Cross-cultural comparison of theory of mind deficits in patients with schizophrenia from China and Denmark: different aspects of ToM show different results

Abstract

Introduction: Theory of mind (ToM) has been established as one of the most investigated and pronounced social cognitive deficits in schizophrenia. Yet, knowledge on whether measures of ToM can be used and compared across cultures is sparse. In this study, we used two simple, non-verbal ToM tests in patients with schizophrenia and non-clinical controls from China and Denmark to investigate whether culture has an impact on ToM performance.

Methods: Sixty-six patients with schizophrenia (35 Chinese) and 67 matched non-clinical controls (38 Chinese) from China and Denmark were tested with Brünés Picture Sequencing Task and Animated Triangles Task. We compared three models for each outcome variable in order to investigate which model best fitted the data: the first model included group (controls, patients) as a predictor variable, the second included group and nationality (Chinese, Danish), and the third included both predictors and their interaction.

Results: On most ToM subtests, culture seemed to play a role. Only performance on Brüne’s 1st order ToM were best described as similar in both countries. The second model had the best fit for most of the subtests indicating that the difference between patients and controls in China and Denmark, respectively, is similar.

Conclusions: Caution to cultural differences should be taken when comparing ToM in Asian and Western patients with schizophrenia as well as healthy individuals.

Keywords:

• Social cognition
• culture
• neurocognition
• mentalizing

Acknowledgements

The authors would like to thank research assistants: Anne Katrine Kjaerskov, Anna-Sofie Lose Landert, Lotte Veddum and Maria Lotus Thai.

Author contribution

Yuan Zhou and Vibeke Bliksted designed the study, wrote the protocol and supervised the clinical data collection. Huiling Wang and Liuqing Yang collected the Chinese data and made the Chinese database. Arndis Simonsen did the statistical analyses. Katrine Ingeman Beck wrote the first draft of the paper. All authors contributed to and have approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Danish part of the project was funded with ‘Seed Money’ from Interacting Minds Center, Aarhus University, Denmark (V.B.) and the Carlsberg Foundation (A.S). The Chinese part was funded by the National Natural Science Foundation of China [81371476], the Youth Innovation Promotion Association of Chinese Academy of Science [2012075] and the Beijing Nova Program [Z121107002512064].