The cultural adaptability of intermediate measures of functional outcome in schizophrenia

Dawn I. Velligan, Maureen Rubin, Megan M. Fredrick, Jim Mintz, Keith H. Nuechterlein, Nina R. Schooler, Judith Jaeger, Nancy M. Peters, Raimund Buller, Stephen R. Marder, Sanjay Dube

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


The Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative was designed to encourage the development of cognitive enhancing agents for schizophrenia. For a medication to receive this indication, regulatory agencies require evidence of improvement in both cognition and functional outcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, Cognitive Assessment Interview [CAI]) made by experienced clinical researchers at 31 sites in 8 countries. English-speaking research staff familiar with conducting medication trials rated the extent to which each subscale of each intermediate measure could be applied to their culture and to subgroups within their culture based on gender, geographic region, ethnicity, and socioeconomic status on the Cultural Adaptation Rating Scale. Ratings suggested that the CAI would be easiest to adapt across cultures. However, in a recent study, the CAI was found to have weaker psychometric properties than some of the other measures. Problems were identified for specific subscales on all the performance-based assessments across multiple countries. India, China, and Mexico presented the greatest challenges in adaptation. For international clinical trials, it would be important to use the measures that are most adaptable, to adapt subscales that are problematic for specific countries or regions, or to develop a battery composed of the subscales from different instruments that may be most acceptable across multiple cultures with minimal adaptation.

Original languageEnglish (US)
Pages (from-to)630-641
Number of pages12
JournalSchizophrenia bulletin
Issue number3
StatePublished - May 2012


  • co-primary measures
  • cognitive impairments
  • functional capacity measures
  • intermediate measures
  • international clinical trials
  • schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health


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