Measures

Negative symptoms were assessed using the Scale for the Assessment of Negative Symptoms (SANS).¹⁸ We used first-order (avolition, anhedonia or apathy, flat affect, and alogia) and second-order (experiential and expressive) factors in analyses. First-order factors used global scores corresponding to each domain, and second-order factors were calculated using the mean of global scores. SANS items were scored on a 0 to 5 scale, with higher scores indicating greater symptom severity. Attention items were not included. Positive symptoms were assessed using the Scale for the Assessment of Positive Symptoms (SAPS).¹⁹ The SAPS measures 4 domains on the same 0 to 5 scale: hallucinations, delusions, bizarre behavior, and thought disorder.

The Role Functioning Scale (RFS)²⁰ assessed 4 interviewer-rated role functions: work functioning, independent living and self-care, family relationships, and immediate social network relationships. All RFS items were rated initially on a 1 to 7 scale, with higher score indicating better functioning. However, to aid in interpretation and consistency with symptom scales, all RFS ratings were reverse scored so that higher scores indicated worse functioning.