Measuring theory of mind in schizophrenia research: Cross-cultural validation

Theory of mind (ToM) is the ability to understand mental states of others and it is crucial for building sensitivity to other persons or events. Measuring ToM is important for understanding and rehabilitating social cognitive impairments in persons with schizophrenia. The Social Attribution Task-Multiple Choice (SAT-MC) has been successfully employed to measure ToM between individuals with schizophrenia (SZ) and healthy controls (HC) in North America. Given that the SAT-MC uses geometric shapes, is nonverbal and less culturally loaded than other social cognition measures, it may serve for measuring ToM in schizophrenia across cultures. A total of 120 participants (30 per group; Korean SZ; Korean HC; North American SZ; North American HC) were selected from existing databases to examine the reliability and validity of the SAT-MC. Internal consistency, factor structure, measurement invariance, discriminant validity, and convergent/divergent validity were examined. The SAT-MC had good internal consistency regardless of the clinical and cultural group as evidence by Cronbach's α ≥ 0.78 in all groups. Confirmatory factor analysis confirmed the one-factor model with a good model fit (χ² = 188.122, TLI = 0.958, CFI = 0.963, RMSEA = 0.045). The SAT-MC was sensitive to detect individual differences in ToM of SZ and HC, regardless of culture (p < 0.001), and significantly correlated with other social cognition tasks (Hinting and Reading the Mind in the Eyes Test) among Korean and North American patients. The SAT-MC is a reliable measure for evaluating ToM in both Koreans and North Americans with or without schizophrenia, supporting its potential utility in diverse language and cultures for schizophrenia research.