title: Cross-cultural adaptation, validation and factor structure of the Insight Scale for Affective Disorders.
abstract: BACKGROUND
  In the last few decades, several tools for studying insight in bipolar disorders have been used. Olaya and colleagues developed the Insight Scale for Affective Disorders (ISAD), which consists of a scale measuring insight through hetero evaluation for patients with mood disorders. The objective of this work is to translate and adapt the original English version of the ISAD to Brazilian Portuguese (ISAD-BR) and to conduct an evaluation of its psychometric properties.
  
  
  METHODS
  Adaptation procedures included translation/back-translation and consultation with a panel of experts. 95 patients with the diagnosis of Type 1 bipolar disorder were evaluated with the final version of the ISAD-BR, which was applied, simultaneously, but independently, by two examiners. Internal consistency and inter-rater reliability were explored and the latent structure of the scale was investigated with principal axis factoring and promax rotation. A second-order factor analysis was conducted to test if the scale had a hierarchical factor structure.
  
  
  RESULTS
  The ISAD-BR showed good internal consistency and good inter-rater reliability. The analysis pointed to a four-factor solution of the ISAD-BR: awareness of symptoms associated with activity/energy; awareness of having a disorder; awareness of self-esteem and feelings of pleasure; and awareness of social functioning and relationships. The second order factor analysis indicated a hierarchical factor structure for the ISAD-BR, with the four lower-order factors loading on a single higher-order factor.
  
  
  CONCLUSIONS
  Insight into bipolar disorder is a multidimensional construct, covering different aspects of the condition and its symptomatology. Nevertheless, insight about activity/energy changes may be a crucial aspect of insight into bipolar disorder.
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil; Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: de Assis da Silva
authors.affiliation: Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil; Institute of Psychiatry, King׳s College, London, UK. Electronic address: daniel.mograbi@kcl.ac.uk.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Mograbi
authors.affiliation: Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Evelyn V M
authors.initials: EV
authors.lastname: Camelo
authors.affiliation: Department of Anthropology, University of Chicago, USA.
authors.forename: Gregory Duff
authors.initials: GD
authors.lastname: Morton
authors.affiliation: Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil; Universidade Estácio de Sá (UNESA), Rio de Janeiro, RJ, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Landeira-Fernandez
authors.affiliation: Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil; Faculdade de Ciências Médicas da Universidade do Estado Do Rio de Janeiro (FCM/UERJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Elie
authors.initials: E
authors.lastname: Cheniaux
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D001938:Brazil; D032882:Comprehension; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007600:Judgment; D007802:Language; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D015588:Observer Variation; D011594:Psychometrics; D015203:Reproducibility of Results; D012649:Self Concept; D011795:Surveys and Questionnaires / Q000592:standards*; D014177:Translations
keywords: Adaptation; Awareness; Bipolar disorder; Factor analysis; Insight; Validation