Psychosocial functioning impairment is prevalent in first-episode psychosis and chronic schizophrenia. The Quality of Life Scale (QLS) is a widely used tool to measure psychosocial functioning; however, given the overlap between negative symptoms and functioning, along with the QLS being conceptualized initially as a measure of the deficit syndrome, it is unclear whether summing QLS items into a total score is an appropriate measure of overall psychosocial functioning. This study aimed to examine the centrality of QLS items and the appropriateness of using a QLS total score. Participants with first-episode psychosis (n = 404) completed the QLS. Item centrality was assessed using a network analysis approach, while reliability and dimensionality of the QLS total score and subscales were measured using bifactor modeling and related psychometric indices. Network analysis results showed that an item relating to motivation was the most central item within the scale. Moreover, bifactor modeling results found that motivation and other items relating to negative symptoms may reflect the QLS total score more strongly than other functioning (i.e., Interpersonal, Instrumental) domains. Based on these findings, we urge researchers to use caution when using a QLS total score, as it may unequally confound functional domains and motivation. Moreover, our results continue to underscore the importance of negative symptoms, particularly motivational impairment, in psychosocial functioning. Future studies should aim to examine the centrality of other functioning measures in psychosis and schizophrenia, as our results suggest that psychosocial functioning may be greatly influenced by motivation. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

中文翻译：

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动机在社会心理功能中的中心地位：首发精神病生活质量量表的网络和双因素分析。

心理社会功能障碍在首发精神病和慢性精神分裂症中普遍存在。生活质量量表 (QLS) 是一种广泛使用的衡量社会心理功能的工具；然而，考虑到阴性症状和功能之间的重叠，以及 QLS 最初被概念化为衡量缺陷综合征的指标，尚不清楚将 QLS 项目加总到总分中是否是衡量整体社会心理功能的适当指标。本研究旨在检验 QLS 项目的中心性和使用 QLS 总分的适当性。患有首发精神病的参与者（n= 404) 完成了 QLS。使用网络分析方法评估项目中心性，同时使用双因素建模和相关心理测量指标测量 QLS 总分和子量表的可靠性和维度。网络分析结果表明，与动机相关的项目是量表中最核心的项目。此外，双因素建模结果发现，与消极症状相关的动机和其他项目可能比其他功能（即人际关系、工具）领域更强烈地反映 QLS 总分。基于这些发现，我们敦促研究人员在使用 QLS 总分时要谨慎，因为它可能不平等地混淆功能域和动机。此外，我们的结果继续强调阴性症状的重要性，尤其是动机障碍，在社会心理功能方面。未来的研究应该旨在检查其他功能测量在精神病和精神分裂症中的中心地位，因为我们的结果表明心理社会功能可能受到动机的很大影响。（PsycInfo 数据库记录 (c) 2021 APA，保留所有权利）