9% sepa a ed o di o ced). Also, mos o hem had a seconda y school ce i ica e o p o essional aining (54.2% s 36.8% uni e si y g ade s 9% p ima y school ce i ica e). Howe e , only 25.2% o hem we e employed (31.6% unemployed s 18.7% s uden s s 20% pensione s 4.5% homemake ). All o hem we e in o mal men al heal h ea men a he Andalusian Public Heal h Sys em’s Communi y Men al Heal h Uni s loca ed in u ban a eas. As exclusion c i e ia, he ollowing we e conside ed: (1) se e e o ganic disease and (2) abuse o dependence on oxic subs ances. Measu es Pe sonal Belie s abou Illness Ques ionnai e-Re ised (PBIQ-R; Bi chwood e al., 2012) This e ised e sion consis s o 20 i ems g ouped in o i e dimensions co e ing he sel - assessmen ha people make abou hei own psycho ic diso de : shame (e.g. ‘Iam emba assed by my illness’), loss (e.g. ‘My illness s ops me doing hings I wan o do’), en apmen (e.g. ‘My illness s ops me ge ing on wi h hings I wan o do’), con ol o e illness (e.g. ‘I am in imida ed by my illness’), and social ma ginaliza ion/g oup i (e.g. ‘I eel excluded because o my illness’). Each dimension is measu ed wi h ou Like -scale i ems ( esponse ca ego ies ange om 1 ‘comple ely disag ee’ o 4 ‘comple ely ag ee’). The ques ionnai e p o ides a sco e o each dimension ha anges om 4 o 16, whe e highe sco es ep esen ing highe s igma and a lowe social ank. The scale is no designed o p o ide an o e all composi e sco e. I s psychome ic p ope ies will be discussed in he ollowing sec ions. Social Compa ison Scale (SCS; Allan and Gilbe , 1995) Following he Social Rank Theo y (Gilbe , 2000), his scale consis s o 11 i ems using bipola cons uc s a ed om 1 o 10, which measu e how people pe cei e and ank hemsel es in compa ison wi h o he s acco ding o h ee dimensions (e.g. ‘In compa ison o o he s, I eel :::’): a ac i eness (e.g. ‘una ac i e-mo e a ac i e’), adap a ion o he g oup (e.g. ‘inside -ou side ’), and hei social ank (e.g. ‘in e io -supe io ’). Lowe sco es ep esen eelings o in e io i y and low ank sel -pe cep ions. C onbach’s alpha in ou sample was .92 and omega .93. Pa ien Heal h Ques ionnai e-9 (PHQ-9; K oenke e al., 2001) We used he Spanish e sion (Vázquez e al., 2014) o his 9-i em sel - epo measu e which is used o assess dep ession se e i y and c i e ia o a majo dep essi e episode. Pa icula ly, his ques ionnai e asks abou he equency in which symp oms o dep ession ha e been expe ienced du ing he las wo weeks (e.g. ‘li le in e es o pleasu e in doing hings’). Response ancho s ange empo ally om 0 (‘no a all’) o3(‘nea ly e e y day’), and he e o e he ques ionnai e p o ides a composi e o e all sco e ( anging om 0 o 27) ha de e mines he se e i y o dep essi e symp oms: no dep essi e symp oms (0–4), mild (5–9), 530 An onio J. Vázquez Mo ej´on e al. h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess mode a e (10–14), mode a e-se e e (15–19), and se e e o majo (20–27). C onbach’s alpha in ou sample was .83 and omega was .87. Gene alized Anxie y Diso de -7 (GAD-7; Spi ze e al., 2006) We used he Spanish e sion (Ga cía-Campayo e al., 2010) o his 7-i em sel - epo measu e which is used o assess he equency in which people expe ience symp oms o gene al anxie y du ing he las wo weeks (e.g. ‘ ouble elaxing’). Response ancho s ange empo ally om 0 (‘no a all’) o3(‘nea ly e e y day’), and he e o e he ques ionnai e p o ides a composi e o e all sco e ( anging om 0 o 21) ha indica es he se e i y o anxie y symp oms: no anxie y symp oms (0–4), mild (5–9), mode a e (10–14), and se e e (15–21). C onbach’s alpha in ou sample was .89 and omega was .92. P ocedu e Rega ding he PIBQ-R, a e acqui ing au ho iza ion om he au ho s o i s adap a ion, i was ollowed by a o wa d-back ansla ion p ocedu e: (1) wo independen ansla ions we e made om English o Spanish, (2) bo h ansla ions in Spanish we e compa ed, ag eeing on he e ms in which di e ences we e obse ed by aking in o accoun he e minology used in he scien i ic li e a u e on i s episodes o psychosis, (3) his inal Spanish e sion was sen o ansla ion in o English by an independen ansla o , (4) his English e sion was compa ed wi h he o iginal English e sion, ag eeing on hose e ms and aspec s in which mino di e ences in nuances we e obse ed, and (5) he ideli y o his inal English e sion was e iewed and con i med by one o he au ho s o he o iginal English scale. The ype o equi alence used has been seman ic (Behling and Law, 2000). Da a collec ion was ca ied ou du ing ou ine e alua ions o people who me he inclusion c i e ia: (1) being diagnosed o psychosis (F20–F31 acco ding o ICD-10 c i e ia) in a i s in e iew wi h hei assigned clinical psychologis o psychia is in he Communi y Men al Heal h Uni ; (2) being aged be ween 18 and 65 yea s old; and (3) no p esen ing o ganic men al p oblems. All pa icipan s olun a ily accep ed o pa icipa e in he s udy and signed he w i en consen a e a esea ch assis an explained hem he na u e and goal o he s udy. This esea ch assis an was p esen du ing he comple ion o he e alua ion ins umen s o explain how o comple e hem and sol e p oblems. In ha sense, we mus men ion ha , due o p ac ical easons, only he i s 40 pa icipan s comple ed all ins umen s (PBIQ-R, PHQ-9, GAD-7 and SCS), he nex 40 pa icipan s comple ed he PBIQ-R and he SCS, and he emained 70 pa icipan s comple ed jus he PBIQ-R. Fu he mo e, we andomly selec ed 30 pa icipan s o pa icipa e in a ollow-up session 3–4 weeks la e o comple e he PBIQ-R again, and explo e i s es – e- es eliabili y. S a is ical analysis We analysed da a using he s a is ical package SPSS ( e sion 22). Fi s , we conduc ed desc ip i e analyses (means and s anda d de ia ions), checked he in e nal consis ency o he scales using bo h C onbach’s alpha and McDonald’s omega coe icien s, and calcula ed he PBIQ-R empo al eliabili y using he in aclass co ela ion coe icien (ICC). Then we explo ed he alidi y o he PBIQ-R. Concu en alidi y was explo ed using Pea son’s co ela ion be ween he PBIQ-R and he o he a iables included in ou s udy: social compa ison (SCS), dep ession (PHQ-9) and anxie y (GAD-7). Following he ecommenda ions om Geo ge and Malle y (2003), he C onbach coe icien and omega we e alued as ollows: ≥.9, excellen ; ≥.8, good; ≥7, accep able; ≥.6, ques ionable; ≥5, poo ; and ≤.5, no accep able. Cons uc alidi y was examined by p incipal componen analysis o each o he PBIQ-R dimensions Beha iou al and Cogni i e Psycho he apy 531 h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess and by sc ee es g aphs (as i does no p o ide a composi e o e all sco e bu a he sco es in se e al cons uc s in ol ed in he pe sonal belie s in ela ion o psychosis). Resul s Desc ip i e s a is ics, in e nal consis ency and empo al eliabili y Table 1p esen s mean sco es and s anda d de ia ions o each PBIQ-R i em. Mean sco es anged be ween 1.57 (i em 6) and 2.45 (i em 1). Rega ding he heo e ical dimensions, pa icipan s sco ed highe in he dimension ‘loss’(8.83) and lowe in ‘social ma ginaliza ion’(7.79). Also, as can be seen in Table 2, all dimensions showed adequa e in e nal consis ency alues: C onbach’s alpha anged be ween .81 (‘con ol’) and .88 (‘en apmen ’); McDonald’s omega anged be ween .87 (‘con ol’) and .92 (‘en apmen ’). Finally, he empo al eliabili y (i.e. es – e es eliabili y) o an in e al o 3–4 weeks was high as he ICCs indica ed s ong co ela ions anging be ween .77 (‘loss’) and .89 (‘shame’) (see Table 2). Validi y and ac o analysis Rega ding he PBIQ-R concu en alidi y, he co ela ions be ween he PBIQ-R dimensions and he o he a iables included in he s udy we e signi ican and in he expec ed di ec ion (see Table 2). Highe sco es on he belie dimensions we e ela ed o lowe sco es on he social compa ison dimensions ( anging om =–.27 be ween ‘social ma ginaliza ion’and ‘a ac i eness’, o =–.47 be ween ‘en apmen ’and ‘g oup i ’). In o he wo ds, ha ing mo e nega i e belie s abou he psycho ic diso de is associa ed wi h wo se sel -assessmen s in di e en a eas when people compa e hemsel es wi h o he s. Tha is, he wo se hey pe cei ed hemsel es in di e en a eas compa ed wi h o he s, he highe sco es hey p esen ed in nega i e belie s abou hei diso de . In addi ion, highe sco es in he nega i e belie s abou Table 1. Desc ip i e s a is ics o he PIBQ-R i ems and dimensions (N=155) Minimum Maximum Mean SD PBIQ1 1 4 2.45 1.10 PBIQ2 1 4 2.14 1.02 PBIQ3 1 4 2.10 1.03 PBIQ4 1 4 2.16 1.09 PBIQ5 1 4 2.28 1.08 PBIQ6 1 4 1.57 .93 PBIQ7 1 4 2.05 1.05 PBIQ8 1 4 2.21 1.09 PBIQ9 1 4 2.28 1.04 PBIQ10 1 4 2.04 1.04 PBIQ11 1 4 2.17 1.03 PBIQ12 1 4 2.05 1.07 PBIQ13 1 4 2.09 1.03 PBIQ14 1 4 2.24 1.06 PBIQ15 1 4 2.05 1.02 PBIQ16 1 4 1.99 1.02 PBIQ17 1 4 2.03 1.00 PBIQ18 1 4 2.26 1.09 PBIQ19 1 4 2.27 1.02 PBIQ20 1 4 2.02 .98 Loss 4 16 8.83 3.38 Con ol 4 16 8.43 3.31 En apmen 4 16 8.88 3.65 Ma ginaliza ion 4 16 7.79 3.32 Shame 4 16 8.54 3.48 532 An onio J. Vázquez Mo ej´on e al. h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess psychosis a e associa ed wi h highe se e i y o bo h dep essi e symp oms (co ela ions anging be ween .33 and .58) and anxie y symp oms (co ela ions anging be ween .49 and .69). Finally, as can be seen in Table 3, he p incipal componen analysis o he PBIQ-R e ealed a single ac o in each o he dimensions ha explained 64% o he a iance in he dimension ‘shame’(eigen alue=2.4, i em loadings anging om .77 o .82; see also Table 4); 64% in ‘loss’ (eigen alue=2.5, i em loadings anging om .76 o .83); 74% in ‘en apmen ’(eigen alue=2.9, i em loadings anging om .83 o .90); 68% in ‘con ol’(eigen alue=2.7, i em loadings anging om .68 o .89); and 71% in ‘ma ginaliza ion’(eigen alue=2.8, i em loadings anging om .81 o .87), espec i ely. Discussion This s udy aimed o alida e he Spanish ansla ion o he PBIQ-R in people wi h psychosis and ela ed diso de s. In addi ion, his s udy con ibu es o he o iginal alida ion o he ins umen by p o iding new da a on i s psychome ic p ope ies in a sample wi h a wide age ange enabling e olu ion o hei men al diso de s o be isualized. O e all, esul s suppo he eliabili y and alidi y o he ins umen . Rega ding he eliabili y o he ins umen , he C onbach’s alpha coe icien s o each o he i e dimensions we e adequa e, wi h alues anging be ween .81 and .88, sligh ly abo e ha obse ed in he UK sample ( anging be ween .69 and .81 in Bi chwood e al., 2012). Mo eo e , he omega coe icien s, which a e conside ed less biased han C onbach’s alphas (Dunn e al., 2014), o e ed addi ional e idence in a ou o he scale’s in e nal consis ency. Also, esul s suppo he empo al eliabili y o Table 2. Reliabili y and bi a ia e co ela ions o he PBIQ-R Shame Loss En apmen Con ol Social ma ginaliza ion No. o i ems 4 4 4 4 4 Mean in e -i em co ela ions .61 .52 .65 .52 .57 C onbach’s alpha (N=155) .86 .81 .88 .81 .84 Omega coe icien s .91 .88 .92 .88 .89 Tes – e es eliabili y ICC (n=30; 4 weeks) .89 .77 .85 .85 .88 Bi a ia e co ela ions Shame — Loss .69** — En apmen .75** .88** — Con ol .65** .76** .79** — Social ma ginaliza ion .80** .74** .78** .66** — PHQ-9 (n=40) .58** .33* .51** .33* .50** GAD-7 (n=40) .69** .49** .64** .53** .66** SCS-To al (n=80) –.45** –.45** –.46** –.42** –.42** SCS-Rank –.45** –.40** –.43** –.36** –.39** SCS-G oup i –.42** –.46** –.47** –.42** –.45** SCS-A ac i eness –.31** –.31** –.30** –.33** –.27* *p<.05; **p<.01. Table 3. Explo a o y ac o analyses o he heo e ical dimensions (N=155) PBIQ-R Eigen alue % a iance Fac o loading ange Shame 2.6 64 77–82 Loss 2.5 64 76–83 En apmen 2.9 74 83–90 Con ol 2.7 68 68–89 Social ma ginaliza ion 2.8 71 81–87 Beha iou al and Cogni i e Psycho he apy 533 h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess he i e dimensions, wi h ICC co ela ions be ween .78 and .89 o an in e al o 3–4 weeks. These esul s a e e y simila o hose ob ained by Bi chwood e al.(2012) using an in e al o only 1 week, excep o ‘loss’, which in he o iginal s udy p esen s alues sligh ly below he .70 ecommended o he es – e es . In any case, his dimension is he one wi h he lowes eliabili y alues in bo h s udies. In his ega d, di e ences be ween samples may accoun o such esul s. Pa icipan s in he UK sample we e younge and he pe iod o e olu ion o hei psycho ic diso de was sho e compa ed wi h pa icipan s in ou sample, which could lead o g ea e consis ency in he Spanish pa icipan s’belie s because hei longe pe iod o exposu e o he psycho ic diagnosis. In addi ion, ou s udy ex ends he indings o he o iginal s udy because i also includes he omega coe icien s. Rega ding he alidi y o he scale, concu en alidi y is suppo ed by he signi ican , albei modes , co ela ion obse ed be ween he i e dimensions o he PBIQ-R and he o he a iables included in his s udy. In he case o he co ela ions be ween PBIQ-R dimensions and he SCS dimensions, he alues a e simila o hose obse ed by Bi chwood e al.(2012): anging be ween –.42 and –.46 in he Spanish sample, compa ed wi h co ela ions be ween –.39 and –.55 in he UK sample. In ha sense, he loss o s a us and he pe cep ion o being an ou side (e alua ed wi h he SCS), a e signi ican ly associa ed wi h mo e dys unc ional belie s. These esul s indica e ha , al hough bo h he PBIQ-R and he SCS ins umen s a e based on social compa ison and social ank heo ies, he PBIQ-R measu es speci ic pe cep ions abou he illness ha cap u e how people who a e aced wi h a psychosis diagnosis adap o such a diagnosis and an icipa e i s consequences, including he emo ional impac o psycho ic diso de s. In his sense, he esul s ob ained ega ding he co ela ions wi h dep ession and anxie y wi h an e ec size be ween medium and la ge (Cohen, 1992), also con i m he alidi y o he scale. Fu he mo e, in line wi h p e ious s udies, he ela ionship o belie s wi h emo ional dis u bances is con i med by he co ela ion wi h symp oms o dep ession and anxie y (Acos a e al., 2013; Bi chwood e al., 2012). Fo example, Iqbal e al.(2000), al hough using ano he ins umen such as he Calga y Dep ession Scale, ound mode a e co ela ions Table 4. Fac o loading o each i em on he ac o s (N=155) Loss Con ol En apmen Social ma ginaliza ion Shame PBIQ1 .77 PBIQ2 .81 PBIQ3 .80 PBIQ4 .83 PBIQ5 .83 PBIQ6 .68 PBIQ7 .88 PBIQ8 .87 PBIQ9 .80 PBIQ10 .81 PBIQ11 .84 PBIQ12 .81 PBIQ13 .86 PBIQ14 .90 PBIQ15 .82 PBIQ16 .89 PBIQ17 .76 PBIQ18 .85 PBIQ19 .86 PBIQ20 .82 534 An onio J. Vázquez Mo ej´on e al. h ps://doi.o g/10.1017/S1352465822000248 Published online by Camb idge Uni e si y P ess be ween dys unc ional belie s and dep ession, simila o ou s udy. They concluded ha he mechanisms o pos -psycho ic dep ession depend on a g ea ex en o he e alua ions ha people make ega ding he implica ions o psychosis o hemsel es in e ms o loss, ma ginaliza ion and en apmen . Finally, ou ac o analyses con i m he p oposed o iginal s uc u e composed by i e dimensions (Bi chwood e al., 2012). Likewise, he only ac o in each dimension is con i med by sc ee es g aphs. Despi e ou s udy eplica ing and ex ending he o iginal alida ion o he scale, u he s udies could use la ge samples o pe o m mo e obus analyses (e.g. es ing o me ic in a iance among sex o o he demog aphics o CFA), as well as assess o he cha ac e is ics o he scale, as sensi i eness o change, known-g oups alidi y, o p edic i e alidi y. In addi ion, u u e s udies should include longe ime lags be ween he es – e es o check he empo al eliabili y and explo e changes o e ime depending on he se e i y o he diso de . In a simila ein, ou design does no allow us o es ablish a causal ela ionship be ween pe sonal belie s and emo ional dis u bances, and he e o e u u e s udies should include longi udinal da a collec ion o in e causali y. Summa izing, his s udy suppo s he alida ion o he PBIQ-R in Spanish, p o iding da a ha suppo i s eliabili y and alidi y in a sample wi h psycho ic diso de s. In ha sense, his ques ionnai e, which is no ime-consuming, is easy o adminis e and allows he e alua ion o nega i e belie s, acili a ing a mo e p ecise and comp ehensi e knowledge o people wi h i s episodes o psychosis. I con i ms he dimensional s uc u e p oposed in he o iginal scale and p o ides p o essionals wi h an ins umen ha e alua es se e al dimensions o pa ien s’ pe sonal nega i e belie s abou hei illness. Mo eo e , gi en he ele ance o pe sonal belie s abou diso de s o he success ul in ol emen o pa ien s in hei ea men , i is impo an o ha e an ins umen ha allows men al heal h wo ke s add essing such pa ien belie s. Indeed, he assessmen o nega i e belie s is impo an in heal hca e p ac ice because o hei p ognos ic alue and ela ion wi h inc eased isk o suicide (Acos a e al., 2013; Jackson e al., 2009; Lobban e al., 2004). Da a a ailabili y s a emen . Resea ch da a a e no sha ed, as he e is no au ho iza ion om he ins i u ion. Acknowledgemen s. We would like o hank he pa ien s who collabo a ed in his esea ch. Au ho con ibu ions. An onio Vazquez Mo ej´on: Concep ualiza ion (lead), Da a cu a ion (equal), Fo mal analysis (equal), Me hodology (equal), P ojec adminis a ion (equal), Resou ces (equal), So wa e (equal), Supe ision (equal), Valida ion (equal), Visualiza ion (equal), W i ing –o iginal d a (lead), W i ing – e iew & edi ing (equal); Ch is Jackson: Concep ualiza ion (equal), Fo mal analysis (equal), Me hodology (equal), Supe ision (equal), Valida ion (equal), W i ing –o iginal d a (equal), W i ing – e iew & edi ing (equal); Raquel VazquezMo ejon: Concep ualiza ion (equal), Fo mal analysis (equal), Me hodology (equal), Resou ces (equal), Supe ision (equal), Valida ion (equal), W i ing –o iginal d a (equal), W i ing – e iew & edi ing (equal); José Ma ía Le´on-Pé ez: Concep ualiza ion (equal), Fo mal analysis (equal), Me hodology (equal), Valida ion (equal), W i ing – e iew & edi ing (equal). Financial suppo . 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