Development and Validation of the Schizophrenia Disease Burden Scale: A Comprehensive Patient-Reported Outcome Measure Incorporating Socioeconomic and Cultural Contexts 

Development and Validation of the Schizophrenia Disease Burden Scale: A Comprehensive Patient-Reported Outcome Measure Incorporating Socioeconomic and Cultural Contexts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Development and Validation of the Schizophrenia Disease Burden Scale: A Comprehensive Patient-Reported Outcome Measure Incorporating Socioeconomic and Cultural Contexts Abishek J R, Vadivelan Kanniappan, Karthikeyan S, Shrisruthi S, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5517158/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Schizophrenia is a chronic disabling neurocognitive disorder. Physiotherapists being an integral part in improving the quality of life and disease burden of schizophrenia patients, it is important to know the disease burden of the patients. Most of the patient reported outcome measure examining the quality of life and disease burden of individuals living with Schizophrenia focuses on the impact of psychiatric symptoms overseeing the somatic complaints. There is need for Indian based Schizophrenia specific questionnaire that may significantly influence the symptoms, course and outcomes. This will help health care professionals in developing a patient centered treatment protocol and enhance active participation. This study aims to construct and validate Schizophrenia disease burden scale that which will be culturally sensitive. Methods Based on the results of qualitative analysis, a questionnaire was framed and content validated by 11 experts. Following which the questionnaire was circulated to 325 participants based on consecutive sampling method for quantitative analysis. Exploratory factor analysis was done using Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy. Results Content validity of the scale was found to be 0.87 and has a Cronbach’s alpha of 0.922. Following item reduction, a 24-item scale finalized with KMO value of 0.744. 6 domains were identified in scree plot and was confirmed with confirmatory factor analysis. Conclusion The Schizophrenia Disease Burden Scale takes into account the unique experiences, challenges and social dynamics that individuals face in India, specifically Tamil Nadu, thus providing a more relevant and culturally sensitive assessment of disease burden. Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Schizophrenia India Physical therapy modalities Patient-reported outcome measures Disease burden Figures Figure 1 Figure 2 Figure 3 BACKGROUND Patient-reported outcome measure (PROM) has been recognized as an efficient measure of understanding patient’s perspectives about their quality of life, burdens, physical efficiency, societal factors, participation and expectations along with their psychological status. ( 1 , 2 ) Initially, PROM was used exclusively in the research sector to know the outcome but gradually with time PROM has not only limited itself to clinical evaluation but has become an integral factor in devising, implementing and evaluating government policies for the betterment of patients. ( 3 ) The increasing importance of PROM is owing to the shift of rehabilitation towards the improvement of overall quality of life which is best captured by PROM. It helps in understanding the patient's needs and provides a comprehensive cost-effective method for shared decision making. ( 4 , 5 ) There are two disease-specific PROM for Schizophrenia which are widely used – Quality of Life in Schizophrenia (QLiS) and Schizophrenia Quality of Life (SQLS) which were developed in the western region and overlook somatic symptoms and fails to provide an extensive on their quality of life. ( 6 ) New studies on individuals living with Schizophrenia emphasize that there are several other somatic symptoms such as fatigue, weakness, sleep disturbances, etc., other than the commonly known psychiatric symptoms which significantly adds up to the disease burden. ( 7 , 8 ) The burden of their disease included several other sequelae including participation restriction, activity limitation, social isolation, stigmatisation, reduced social function, economic instability, recreation, leisure and cultural factors that are usually not covered in the available disease-specific PROM.( 9 – 11 ) More than one-fourth of the population living with Schizophrenia strongly exhibit symptoms of somatisation that cannot be overlooked while evaluating them. ( 7 ) Mental health is bidirectional with physical health. Physiotherapists have been recognised as an integral part of mental health rehabilitation including illnesses like Schizophrenia to improve their physical health, mental health and longevity.( 10 , 12 , 13 ) Despite all these, Physiotherapists and other healthcare professionals have less knowledge about many factors associated with Schizophrenia. This has imposed a major challenge for healthcare professionals in evaluating and treating individuals living with Schizophrenia. ( 14 ) On the other hand, various authors who have extensively worked with individuals living with Schizophrenia in evaluating their quality of life of have stated that the major limitation in patient evaluation is the lack of cross-culturally validated disease-specific patient-reported outcome measures. ( 6 , 10 , 15 , 16 ) A robust review of the psychometric properties of PROM is widely used for the Schizophrenic population and they found that all PROMs to date lacked validity to cover the entire array of symptoms in a multidimensional condition like Schizophrenia and strongly emphasized the need for a new PROM. ( 17 ) There is an increasing global burden of Schizophrenia with increasing prevalence in Asian countries. It also has an extensive economic burden. India shares about a population of 3.5 million among the global prevalence of 21 million. ( 18 , 19 ) In this population of 3.5 million, more than half of them exhibited certifiable disabilities in India. Despite this, there is less focus in India towards them especially in aspects of their needs and quality of life. ( 20 , 21 ) A Health Care professional should be able to come out of their set assumptions or goals and must shift their focus toward the patients’ perspective and respect their complaints by looking beyond the disease that an individual is affected with to achieve a greater outcome. ( 22 ) However, there exists a clear gap in knowledge about the experiences and symptoms faced by individuals suffering from mental health disorders such as Schizophrenia. It becomes important to bridge the gap which can be analysed through qualitative phenomenological studies. ( 23 ) It is advised to approach Schizophrenic patients during the maintenance phase, to gain their insight and validate a PROM. This will pave the way for developing a regional disease-specific PROM for the Schizophrenic population. There is a limited number of disease-specific measures for schizophrenia but they are not cross-culturally validated or somatic components of the disease are overseen, thus, it becomes difficult to assess the actual condition of the patient as well as the exact health outcomes. To treat the patient as a whole and to assess the clinical outcome, it becomes important to understand the burden of patients and develop a structured outcome measure that can be achieved by ground-level qualitative assessment. Hence this study aimed to construct and validate the Schizophrenia Disease Burden Scale to comprehensively cover all the symptoms with relevance to the cultural context of Tamil Nadu METHODS DESIGN This study followed a development and validation study design and was implemented in four phases as follows: Phase 1-Initial Phase (Literature review and in-depth interview), Phase 2- Developmental Phase (Theme identification and content analysis and framing questionnaire), Phase 3 - Validation Phase (expert validation) and Phase 4 – Evaluation phase (Internal consistency, Exploratory Factor Analysis and Confirmatory Factor Analysis). Figure 1 depicts the gist of steps involved in development of the Schizophrenia Disease Burden Scale. The questionnaire was developed after careful review of the literature and from our earlier qualitative study (reference 24 in the manuscript). Classic patient-reported outcome measures like the Quality of Life in Schizophrenia (QLiS) and the Schizophrenia Quality of Life Scale (SQLS) were examined, in addition to qualitative studies examining the lived experiences of schizophrenia patients. Also, pilot interviews with Tamil Nadu patients assisted in clarifying the items to make sure psychiatric, somatic, as well as social components of the disorder were well covered. These sources have been clearly identified in the updated manuscript. The steps are elaborated below. PHASE 1 – INITIAL PHASE i) LITERATURE REVIEW An extensive literature review was done in search engines including Google Scholar, PubMed, Scopus, and Cochrane Library on previously published qualitative research works exploring the experiences of individuals living with Schizophrenia in various regions and quantitative studies done in the same population with regards to their physical/somatic problems, stigma, quality of life, disease burden, factor influencing their symptoms and cognitive problems. ii) IN DEPTH INTERVIEW WITH INDIVIDUALS LIVING WITH SCHIZOPHRENIA Interview was conducted with Schizophrenic participants, to comprehensively explore various factors and dynamics that affect their quality of living. Data saturation was attained iteratively The process of interview, methods and selection criteria were explained in the previous study. ( 24 ) PHASE 2: DEVELOPMENTAL PHASE i) THEME IDENTIFICATION The entire interview was translated and transcribed in English. The responses were coded based on grounded theory. The process of coding, theme identification and results of the interview were disclosed in the previous qualitative study. ( 24 ) ii) FRAMING QUESTIONNAIRE With coding performed and the highlighted keywords, a close-ended questionnaire was framed with 78 questions under separate domains. Questions were framed with care such that it was not ambiguous double-ended or offensive. Framed questions were placed under appropriate domains and subdomains. Scoring of the questions was with accordance to 5-point - Likert scale that had a different set of options according to the questions. Framed questions were paraphrased, reframed and re-arranged by the opinions obtained from four experienced clinical psychologists through panel discussions who were recruited purposively. As a result, 65 questions were finalized and placed under the appropriate domains PHASE 3 – CONTENT VALIDATION PHASE The constructed questionnaire was further sent for content validation to the expert committee to check the relevancy, evidence of content and technical quality For expert validation, the panel was not blinded to the questionnaire since their task was to evaluate content relevance and cultural appropriateness. Nonetheless, each expert evaluated the questionnaire independently to reduce any possible bias. The board consisted of 11 experts who had at least five years' clinical experience in the field of psychiatry. They included one psychiatric social worker with community mental health expertise, four clinical psychologists with schizophrenia and mental health evaluation expertise, three physiotherapists experienced in neuropsychiatric rehabilitation, and three health policy and epidemiology experts specializing in public health. This provided a multidisciplinary framework ensuring thorough validation using psychiatric, physical, and socio-cultural viewpoints.. Content validated questionnaire was forward translated into Tamil and was reverse translated to English by two independent literature experts to ensure that the translation was accurately done without having a potential change in the actual meaning. PHASE 4 – EVALUATION PHASE The framed questionnaire was then sent for testing to the target population. 325 participants were recruited. This sample size followed the ratio of 1:5 i.e. 5 participants per question. Primary study setting was Aadharavu home, Periyapalayam, Chennai. The data recruitment followed snow ball sampling method. Inclusion criteria for the study were stable participants with age ranging between of 18 to 65 years of both genders with a history of Schizophrenia at least and under regular psychiatric treatment with insight to respond were included in the study. Participants with uncontrolled psychiatric disorders, neurological problems, primary dementia, recent history of hospitalization, exacerbation of disease within last 3 months, difficulty in comprehending or responding and non-willingness to participate were excluded. With the responses obtained from the participants, internal consistency and exploratory factor analysis were performed and item reduction was done. The item-reduced questionnaire was then forwarded for confirmatory factor analysis. ANALYSIS OF DATA IBM SPSS version 20 software was employed for analysis. Demographic data and the responses filled by the participants were analyzed using descriptive statistics. Reliability statistics were employed to find out Cronbach’s alpha. Exploratory factor analysis was performed using the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett’s Test of Sphericity and principal component analysis was performed. Confirmatory factor analysis was performed and factors were identified with a scree plot. The relations between the items were analysed using the Structural Equation Model (SEM) RESULTS CONTENT VALIDATION All the items of the scale had an acceptable to excellent validity with I-CVI ranging from 0.73 to 1 with an overall S-CVI of 0.87 which is a good validity. INTERNAL CONSISTENCY Table 1 depicts the demographic characteristics of the 325 participants who took part in the quantitative analysis of the Schizophrenia disease burden scale. Table 1 DEMOGRAPHIC CHARACTERISTICS OF THE PARTICIPANTS MINIMUM MAXIMUM MEAN SD AGE 20.00 60.00 42.64 11.62 HEIGHT (Cms) 142.00 179.00 164.48 9.23 WEIGHT 45.00 99.00 66.78 12.39 DURATION OF ILLNESS 2.00 30.00 10.36 8.15 GENDER (%) MEN WOMEN 205 (63.1%) 120 (36.9%) Table 1 depicts that the mean age of participants were 42.64 + 11.62 while average height and weight of the participants were 164.48 + 9.23 and 66.78 + 12.39 respectively Reliability analysis of the scale showed an excellent Cronbach’s alpha with a value of 0.922 for the 65-item questionnaire. From Table 2 it can be inferred from the table that all items of the scale are consistent with Cronbach value above 0.9 and deleting any item will not improve the overall reliability significantly. Table 2 ITEM TOTAL STATISTICS - RELIABILITY OF THE SCALE SCALE MEAN IF ITEM DELETED SCALE VARIANCE IF ITEM DELETED CORRECTED ITEM-TOTAL CORRELATION CRONBACH'S ALPHA IF ITEM DELETED Q1 184.6277 1107.271 .202 .922 Q2 183.9662 1098.916 .260 .922 Q3 184.7046 1111.517 .190 .922 Q4 184.4308 1109.913 .186 .922 Q5 184.8338 1099.096 .344 .921 Q6 183.1600 1093.215 .492 .920 Q7 183.1723 1091.304 .462 .920 Q8 183.7723 1125.695 .013 .924 Q9 184.4646 1108.540 .205 .922 Q10 184.3662 1118.091 .112 .923 Q11 184.3754 1123.365 .047 .923 Q12 182.5631 1131.913 − .053 .924 Q13 184.0215 1091.416 .458 .920 Q14 183.8031 1078.739 .593 .919 Q15 184.2769 1095.368 .368 .921 Q16 184.3015 1103.915 .278 .922 Q17 183.1292 1085.292 .526 .920 Q18 183.2831 1074.370 .695 .919 Q19 183.2308 1081.647 .658 .919 Q20 183.4031 1090.636 .517 .920 Q21 183.7631 1079.786 .677 .919 Q22 183.5015 1069.109 .675 .919 Q23 183.0308 1109.974 .234 .922 Q24 184.1446 1095.698 .400 .921 Q25 183.9846 1083.805 .549 .920 Q26 183.5200 1093.503 .361 .921 Q27 183.4954 1093.911 .407 .921 Q28 184.3723 1082.413 .561 .920 Q29 183.7446 1087.524 .467 .920 Q30 184.5569 1074.680 .593 .919 Q31 183.8892 1069.364 .579 .919 Q32 184.1385 1062.848 .726 .918 Q33 183.8800 1095.513 .412 .921 Q34 183.7569 1113.043 .150 .923 Q35 184.1015 1101.196 .284 .922 Q36 183.4923 1095.985 .396 .921 Q37 184.4000 1087.568 .424 .920 Q38 183.5231 1081.090 .668 .919 Q39 184.1015 1078.487 .605 .919 Q40 184.1569 1073.133 .600 .919 Q41 183.7600 1121.029 .109 .922 Q42 183.8215 1088.030 .497 .920 Q43 184.7262 1101.298 .315 .921 Q44 184.5538 1122.853 .061 .923 Q45 184.9354 1126.462 .011 .923 Q46 183.4000 1099.130 .418 .921 Q47 183.3138 1122.617 .053 .923 Q48 184.1446 1099.569 .322 .921 Q49 184.2031 1068.230 .617 .919 Q50 184.6646 1097.187 .371 .921 Q51 184.3046 1075.348 .563 .919 Q52 183.8246 1094.108 .391 .921 Q53 183.8769 1089.361 .434 .920 Q54 183.6431 1085.280 .527 .920 Q55 184.1508 1086.474 .514 .920 Q56 183.8862 1073.577 .613 .919 Q57 182.5631 1125.876 .037 .923 Q58 183.6800 1116.478 .110 .923 Q59 185.0431 1094.220 .468 .920 Q60 184.4923 1079.584 .610 .919 Q61 183.8369 1087.149 .527 .920 Q62 184.0400 1094.372 .362 .921 Q63 184.4000 1105.877 .227 .922 Q64 183.6492 1117.031 .116 .923 Q65 183.6338 1110.683 .224 .922 Table 2 depicts that the internal consistency of each question of the scale is above 0.9, indicating an excellent reliability. EXPLORATORY FACTOR ANALYSIS Table 3 shows the factor analysis with the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett's Test of Sphericity. It reveals that the scale reduced to 24 items based on principal component analysis has an acceptable KMO value of 0.744 with a significance of 0.000. Item reduction was based on factor loading. Any item with a value less than 0.5 was eliminated to ensure better validity. Table 3 FACTOR ANALYSIS OF SCHIZOPHRENIA DISEASE BURDEN SCALE - KAISER-MEYER-OLKIN (KMO) MEASURE OF SAMPLING ADEQUACY AND BARTLETT'S TEST OF SPHERICITY KMO AND BARTLETT'S TEST KAISER-MEYER-OLKIN MEASURE OF SAMPLING ADEQUACY. .744 BARTLETT'S TEST OF SPHERICITY Approx. Chi-Square 5978.334 Df 276 Sig. .000 Communalities INITIAL EXTRACTION Q22 1.000 .720 Q32 1.000 .793 Q18 1.000 .798 Q38 1.000 .673 Q19 1.000 .759 Q40 1.000 .755 Q21 1.000 .714 Q25 1.000 .741 Q30 1.000 .704 Q51 1.000 .665 Q56 1.000 .604 Q31 1.000 .703 Q60 1.000 .624 Q17 1.000 .624 Q54 1.000 .803 Q33 1.000 .814 Q55 1.000 .801 Q37 1.000 .665 Q61 1.000 .676 Q42 1.000 .693 Q16 1.000 .899 Q15 1.000 .919 Q12 1.000 .428 Q2 1.000 .784 Extraction Method: Principal Component Analysis. Table 3 depicts that the scale has adequacy of 0.744 with Bartlett’s significance of 0.000 following the item reduction based on principal factor analysis Table 4 depicts the explanation of total variances included in the 24-item version of the scale. 6 factors were identified in the scree plot and the included questions were arranged according to the rotated component matrix. The fit model of the scale is shown in Fig. 2 While the scree plot is depicted in Fig. 3 . Table 5 depicts the rotated component matrix of the short-listed 24 questions of the Schizophrenia disease burden scale. The six factors were as follows: Cognitive factor, Psychological factors, Personal factors I, Personal factors II, Vocational factors and Physical factors Table 4 SCHIZOPHRENIA DISEASE BURDEN SCALE – PRINCIPAL COMPONENT ANALYSIS – TOTAL VARIANCE EXPLAINED COMPONENT INITIAL EIGENVALUES TOTAL % OF VARIANCE CUMULATIVE % Q22 8.729 36.369 36.369 Q32 2.351 9.798 46.167 Q18 2.077 8.655 54.821 Q38 1.603 6.678 61.499 Q19 1.447 6.030 67.529 Q40 1.152 4.799 72.328 Q21 .903 3.763 76.091 Q25 .843 3.513 79.603 Q30 .733 3.056 82.659 Q51 .626 2.607 85.266 Q56 .569 2.373 87.639 Q31 .532 2.216 89.855 Q60 .385 1.602 91.457 Q17 .364 1.518 92.975 Q54 .297 1.238 94.213 Q33 .278 1.158 95.371 Q55 .221 .922 96.293 Q37 .206 .859 97.152 Q61 .186 .773 97.925 Q42 .160 .668 98.594 Q16 .125 .519 99.113 Q15 .111 .463 99.576 Q12 .070 .293 99.870 Q2 .031 .130 100.000 Extraction Method: Principal Component Analysis. Table 5 SCHIZOPHRENIA DISEASE BURDEN SCALE – PRINCIPAL COMPONENT ANALYSIS – ROTATED COMPONENT MATRIX COMPONENT 1 2 3 4 5 6 Q18 .813 Q21 .795 Q19 .775 Q17 .711 Q22 .643 Q60 .617 Q25 .804 Q33 .759 Q37 .742 Q32 .709 Q40 .579 .522 Q38 .557 Q30 .556 .544 Q55 .789 Q51 .705 Q31 .689 Q56 .603 Q54 .786 Q61 .733 Q42 .558 Q16 .925 Q15 .911 Q2 .874 Q12 .593 Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. a a. Rotation converged in 7 iterations. Table 6 depicts the mean value and standard deviation of the responses obtained from the participants for the short-listed 24 items. It can be observed that the most reported burden is that the participant is unable to sleep without medications which has a mean of 4.25 ± 1.25 followed by the burden that they are not able to work as efficiently as before (3.68 ± 1.22) and “It is hard for me to arrange and plan out how to accomplish a task with a mean of 3.58 ± 1.07. The least reported was the suicidal thoughts with a mean value of 2.26 ± 1.35 followed by “I need others to remind me or force me to take tablets” with a mean of 2.32 ± 1.20. Table 6 RESPONSES OF THE PARTICIPANTS TO THE FINAL VERSION OF SCHIZOPHRENIA DISEASE BURDEN SCALE ITEM MINIMUM MAXIMUM MEAN STD. DEVIATION Q2 1.00 5.00 2.85 1.59 Q12 1.00 5.00 4.25 1.25 Q15 1.00 5.00 2.54 1.31 Q16 1.00 5.00 2.51 1.27 Q17 1.00 5.00 3.68 1.22 Q18 1.00 5.00 3.53 1.17 Q19 1.00 5.00 3.58 1.07 Q21 1.00 5.00 3.05 1.08 Q22 1.00 5.00 3.31 1.32 Q25 1.00 5.00 2.83 1.21 Q30 1.00 5.00 2.26 1.35 Q31 1.00 5.00 2.92 1.51 Q32 1.00 5.00 2.67 1.36 Q33 1.00 5.00 2.93 1.18 Q37 1.00 5.00 2.41 1.41 Q38 1.00 5.00 3.29 1.06 Q40 1.00 5.00 2.66 1.37 Q42 1.00 5.00 2.99 1.21 Q51 1.00 5.00 2.51 1.40 Q54 1.00 5.00 3.17 1.22 Q55 1.00 5.00 2.66 1.21 Q56 1.00 5.00 2.93 1.34 Q60 1.00 5.00 2.32 1.19 Q61 1.00 5.00 2.98 1.17 Table 6 shows that the highest mean value of 4.25 was obtained for question 12 whereas the lowest mean value of 2.26 was obtained for question 30. DISCUSSION This study aimed to develop a disease-specific PROM measure that is relevant to socioeconomic and cultural contexts. The key feature of this questionnaire was that it was developed from the ground level and was constructed inductively. In the construction of the questionnaire, we paid close attention to socio-economic as well as to cultural environments applicable to the Tamil Nadu population. The economic factors were concerns of financial instability and unemployment issues that directly affect the patient's quality of life. At a cultural level, we were concerned with family structure, stigma, and social expectations of community regarding mental health, such that the questionnaire captured attitudes and beliefs specific to the region. Secondly, variation in access to mental health care among socio-economic strata was considered, with respect to the differences in healthcare delivery. A 65-item content-validated questionnaire that was framed based on the interview results and expert suggestion was tested for consistency and principal component analysis by circulating it to three twenty-five participants. All items on the scale were found to have good consistency. Any item having a value less than 0.5 in KMO analysis was removed. 24 items were included following item reduction which was placed under 5 domains initially. The item-reduced questionnaire with 24 items underwent confirmatory factor analysis and rotated component matrix. The fit model was analysed using SEM analysis and the 6 factors were identified by scree plot and the questions were systematically placed under 6 factors based on loading. Although the new arrangement of questions under factors did not vary much from the domains in that they were placed initially, a few questions were arranged differently. The factors were renamed according to the questions they included. The frequency analysis revealed that sleep was the most bothersome problem, followed by which panning of tasks became difficult. The items that had higher responses were related to longing for love, vocational instability, interpersonal relationships, work efficiency, social exclusion and tremors. ( 9 , 10 ) Initially, the construction of the scale aimed at the maximal inclusion of physical/somatic symptoms experienced by individuals living with Schizophrenia. Though the initial version of the scale consisted of 13 items related to physical/somatic factors, following the item reduction based on the participant responses, it was reduced to only 2 items under a physical domain. This could be because the participants are so bothered by the vocational and emotional factors that they tend to give less importance to physical factors. Vocational factors may not be relevant to a certain population, in such cases the domain may be considered as not applicable while scoring. In case of students, “workplace” in vocational factors may be considered as school/college and colleagues may be considered as peer friends and teachers. Participants in qualitative interviews expressed, they require some one to remind them of their tasks such as taking medicine, carrying out and organizing task. This is because they tend to forget thing quite often. ( 24 ) But in contrast, the quantitative results revealed that the participants were more bothered about their work performance rather than the cognitive problems implying that the rehabilitation should focus on functional outcomes rather than impairment to reduce remission rates. ( 25 ) Failing memory and difficulty in organising tasks and implementing them might be attributed to the lateral prefrontal cortex involvement. ( 7 , 26 ) By encompassing a broader range of domains, this scale provides a more comprehensive assessment of the multifaceted burden experienced by individuals with Schizophrenia and can help researchers and healthcare professionals gain a deeper understanding of the overall impact of the illness on individuals’ lives When compared to the previously available disease-specific patient-reported burden measure for Schizophrenia, this scale – “Schizophrenia Disease Burden Scale” is unique in that it is constructed according to the socio-economic context along with a focus on the physical, mental, social, personal and environmental aspects thereby serving as a tool to assess their disease burden. A higher score on this scale implies an increased burden with poor quality of life among individuals living with Schizophrenia. ( 6 , 10 , 15 , 16 ) The limitation of the study is that the results of the scale were not counter-verified caregivers of the participants as the actual burden may vary. Educational status and gender differences were not addressed. The options provided in the scale are questions but the questions do not include any specific time frame, thus the administrator has to be specific while assessing. The disease burden of individuals who have recurrent remissions and recent hospitalization may vary from the current results. Future studies must consider comparing the scale with previously existing ones. Test-retest reliability has to be established. Future studies must focus on assessing the validity of this scale in various other states in India to understand its applicability all over India FUTURE IMPLICATIONS To improve inclusion of individuals living with Schizophrenia in their family, to improve treatment adherence and outcomes, it is important to incorporate family centred rehabilitation where in family will be involved as integral part of treatment process There is a need for government policies and awareness programmes to enhance the social integration of individuals with mental health disorders like Schizophrenia. There is an immediate necessity for providing vocational rehabilitation and integration for individuals living with Schizophrenia to make them economically stable and earn their livelihood. CONCLUSION The Schizophrenia Disease Burden Scale takes into account the unique experiences, challenges and social dynamics that individuals face in India, specifically Tamil Nadu, thus providing a more relevant and culturally sensitive assessment of disease burden. The schizophrenia disease burden scale demonstrated good validity and internal consistency in measuring the disease burden experienced by the individuals living with Schizophrenia with relevance to socio-cultural and economic context Declarations Ethical approval and consent to participate: The entire study complied with Helsinki’s declaration. The study was approved by the Institution Ethics Committee of SRM Medical College Hospital and Research Centre (SRM MCH & RC) with approval number 8314/IEC/2022 on 25.03.2022. Informed consent form for participation was taken from all the participants of the study Consent for publication: Prior to enrolment, participants were explained about the research. Voluntary willingness and consent to publication was obtained from the participants. Competing interest: The authors declare that they have no competing interests Sources of funding: No sources of funding Data availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Author Contributions: VK, AJR: Conceptualization and study design VK, SSS: refined the study design AJR, VK, KS: Prepared and processed for ethical clearance SSS, VTS, VK: Participated in conceptual process of the study and provided mentorship AJR, KS: Wrote the first draft of the study protocol AJR, KS, SSS, VK: Refined the manuscript: All authors contributed to the revision of the protocol and read and approved the final manuscript Acknowledgements: Authors extend their thanks to Dr. Bashi Sugumaran and his team, Department of Clinical Psychology, SRM Medical College Hospital and Research Centre for their support and guidance throughout the research Authors would like to express their heartfelt gratitude to Dr. Koteeshwar Rao, Managing Trustee, Aadharavu home, Periyapalayam and his entire team for extending their support in completion of the study and permitting for data collection. References Kingsley C, Patel S. 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The burden of disease in early schizophrenia - a systematic literature review. Curr Med Res Opin. 2021 Jan;37(1):109–21. Desalegn D, Girma S, Abdeta T. Quality of life and its association with psychiatric symptoms and socio-demographic characteristics among people with schizophrenia: A hospital-based cross-sectional study. PLoS One. 2020;15(2):e0229514. Lloyd J, Lloyd H, Fitzpatrick R, Peters M. Treatment outcomes in schizophrenia: qualitative study of the views of family carers. BMC Psychiatry. 2017 Jul 21;17(1):266. Andrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists’ views about providing physiotherapy services to people with severe and persistent mental illness: a mixed methods study. J Physiother. 2019 Oct;65(4):222–9. Engh JA, Andersen E, Holmen TL, Martinsen EW, Mordal J, Morken G, et al. Effects of high-intensity aerobic exercise on psychotic symptoms and neurocognition in outpatients with schizophrenia: study protocol for a randomized controlled trial. Trials. 2015 Dec 8;16:557. Yosep I, Mediani HS, Lindayani L, Sriati A. How patients with schizophrenia “as a Victim” cope with violence in Indonesia: a qualitative study. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021 Jun 12;57(1):71. Mohandoss AA. Quality of life in schizophrenic patients: Comparative study from South India. Journal of Dr YSR University of Health Sciences. 2017 Dec;6(4):224. Galuppi A, Turola MC, Nanni MG, Mazzoni P, Grassi L. Schizophrenia and quality of life: how important are symptoms and functioning? Int J Ment Health Syst. 2010 Dec 8;4:31. Millier A, Clay E, Charaf I, Chauhan D, Murthy V, Toumi M, et al. Patient Reported Outcomes Instruments in Schizophrenia: A Review of Psychometric Properties. Open Journal of Medical Psychology. 2014 Jan 17;3(2):141–56. Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016. Schizophr Bull. 2018 Oct;44(6):1195–203. Bondre AP, Shrivastava R, Raghuram H, Tugnawat D, Khan A, Gupta S, et al. A qualitative exploration of perceived needs and barriers of individuals with schizophrenia, caregivers and clinicians in using mental health applications in Madhya Pradesh, India. SSM Ment Health. 2022 Dec;2:100063. Ranjan LK, Gupta PR, Kiran M, Singh NK. Family Care Burden and its Association with Psychological Distress Among Caregivers of Chronic Patients with Schizophrenia. Journal of Public Health and Primary Care. 2022 Dec;3(3):81. Ramadas S, Bonanthaya V. Quality of life of patients with schizophrenia and chronic obstructive pulmonary disease: An observational study. Ind Psychiatry J. 2017;26(2):140–5. Coelho A, de Bienassis K, Klazinga N, Santo S, Frade P, Costa A, et al. Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal. Int J Environ Res Public Health. 2022 Sep 6;19(18):11153. Gewurtz R, Moll S, Poole JM, Gruhl KR. Qualitative Research in Mental Health and Mental Illness. In: Olson K, Young RA, Schultz IZ, editors. Handbook of Qualitative Health Research for Evidence-Based Practice [Internet]. New York, NY: Springer; 2016 [cited 2024 Mar 16]. p. 203–23. Available from: https://doi.org/10.1007/978-1-4939-2920-7_13 Kanniappan V, Abishek JR. Hermeneutic Phenomenological Approach to the Experiences of the Individuals Living with Schizophrenia: A Qualitative Study. Indian J Community Med. 2023;48(5):762–70. Haynes VS, Zhu B, Stauffer VL, Kinon BJ, Stensland MD, Xu L, et al. Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study. BMC Psychiatry. 2012 Dec 5;12(1):222. Gibson M. Witnessing Life with Schizophrenia and Anosognosia: A Qualitative Research Study OPEN ACCESS. 2018 Jun 18;1(2):1–7. Additional Declarations No competing interests reported. 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Kanniappan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3Ooa7CMBSA4aN6zZLaM8MzHNKkQSy5r7KGBMwEEoGYGoZkmre4CwY5sgTMCLY4EKAQ4CBZCB3Bwd3AIfqLpm365RTAZvvOKAVoES+3PjxWv54gueH9Mb1HoCQlfBzq3i+yJHP6KMRqufvbFAXwn4BgO60geaeXOTlKqbtSq4jAHR0IVP4/ccOAZuMIPakZ0yokIG2mqKiCxAdDruiJeM60XxD81hGOAaWnECVBxxBmpmAt2ffS4xwFakNUJBzMzU0VYbw9OfoDrxmbj63PRaPBh+1ke6kgTznlkn4AbDabzfaiG7G4UhjgYc6OAAAAAElFTkSuQmCC","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Vadivelan","middleName":"","lastName":"Kanniappan","suffix":""},{"id":434741628,"identity":"ce860725-042c-4ade-aa29-54a11dc03a60","order_by":2,"name":"Karthikeyan S","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Karthikeyan","middleName":"","lastName":"S","suffix":""},{"id":434741629,"identity":"789a0d8a-a285-4895-b205-20507b1ca4ff","order_by":3,"name":"Shrisruthi S","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Shrisruthi","middleName":"","lastName":"S","suffix":""},{"id":434741630,"identity":"3df23533-1124-45f2-92c8-9c774113bd25","order_by":4,"name":"Veeragoudhaman T S","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Veeragoudhaman","middleName":"T","lastName":"S","suffix":""}],"badges":[],"createdAt":"2024-11-25 05:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5517158/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5517158/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79552165,"identity":"23c523f8-0ef9-42ee-9eea-ff0b8c48ca5c","added_by":"auto","created_at":"2025-03-31 06:45:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":330368,"visible":true,"origin":"","legend":"\u003cp\u003eSteps involved in Development of Schizophrenia Disease Burden Scale\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/9348bbcc1b6aff1cc00894b3.png"},{"id":79549991,"identity":"c616ecbf-3183-4260-8768-a5d3804e4473","added_by":"auto","created_at":"2025-03-31 06:29:45","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35285,"visible":true,"origin":"","legend":"\u003cp\u003eScree Plot\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/51059e7fad0f00b310f7845e.jpg"},{"id":79549997,"identity":"b84c03fb-5ba0-4041-84c6-b33d7540ebe7","added_by":"auto","created_at":"2025-03-31 06:29:45","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":207581,"visible":true,"origin":"","legend":"\u003cp\u003eStructural Equation Model\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/db6af1ecaa0f914e020d9253.jpg"},{"id":79552702,"identity":"d80ece27-ed2e-42c1-a172-f7e7ecd62a0d","added_by":"auto","created_at":"2025-03-31 06:53:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1941716,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/229e2c67-6062-442f-af76-70866487ed0e.pdf"},{"id":79551032,"identity":"1238e4b9-87dd-486e-a1a3-077d2711fa81","added_by":"auto","created_at":"2025-03-31 06:37:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20427,"visible":true,"origin":"","legend":"","description":"","filename":"SchizophreniaDiseaseBurdenScalewithScoringEnglish.docx","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/8fbfb5d9ddb9ce4e2baa2f19.docx"},{"id":79551034,"identity":"4230ffee-c706-4cba-a208-26283ab917ea","added_by":"auto","created_at":"2025-03-31 06:37:45","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":25993,"visible":true,"origin":"","legend":"","description":"","filename":"SchizophreniaDiseaseBurdenScalewithScoringTamil.docx","url":"https://assets-eu.researchsquare.com/files/rs-5517158/v1/633c589eb9f7ddb590f14fa9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Validation of the Schizophrenia Disease Burden Scale: A Comprehensive Patient-Reported Outcome Measure Incorporating Socioeconomic and Cultural Contexts ","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePatient-reported outcome measure (PROM) has been recognized as an efficient measure of understanding patient\u0026rsquo;s perspectives about their quality of life, burdens, physical efficiency, societal factors, participation and expectations along with their psychological status. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eInitially, PROM was used exclusively in the research sector to know the outcome but gradually with time PROM has not only limited itself to clinical evaluation but has become an integral factor in devising, implementing and evaluating government policies for the betterment of patients. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe increasing importance of PROM is owing to the shift of rehabilitation towards the improvement of overall quality of life which is best captured by PROM. It helps in understanding the patient's needs and provides a comprehensive cost-effective method for shared decision making. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThere are two disease-specific PROM for Schizophrenia which are widely used \u0026ndash; Quality of Life in Schizophrenia (QLiS) and Schizophrenia Quality of Life (SQLS) which were developed in the western region and overlook somatic symptoms and fails to provide an extensive on their quality of life. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNew studies on individuals living with Schizophrenia emphasize that there are several other somatic symptoms such as fatigue, weakness, sleep disturbances, etc., other than the commonly known psychiatric symptoms which significantly adds up to the disease burden. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe burden of their disease included several other sequelae including participation restriction, activity limitation, social isolation, stigmatisation, reduced social function, economic instability, recreation, leisure and cultural factors that are usually not covered in the available disease-specific PROM.(\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMore than one-fourth of the population living with Schizophrenia strongly exhibit symptoms of somatisation that cannot be overlooked while evaluating them. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Mental health is bidirectional with physical health. Physiotherapists have been recognised as an integral part of mental health rehabilitation including illnesses like Schizophrenia to improve their physical health, mental health and longevity.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite all these, Physiotherapists and other healthcare professionals have less knowledge about many factors associated with Schizophrenia. This has imposed a major challenge for healthcare professionals in evaluating and treating individuals living with Schizophrenia. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOn the other hand, various authors who have extensively worked with individuals living with Schizophrenia in evaluating their quality of life of have stated that the major limitation in patient evaluation is the lack of cross-culturally validated disease-specific patient-reported outcome measures. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA robust review of the psychometric properties of PROM is widely used for the Schizophrenic population and they found that all PROMs to date lacked validity to cover the entire array of symptoms in a multidimensional condition like Schizophrenia and strongly emphasized the need for a new PROM. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThere is an increasing global burden of Schizophrenia with increasing prevalence in Asian countries. It also has an extensive economic burden. India shares about a population of 3.5\u0026nbsp;million among the global prevalence of 21\u0026nbsp;million. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this population of 3.5\u0026nbsp;million, more than half of them exhibited certifiable disabilities in India. Despite this, there is less focus in India towards them especially in aspects of their needs and quality of life. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA Health Care professional should be able to come out of their set assumptions or goals and must shift their focus toward the patients\u0026rsquo; perspective and respect their complaints by looking beyond the disease that an individual is affected with to achieve a greater outcome. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, there exists a clear gap in knowledge about the experiences and symptoms faced by individuals suffering from mental health disorders such as Schizophrenia. It becomes important to bridge the gap which can be analysed through qualitative phenomenological studies. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt is advised to approach Schizophrenic patients during the maintenance phase, to gain their insight and validate a PROM. This will pave the way for developing a regional disease-specific PROM for the Schizophrenic population.\u003c/p\u003e \u003cp\u003eThere is a limited number of disease-specific measures for schizophrenia but they are not cross-culturally validated or somatic components of the disease are overseen, thus, it becomes difficult to assess the actual condition of the patient as well as the exact health outcomes.\u003c/p\u003e \u003cp\u003eTo treat the patient as a whole and to assess the clinical outcome, it becomes important to understand the burden of patients and develop a structured outcome measure that can be achieved by ground-level qualitative assessment. Hence this study aimed to construct and validate the Schizophrenia Disease Burden Scale to comprehensively cover all the symptoms with relevance to the cultural context of Tamil Nadu\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDESIGN\u003c/h2\u003e \u003cp\u003eThis study followed a development and validation study design and was implemented in four phases as follows: Phase 1-Initial Phase (Literature review and in-depth interview), Phase 2- Developmental Phase (Theme identification and content analysis and framing questionnaire), Phase 3 - Validation Phase (expert validation) and Phase 4 \u0026ndash; Evaluation phase (Internal consistency, Exploratory Factor Analysis and Confirmatory Factor Analysis). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the gist of steps involved in development of the Schizophrenia Disease Burden Scale.\u003c/p\u003e \u003cp\u003eThe questionnaire was developed after careful review of the literature and from our earlier qualitative study (reference 24 in the manuscript). Classic patient-reported outcome measures like the Quality of Life in Schizophrenia (QLiS) and the Schizophrenia Quality of Life Scale (SQLS) were examined, in addition to qualitative studies examining the lived experiences of schizophrenia patients. Also, pilot interviews with Tamil Nadu patients assisted in clarifying the items to make sure psychiatric, somatic, as well as social components of the disorder were well covered. These sources have been clearly identified in the updated manuscript. The steps are elaborated below.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePHASE 1 \u0026ndash; INITIAL PHASE\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ei) LITERATURE REVIEW\u003c/h3\u003e\n\u003cp\u003eAn extensive literature review was done in search engines including Google Scholar, PubMed, Scopus, and Cochrane Library on previously published qualitative research works exploring the experiences of individuals living with Schizophrenia in various regions and quantitative studies done in the same population with regards to their physical/somatic problems, stigma, quality of life, disease burden, factor influencing their symptoms and cognitive problems.\u003c/p\u003e\n\u003ch3\u003eii) IN DEPTH INTERVIEW WITH INDIVIDUALS LIVING WITH SCHIZOPHRENIA\u003c/h3\u003e\n\u003cp\u003eInterview was conducted with Schizophrenic participants, to comprehensively explore various factors and dynamics that affect their quality of living. Data saturation was attained iteratively The process of interview, methods and selection criteria were explained in the previous study. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003ePHASE 2: DEVELOPMENTAL PHASE\u003c/b\u003e \u003c/p\u003e\n\u003ch3\u003ei) THEME IDENTIFICATION\u003c/h3\u003e\n\u003cp\u003eThe entire interview was translated and transcribed in English. The responses were coded based on grounded theory. The process of coding, theme identification and results of the interview were disclosed in the previous qualitative study. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eii) FRAMING QUESTIONNAIRE\u003c/h3\u003e\n\u003cp\u003eWith coding performed and the highlighted keywords, a close-ended questionnaire was framed with 78 questions under separate domains. Questions were framed with care such that it was not ambiguous double-ended or offensive. Framed questions were placed under appropriate domains and subdomains.\u003c/p\u003e \u003cp\u003eScoring of the questions was with accordance to 5-point - Likert scale that had a different set of options according to the questions.\u003c/p\u003e \u003cp\u003eFramed questions were paraphrased, reframed and re-arranged by the opinions obtained from four experienced clinical psychologists through panel discussions who were recruited purposively. As a result, 65 questions were finalized and placed under the appropriate domains\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePHASE 3 \u0026ndash; CONTENT VALIDATION PHASE\u003c/h2\u003e \u003cp\u003eThe constructed questionnaire was further sent for content validation to the expert committee to check the relevancy, evidence of content and technical quality\u003c/p\u003e \u003cp\u003eFor expert validation, the panel was not blinded to the questionnaire since their task was to evaluate content relevance and cultural appropriateness. Nonetheless, each expert evaluated the questionnaire independently to reduce any possible bias. The board consisted of 11 experts who had at least five years' clinical experience in the field of psychiatry. They included one psychiatric social worker with community mental health expertise, four clinical psychologists with schizophrenia and mental health evaluation expertise, three physiotherapists experienced in neuropsychiatric rehabilitation, and three health policy and epidemiology experts specializing in public health. This provided a multidisciplinary framework ensuring thorough validation using psychiatric, physical, and socio-cultural viewpoints..\u003c/p\u003e \u003cp\u003eContent validated questionnaire was forward translated into Tamil and was reverse translated to English by two independent literature experts to ensure that the translation was accurately done without having a potential change in the actual meaning.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePHASE 4 – EVALUATION PHASE\u003c/h3\u003e\n\u003cp\u003eThe framed questionnaire was then sent for testing to the target population. 325 participants were recruited. This sample size followed the ratio of 1:5 i.e. 5 participants per question.\u003c/p\u003e \u003cp\u003ePrimary study setting was Aadharavu home, Periyapalayam, Chennai. The data recruitment followed snow ball sampling method.\u003c/p\u003e \u003cp\u003eInclusion criteria for the study were stable participants with age ranging between of 18 to 65 years of both genders with a history of Schizophrenia at least and under regular psychiatric treatment with insight to respond were included in the study. Participants with uncontrolled psychiatric disorders, neurological problems, primary dementia, recent history of hospitalization, exacerbation of disease within last 3 months, difficulty in comprehending or responding and non-willingness to participate were excluded.\u003c/p\u003e \u003cp\u003e With the responses obtained from the participants, internal consistency and exploratory factor analysis were performed and item reduction was done. The item-reduced questionnaire was then forwarded for confirmatory factor analysis.\u003c/p\u003e\n\u003ch3\u003eANALYSIS OF DATA\u003c/h3\u003e\n\u003cp\u003eIBM SPSS version 20 software was employed for analysis. Demographic data and the responses filled by the participants were analyzed using descriptive statistics. Reliability statistics were employed to find out Cronbach\u0026rsquo;s alpha. Exploratory factor analysis was performed using the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett\u0026rsquo;s Test of Sphericity and principal component analysis was performed. Confirmatory factor analysis was performed and factors were identified with a scree plot. The relations between the items were analysed using the Structural Equation Model (SEM)\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCONTENT VALIDATION\u003c/h2\u003e \u003cp\u003eAll the items of the scale had an acceptable to excellent validity with I-CVI ranging from 0.73 to 1 with an overall S-CVI of 0.87 which is a good validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eINTERNAL CONSISTENCY\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the demographic characteristics of the 325 participants who took part in the quantitative analysis of the Schizophrenia disease burden scale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDEMOGRAPHIC CHARACTERISTICS OF THE PARTICIPANTS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMINIMUM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAXIMUM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEAN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAGE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHEIGHT (Cms)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWEIGHT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDURATION OF ILLNESS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGENDER (%)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMEN\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eWOMEN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e \u003cp\u003e205 (63.1%)\u003c/p\u003e \u003cp\u003e120 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e depicts that the mean age of participants were 42.64 \u003cu\u003e+\u003c/u\u003e 11.62 while average height and weight of the participants were 164.48 \u003cu\u003e+\u003c/u\u003e 9.23 and 66.78 \u003cu\u003e+\u003c/u\u003e 12.39 respectively\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\u003cp\u003eReliability analysis of the scale showed an excellent Cronbach\u0026rsquo;s alpha with a value of 0.922 for the 65-item questionnaire. From Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e it can be inferred from the table that all items of the scale are consistent with Cronbach value above 0.9 and deleting any item will not improve the overall reliability significantly.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eITEM TOTAL STATISTICS - RELIABILITY OF THE SCALE\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSCALE MEAN IF ITEM DELETED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSCALE VARIANCE IF ITEM DELETED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCORRECTED ITEM-TOTAL CORRELATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCRONBACH'S ALPHA IF ITEM DELETED\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.6277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1107.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.9662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1098.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.7046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1111.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.4308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1109.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.8338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1099.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.1600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1093.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.1723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1091.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.7723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1125.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.4646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1108.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.3662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1118.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.3754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1123.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182.5631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1131.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.0215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1091.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.8031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1078.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.2769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1095.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e 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align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.8369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1087.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.0400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1094.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184.4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1105.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.6492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1117.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183.6338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1110.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e depicts that the internal consistency of each question of the scale is above 0.9, indicating an excellent reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEXPLORATORY FACTOR ANALYSIS\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the factor analysis with the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett's Test of Sphericity. It reveals that the scale reduced to 24 items based on principal component analysis has an acceptable KMO value of 0.744 with a significance of 0.000. Item reduction was based on factor loading. Any item with a value less than 0.5 was eliminated to ensure better validity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFACTOR ANALYSIS OF SCHIZOPHRENIA DISEASE BURDEN SCALE - KAISER-MEYER-OLKIN (KMO) MEASURE OF SAMPLING ADEQUACY AND BARTLETT'S TEST OF SPHERICITY\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eKMO AND BARTLETT'S TEST\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKAISER-MEYER-OLKIN MEASURE OF SAMPLING ADEQUACY.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBARTLETT'S TEST OF SPHERICITY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApprox. Chi-Square\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5978.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunalities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eINITIAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEXTRACTION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.720\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.814\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eExtraction Method: Principal Component Analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e depicts that the scale has adequacy of 0.744 with Bartlett\u0026rsquo;s significance of 0.000 following the item reduction based on principal factor analysis\u0026nbsp;\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e depicts the explanation of total variances included in the 24-item version of the scale. 6 factors were identified in the scree plot and the included questions were arranged according to the rotated component matrix. The fit model of the scale is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e While the scree plot is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e depicts the rotated component matrix of the short-listed 24 questions of the Schizophrenia disease burden scale. The six factors were as follows: Cognitive factor, Psychological factors, Personal factors I, Personal factors II, Vocational factors and Physical factors\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSCHIZOPHRENIA DISEASE BURDEN SCALE \u0026ndash; PRINCIPAL COMPONENT ANALYSIS \u0026ndash; TOTAL VARIANCE EXPLAINED\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOMPONENT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eINITIAL EIGENVALUES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% OF VARIANCE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCUMULATIVE %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.659\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.371\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.870\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eExtraction Method: Principal Component Analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSCHIZOPHRENIA DISEASE BURDEN SCALE \u0026ndash; PRINCIPAL COMPONENT ANALYSIS \u0026ndash; ROTATED COMPONENT MATRIX\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eCOMPONENT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ22\u003c/b\u003e\u003c/p\u003e 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align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ32\u003c/b\u003e\u003c/p\u003e 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colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eExtraction Method: Principal Component Analysis.\u003c/p\u003e \u003cp\u003eRotation Method: Varimax with Kaiser Normalization.\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ea. Rotation converged in 7 iterations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e depicts the mean value and standard deviation of the responses obtained from the participants for the short-listed 24 items. It can be observed that the most reported burden is that the participant is unable to sleep without medications which has a mean of 4.25\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.25 followed by the burden that they are not able to work as efficiently as before (3.68\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.22) and \u0026ldquo;It is hard for me to arrange and plan out how to accomplish a task with a mean of 3.58\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.07. The least reported was the suicidal thoughts with a mean value of 2.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.35 followed by \u0026ldquo;I need others to remind me or force me to take tablets\u0026rdquo; with a mean of 2.32\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.20.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRESPONSES OF THE PARTICIPANTS TO THE FINAL VERSION OF SCHIZOPHRENIA DISEASE BURDEN SCALE\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eITEM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMINIMUM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAXIMUM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEAN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSTD. DEVIATION\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQ61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e shows that the highest mean value of 4.25 was obtained for question 12 whereas the lowest mean value of 2.26 was obtained for question 30.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to develop a disease-specific PROM measure that is relevant to socioeconomic and cultural contexts. The key feature of this questionnaire was that it was developed from the ground level and was constructed inductively.\u003c/p\u003e \u003cp\u003eIn the construction of the questionnaire, we paid close attention to socio-economic as well as to cultural environments applicable to the Tamil Nadu population. The economic factors were concerns of financial instability and unemployment issues that directly affect the patient's quality of life. At a cultural level, we were concerned with family structure, stigma, and social expectations of community regarding mental health, such that the questionnaire captured attitudes and beliefs specific to the region. Secondly, variation in access to mental health care among socio-economic strata was considered, with respect to the differences in healthcare delivery.\u003c/p\u003e \u003cp\u003eA 65-item content-validated questionnaire that was framed based on the interview results and expert suggestion was tested for consistency and principal component analysis by circulating it to three twenty-five participants.\u003c/p\u003e \u003cp\u003eAll items on the scale were found to have good consistency. Any item having a value less than 0.5 in KMO analysis was removed. 24 items were included following item reduction which was placed under 5 domains initially.\u003c/p\u003e \u003cp\u003eThe item-reduced questionnaire with 24 items underwent confirmatory factor analysis and rotated component matrix. The fit model was analysed using SEM analysis and the 6 factors were identified by scree plot and the questions were systematically placed under 6 factors based on loading.\u003c/p\u003e \u003cp\u003eAlthough the new arrangement of questions under factors did not vary much from the domains in that they were placed initially, a few questions were arranged differently. The factors were renamed according to the questions they included.\u003c/p\u003e \u003cp\u003eThe frequency analysis revealed that sleep was the most bothersome problem, followed by which panning of tasks became difficult. The items that had higher responses were related to longing for love, vocational instability, interpersonal relationships, work efficiency, social exclusion and tremors. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eInitially, the construction of the scale aimed at the maximal inclusion of physical/somatic symptoms experienced by individuals living with Schizophrenia. Though the initial version of the scale consisted of 13 items related to physical/somatic factors, following the item reduction based on the participant responses, it was reduced to only 2 items under a physical domain. This could be because the participants are so bothered by the vocational and emotional factors that they tend to give less importance to physical factors.\u003c/p\u003e \u003cp\u003eVocational factors may not be relevant to a certain population, in such cases the domain may be considered as not applicable while scoring. In case of students, \u0026ldquo;workplace\u0026rdquo; in vocational factors may be considered as school/college and colleagues may be considered as peer friends and teachers.\u003c/p\u003e \u003cp\u003e Participants in qualitative interviews expressed, they require some one to remind them of their tasks such as taking medicine, carrying out and organizing task. This is because they tend to forget thing quite often. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBut in contrast, the quantitative results revealed that the participants were more bothered about their work performance rather than the cognitive problems implying that the rehabilitation should focus on functional outcomes rather than impairment to reduce remission rates. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFailing memory and difficulty in organising tasks and implementing them might be attributed to the lateral prefrontal cortex involvement. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBy encompassing a broader range of domains, this scale provides a more comprehensive assessment of the multifaceted burden experienced by individuals with Schizophrenia and can help researchers and healthcare professionals gain a deeper understanding of the overall impact of the illness on individuals\u0026rsquo; lives\u003c/p\u003e \u003cp\u003eWhen compared to the previously available disease-specific patient-reported burden measure for Schizophrenia, this scale \u0026ndash; \u0026ldquo;Schizophrenia Disease Burden Scale\u0026rdquo; is unique in that it is constructed according to the socio-economic context along with a focus on the physical, mental, social, personal and environmental aspects thereby serving as a tool to assess their disease burden. A higher score on this scale implies an increased burden with poor quality of life among individuals living with Schizophrenia. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe limitation of the study is that the results of the scale were not counter-verified caregivers of the participants as the actual burden may vary. Educational status and gender differences were not addressed. The options provided in the scale are questions but the questions do not include any specific time frame, thus the administrator has to be specific while assessing. The disease burden of individuals who have recurrent remissions and recent hospitalization may vary from the current results. Future studies must consider comparing the scale with previously existing ones. Test-retest reliability has to be established. Future studies must focus on assessing the validity of this scale in various other states in India to understand its applicability all over India\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFUTURE IMPLICATIONS\u003c/h2\u003e \u003cp\u003eTo improve inclusion of individuals living with Schizophrenia in their family, to improve treatment adherence and outcomes, it is important to incorporate family centred rehabilitation where in family will be involved as integral part of treatment process\u003c/p\u003e \u003cp\u003eThere is a need for government policies and awareness programmes to enhance the social integration of individuals with mental health disorders like Schizophrenia.\u003c/p\u003e \u003cp\u003eThere is an immediate necessity for providing vocational rehabilitation and integration for individuals living with Schizophrenia to make them economically stable and earn their livelihood.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe Schizophrenia Disease Burden Scale takes into account the unique experiences, challenges and social dynamics that individuals face in India, specifically Tamil Nadu, thus providing a more relevant and culturally sensitive assessment of disease burden.\u003c/p\u003e \u003cp\u003eThe schizophrenia disease burden scale demonstrated good validity and internal consistency in measuring the disease burden experienced by the individuals living with Schizophrenia with relevance to socio-cultural and economic context\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e The entire study complied with Helsinki\u0026rsquo;s declaration. The study was approved by the Institution Ethics Committee of SRM Medical College Hospital and Research Centre (SRM MCH \u0026amp; RC) with approval number 8314/IEC/2022 on 25.03.2022. Informed consent form for participation was taken from all the participants of the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003ePrior to enrolment, participants were explained about the research. Voluntary willingness and consent to publication was obtained from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding:\u003c/strong\u003e No sources of funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVK, AJR: Conceptualization and study design\u003c/p\u003e\n\u003cp\u003eVK, SSS: refined the study design\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;AJR, VK, KS: Prepared and processed for ethical clearance\u003c/p\u003e\n\u003cp\u003eSSS, VTS, VK: Participated in conceptual process of the study and provided mentorship\u003c/p\u003e\n\u003cp\u003eAJR, KS: Wrote the first draft of the study protocol\u003c/p\u003e\n\u003cp\u003eAJR, KS, SSS, VK: Refined the manuscript:\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the revision of the protocol and read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Authors extend their thanks to Dr. Bashi Sugumaran and his team, Department of Clinical Psychology, SRM Medical College Hospital and Research Centre for their support and guidance throughout the research\u003c/p\u003e\n\u003cp\u003eAuthors would like to express their heartfelt gratitude to Dr. Koteeshwar Rao, Managing Trustee, Aadharavu home, Periyapalayam and his entire team for extending their support in completion of the study and permitting for data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Education. 2017 Apr;17(4):137\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eAimola L, Gordon-Brown J, Etherington A, Zalewska K, Cooper S, Crawford MJ. Patient-reported experience and quality of care for people with schizophrenia. BMC Psychiatry. 2019 Jan 9;19(1):17. \u003c/li\u003e\n\u003cli\u003eMcIntyre RS, Ismail Z, Watling CP, Weiss C, Meehan SR, Musingarimi P, et al. Patient-reported outcome measures for life engagement in mental health: a systematic review. J Patient Rep Outcomes. 2022 Jun 10;6(1):62. \u003c/li\u003e\n\u003cli\u003eChurruca K, Pomare C, Ellis LA, Long JC, Henderson SB, Murphy LED, et al. Patient-reported outcome measures (PROMs): A review of generic and condition-specific measures and a discussion of trends and issues. Health Expect. 2021 Aug;24(4):1015\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eQuittner AL, Nicolais CJ, Saez-Flores E. 13 - Integrating Patient-Reported Outcomes Into Research and Clinical Practice. In: Wilmott RW, Deterding R, Li A, Ratjen F, Sly P, Zar HJ, et al., editors. Kendig\u0026rsquo;s Disorders of the Respiratory Tract in Children (Ninth Edition) [Internet]. Philadelphia: Elsevier; 2019 [cited 2024 Mar 16]. p. 231-240.e3. Available from: https://www.sciencedirect.com/science/article/pii/B9780323448871000134\u003c/li\u003e\n\u003cli\u003eDurgoji S, Muliyala KP, Jayarajan D, Chaturvedi SK. Quality of Life in Schizophrenia: What is Important for Persons with Schizophrenia in India? Indian J Psychol Med. 2019 Sep 5;41(5):420\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKanchanatawan B, Sirivichayakul S, Thika S, Ruxrungtham K, Carvalho AF, Geffard M, et al. Physio-somatic symptoms in schizophrenia: association with depression, anxiety, neurocognitive deficits and the tryptophan catabolite pathway. Metab Brain Dis. 2017 Aug;32(4):1003\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eOud MJT, Meyboom-de Jong B. Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care. BMC Fam Pract. 2009 May 9;10:32. \u003c/li\u003e\n\u003cli\u003eCrespo-Facorro B, Such P, Nylander AG, Madera J, Resemann HK, Worthington E, et al. The burden of disease in early schizophrenia - a systematic literature review. Curr Med Res Opin. 2021 Jan;37(1):109\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eDesalegn D, Girma S, Abdeta T. Quality of life and its association with psychiatric symptoms and socio-demographic characteristics among people with schizophrenia: A hospital-based cross-sectional study. PLoS One. 2020;15(2):e0229514. \u003c/li\u003e\n\u003cli\u003eLloyd J, Lloyd H, Fitzpatrick R, Peters M. Treatment outcomes in schizophrenia: qualitative study of the views of family carers. BMC Psychiatry. 2017 Jul 21;17(1):266. \u003c/li\u003e\n\u003cli\u003eAndrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists\u0026rsquo; views about providing physiotherapy services to people with severe and persistent mental illness: a mixed methods study. J Physiother. 2019 Oct;65(4):222\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eEngh JA, Andersen E, Holmen TL, Martinsen EW, Mordal J, Morken G, et al. Effects of high-intensity aerobic exercise on psychotic symptoms and neurocognition in outpatients with schizophrenia: study protocol for a randomized controlled trial. Trials. 2015 Dec 8;16:557. \u003c/li\u003e\n\u003cli\u003eYosep I, Mediani HS, Lindayani L, Sriati A. How patients with schizophrenia \u0026ldquo;as a Victim\u0026rdquo; cope with violence in Indonesia: a qualitative study. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021 Jun 12;57(1):71. \u003c/li\u003e\n\u003cli\u003eMohandoss AA. Quality of life in schizophrenic patients: Comparative study from South India. Journal of Dr YSR University of Health Sciences. 2017 Dec;6(4):224. \u003c/li\u003e\n\u003cli\u003eGaluppi A, Turola MC, Nanni MG, Mazzoni P, Grassi L. Schizophrenia and quality of life: how important are symptoms and functioning? Int J Ment Health Syst. 2010 Dec 8;4:31. \u003c/li\u003e\n\u003cli\u003eMillier A, Clay E, Charaf I, Chauhan D, Murthy V, Toumi M, et al. Patient Reported Outcomes Instruments in Schizophrenia: A Review of Psychometric Properties. Open Journal of Medical Psychology. 2014 Jan 17;3(2):141\u0026ndash;56. \u003c/li\u003e\n\u003cli\u003eCharlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016. Schizophr Bull. 2018 Oct;44(6):1195\u0026ndash;203. \u003c/li\u003e\n\u003cli\u003eBondre AP, Shrivastava R, Raghuram H, Tugnawat D, Khan A, Gupta S, et al. A qualitative exploration of perceived needs and barriers of individuals with schizophrenia, caregivers and clinicians in using mental health applications in Madhya Pradesh, India. SSM Ment Health. 2022 Dec;2:100063. \u003c/li\u003e\n\u003cli\u003eRanjan LK, Gupta PR, Kiran M, Singh NK. Family Care Burden and its Association with Psychological Distress Among Caregivers of Chronic Patients with Schizophrenia. Journal of Public Health and Primary Care. 2022 Dec;3(3):81. \u003c/li\u003e\n\u003cli\u003eRamadas S, Bonanthaya V. Quality of life of patients with schizophrenia and chronic obstructive pulmonary disease: An observational study. Ind Psychiatry J. 2017;26(2):140\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCoelho A, de Bienassis K, Klazinga N, Santo S, Frade P, Costa A, et al. Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal. Int J Environ Res Public Health. 2022 Sep 6;19(18):11153. \u003c/li\u003e\n\u003cli\u003eGewurtz R, Moll S, Poole JM, Gruhl KR. Qualitative Research in Mental Health and Mental Illness. In: Olson K, Young RA, Schultz IZ, editors. Handbook of Qualitative Health Research for Evidence-Based Practice [Internet]. New York, NY: Springer; 2016 [cited 2024 Mar 16]. p. 203\u0026ndash;23. Available from: https://doi.org/10.1007/978-1-4939-2920-7_13\u003c/li\u003e\n\u003cli\u003eKanniappan V, Abishek JR. Hermeneutic Phenomenological Approach to the Experiences of the Individuals Living with Schizophrenia: A Qualitative Study. Indian J Community Med. 2023;48(5):762\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eHaynes VS, Zhu B, Stauffer VL, Kinon BJ, Stensland MD, Xu L, et al. Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study. BMC Psychiatry. 2012 Dec 5;12(1):222. \u003c/li\u003e\n\u003cli\u003eGibson M. Witnessing Life with Schizophrenia and Anosognosia: A Qualitative Research Study OPEN ACCESS. 2018 Jun 18;1(2):1\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schizophrenia, India, Physical therapy modalities, Patient-reported outcome measures, Disease burden","lastPublishedDoi":"10.21203/rs.3.rs-5517158/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5517158/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSchizophrenia is a chronic disabling neurocognitive disorder. Physiotherapists being an integral part in improving the quality of life and disease burden of schizophrenia patients, it is important to know the disease burden of the patients. Most of the patient reported outcome measure examining the quality of life and disease burden of individuals living with Schizophrenia focuses on the impact of psychiatric symptoms overseeing the somatic complaints. There is need for Indian based Schizophrenia specific questionnaire that may significantly influence the symptoms, course and outcomes. This will help health care professionals in developing a patient centered treatment protocol and enhance active participation. This study aims to construct and validate Schizophrenia disease burden scale that which will be culturally sensitive.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBased on the results of qualitative analysis, a questionnaire was framed and content validated by 11 experts. Following which the questionnaire was circulated to 325 participants based on consecutive sampling method for quantitative analysis. Exploratory factor analysis was done using Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eContent validity of the scale was found to be 0.87 and has a Cronbach\u0026rsquo;s alpha of 0.922. Following item reduction, a 24-item scale finalized with KMO value of 0.744. 6 domains were identified in scree plot and was confirmed with confirmatory factor analysis.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Schizophrenia Disease Burden Scale takes into account the unique experiences, challenges and social dynamics that individuals face in India, specifically Tamil Nadu, thus providing a more relevant and culturally sensitive assessment of disease burden.\u003c/p\u003e","manuscriptTitle":"Development and Validation of the Schizophrenia Disease Burden Scale: A Comprehensive Patient-Reported Outcome Measure Incorporating Socioeconomic and Cultural Contexts ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 06:29:40","doi":"10.21203/rs.3.rs-5517158/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-25T11:02:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-24T11:47:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259067374288012428523913225862431519093","date":"2026-03-09T08:38:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-06T17:23:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325343344433075115402922161019620431058","date":"2026-03-03T16:52:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T10:08:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169643624548152182664895727646085845034","date":"2026-03-03T09:20:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210342880344360234335800268643334033521","date":"2026-02-20T07:53:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-10T13:12:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34361346292742777871453642666370822122","date":"2025-11-26T05:26:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297665835668058693301565656892165608890","date":"2025-07-09T05:52:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134898522039838529156704908388305257412","date":"2025-03-27T04:44:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-27T04:37:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-23T08:52:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-21T04:12:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8792ebca-9578-4efc-be9f-194366185c26","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":46290120,"name":"Health sciences/Health care"},{"id":46290121,"name":"Health sciences/Medical research"},{"id":46290122,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2026-05-04T22:38:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 06:29:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5517158","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5517158","identity":"rs-5517158","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}