A Systematic Review of the Current Measures of Theory of Mind in Adults with Schizophrenia.

Ya-Chin Yeh,Kuan-Lin Chen,Chun-Hua Cheng,Chung-Ying Lin,Ming-Hui Kuo,Ping-Chia Li,Chi-Fa Hung

doi:10.3390/ijerph18137172

Abstract

Adults with schizophrenia usually have impairments in theory of mind (ToM), which subsequently cause them problems in social interaction. Therefore, it is important for healthcare providers to assess their ToM using adequate measures. This systematic review evaluated current ToM measures (or ToM tasks) for adults with schizophrenia and summarized their specific characteristics, including the concept and construct, administration, and psychometric properties. From a review of 117 articles, 13 types of ToM tasks were identified, and the findings from these articles were qualitatively synthesized. The results showed that ToM tasks are diverse in their presentation modalities, answer modes, strategies of controlling cognitive confounders, and scoring. Most tasks employ cognitive and affective dimensions and target a specific, single ToM concept. The present systematic review found that psychometric evidence supporting the ToM tasks, such as internal consistency, test–retest reliability, unidimensionality, and convergent, criterion, and ecological validities, is insufficient. Based on the results, we propose several principles for selecting appropriate ToM tasks in practice, e.g., selecting a task with multiple ToM concepts, or an exclusive ToM construct containing the cognitive and affective dimensions. Moreover, future studies are needed to provide more psychometric evidence on each type of ToM task applied in people with schizophrenia.

Highlights

The literature search was based on PICOS criteria, and in the present systematic review, P was adults with schizophrenia, I was not applicable, C was not applicable, O was theory of mind (ToM) ability measured by ToM task, and S was not applicable
Performances in an individual’s real social context, as compared with ToM tasks, which measure clearly defined ToM concepts or ToM dimensions in experimental contexts. This is the first systematic review to provide an overall evaluation of the current ToM measures in schizophrenia with the rigorous PRISMA guidelines
13 types of ToM tasks used in adults with schizophrenia and discussed their concepts and dimensions, presentation modalities, answer modes for responses, control questions and scoring, as well as the psychometric properties

Summary

Introduction

Theory of mind (ToM) refers to the ability to perceive and reason about other people’s opinions, beliefs, intentions, or feelings [1]. With ToM, an individual can predict others’. Behaviors and make appropriate responses in diverse social contexts [2]. Impairments of ToM have been reported in several mental illnesses, such as schizophrenia, autism spectrum disorders, major depression, bipolar disorder, borderline personality disorder, and Parkinson’s disease [3,4,5,6,7]. The ToM performance in people with schizophrenia reveals specific features that are distinct from those in other illnesses.

Methods

Results

Discussion

Conclusion