Exploring the Latent Structure and Convergent and Incremental Validity of the Metacognition Assessment Scale – Abbreviated in a Sample of Patients with Non-Affective Psychosis

Abstract

Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale – Abbreviated (MAS-A). In this study, we investigated the latent structure as well as the interrater reliability and convergent and incremental validity of the MAS-A in a sample of patients with non-affective psychosis. Analyses indicated that the scale might be one-dimensional. Interrater reliability of the MAS-A total score was good. In terms of convergent validity, correlational analyses showed significant associations of MAS-A metacognition with the Operationalized Psychodynamic Diagnosis Level of Structural Integration Axis (OPD-LSIA) and the Levels of Emotional Awareness Scale (LEAS). In terms of construct validity, a significant association was observed between MAS-A metacognition and a short version of the International Classification of Functioning, Disability and Health (MINI-ICF), which persisted after self-report measures of impairments in structural capacities (Structure Questionnaire of Operationalized Psychodynamic Diagnosis [OPD-SQS]) and mentalizing abilities (Mentalization Questionnaire [MZQ]) were included as covariates, but not after symptom dimensions were included. There was a significant correlation with the current living situation, but not with other external criteria like diagnosis or duration of illness. Future studies should explore alternative outcomes and replicate results in longitudinal designs.

Declaration of interest

All authors confirm that there was no conflict of interest.

Data availability

Data is available from the last author upon reasonable request.

Notes

1 For a definition, see Green et al. (2008) who state that social cognition is an umbrella term for theory of mind, social perception, social knowledge, attributional bias, and emotional processing.

2 1) adjustment to rules and routines, 2) planning and structuring of tasks, 3) flexibility and adaptability, 4) application of professional competencies, 5) decision-making and judgment abilities, 6) sustainability, 7) power of self-assertion, 8) small talk skills, 9) behavior in groups, 10) familiar and intimate relationships, 11) spontaneity, 12) self-care/hygiene and 13) ability to use public transports

3 Interview principles for both expert-ratings are largely overlapping. They allow the interviewer to alternate between open and more structured passages with a variable chronology of questions and an open attitude towards subjectively relevant topics for the patient as well as an individual perspective towards psychotic phenomena and interpersonal situations. Only duration was modified during OPD interviewing of patients.

4 Subscales of the MAS-A describe abilities of self reflection and other reflection in growing complexity. The first two items are referred to as basic requirements and describe that individuals are aware that they/others have mental ideas and experience themselves/others as thinking beings (“I thought that… He/she thought…” etc.). An inability to do so could be caused by particularly fragile ego boundaries.

Additional information

Funding

CM received personal funding (Berlin Institute of Health BIH_PRO_279). The MPP-S study is supported by Deutsche Gesellschaft für Psychoanalyse, Psychotherapie, Psychosomatik und Tiefenpsychologie (DGPT e.V.) and by Köhler Stiftung (Grant number: S112/10211/16).