Psychometric evaluation of a patient- and caregiver-rated early warning signs scale for acute exacerbations in schizophrenia

Abstract

Abstract Background A psychometrically sound instrument is essential for early detection and relapse prevention of schizophrenia by evaluating early warning signs (EWS). This study aimed to modify and shorten the EWS Psychotic Relapse Signature for use by both caregivers and patients in assessing the EWS of individuals with schizophrenia. Methods A total of 312 patient-caregiver pairs were recruited from a mental health service network in southern Taiwan. Results Caregiver and patient pairs completed the 55-item EWS Psychotic Relapse Signature. Item response theory analysis identified five items with low discrimination and high difficulty across both caregiver and patient groups. Additionally, eight items demonstrated low discrimination and high difficulty exclusively in patient responses, while two items exhibited these properties specifically in caregiver responses. Differential Item Functioning (DIF) analysis further identified seven items with significant uniform DIF and two items with significant non-uniform DIF, indicating potential bias across rater groups. Following the removal of these suboptimal items, the final version of the Early Warning Sign-Caregiver and Patient Version (EWS-CP) was refined to 31 items. The EWS-CP demonstrated strong internal consistency, with Cronbach’s alpha coefficients of 0.915 for caregivers and 0.917 for patients. Conclusions The EWS-CP provides a robust, psychometrically sound tool for relapse monitoring in clinical practice, contributing to improved patient outcomes through timely detection and targeted intervention. The dual-informant design allows for comprehensive EWS detection, aiding clinicians and caregivers in proactive relapse prevention, and enhancing early intervention.

Keywords

• Early warning sign
• Relapse prevention
• Caregiver evaluation
• Patient evaluation