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Rater Evaluations for Psychiatric Instruments and Cultural Differences: The Positive and Negative Syndrome Scale in China and the United States

Aggarwal, Neil Krishan MD, MA*†‡; Zhang, Xiang Yang MD, PhD§∥; Stefanovics, Elina PhD; Chen, Da Chun MD; Xiu, Mei Hong MD; Xu, Ke MD, PhD*‡; Rosenheck, Robert A. MD

The Journal of Nervous and Mental Disease: September 2012 - Volume 200 - Issue 9 - p 814–820
doi: 10.1097/NMD.0b013e318266bcaa
Original Articles

This article compares Positive and Negative Syndrome Scale (PANSS) data from Chinese and American inpatients with chronic schizophrenia to show how differences in item ratings may reflect cultural attitudes of raters. The Chinese sample (N = 504) came from Beijing Huilongguan Hospital. The American sample came from 268 PANSS assessments of Clinical Antipsychotic Trials of Intervention Effectiveness subjects hospitalized for 15 days or more to optimize equivalence of the samples. When controlling for age and sex, the Chinese sample scored significantly lower for total score by 25% (p < 0.0001), for the positive subscale by 35% (p < 0.0001), and on the general subscale by 32% (p < 0.0001) but not significantly different on the negative subscale score (+0.26%; p = 0.76). However, the Chinese sample scored 26% higher on the item on poor rapport (p < 0.0001), 10.2% higher on passive social withdrawal (p = 0.003), and most notably 46% higher on the item on lack of judgment and insight (p < 0.0001). These results remain broadly consistent across sex subgroup analyses. Differences seem to be best explained by both cultural differences in patient clinical presentations and varying American and Chinese cultural values affecting rater judgment.

*Department of Psychiatry, Yale University, New Haven, CT; †Connecticut Mental Health Center, New Haven; ‡New York State Psychiatric Institute, New York, NY; §Department of Psychiatry, Baylor College of Medicine, Houston, TX; ∥Beijing HuiLongGuan Hospital, Beijing, China; and ¶New England MIRECC/151D, West Haven Veterans Affairs Medical Center, West Haven, CT.

Neil Krishan Aggarwal and Xiang Yang Zhang are co–first authors.

Send reprint requests to Neil Krishan Aggarwal, MD, MA, Columbia University, 1051 Riverside Drive, Unit 11, New York, NY 10032 E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.