Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis
2. Materials and Methods
2.1. Type of Studies
2.2. Search Methods for Identification of Studies
2.3. Data Collection and Analysis
3.1. Search Results
3.2. Characteristics of Included Studies
Conflicts of Interest
- The protocol described that there would be no restrictions on the type of study design eligible for inclusion; however, later on we realized that only comparative studies would allow us to extract appropriate effect sizes to meta-analyze. Therefore, we restricted the eligibility of studies for meta-analysis to those with a between-groups or within-group design and included the rest of studies in the narrative part of the review.
- The protocol described the use of a random effects model to combine independent effect sizes in an overall meta-analytical estimate; however, the small number of retrieved studies made unfeasible to estimate appropriately between-studies heterogeneity. Additionally, a random effects model with so few studies would equate the importance or weight of those studies without allowing for the different sample size of the included studies. Therefore, we decided to conduct a fixed effect meta-analysis with the included studies.
- The small number of included studies did not allow us to conduct a stratified analysis and publication bias assessment as stated in the protocol.
- Bearden, C.E.; Forsyth, J.K. The many roads to psychosis: Recent advances in understanding risk and mechanisms. F1000 Fac. Rev. 2018, 7. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Crow, T.J. Schizophrenia as the price that homo sapiens pays for language: A resolution of the central paradox in the origin of the species. Brain Res. Rev. 2000, 31, 118–129. [Google Scholar] [CrossRef]
- Zlatev, J. The dialectics of consciousness and language. J. Conscious. Stud. 2008, 15, 5–14. [Google Scholar]
- Whorf, B. Language, Thought and Reality. Selected Writings of Benjamin Lee Whorf, 1st ed.; The M.I.T. Press: Cambridge, MA, USA, 1956. [Google Scholar]
- Zlatev, J.; Blomberg, J. Language may indeed influence thought. Front. Psychol. 2015, 6. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Price, C.S.; Cuellar, I. Effects of Language and Related Variables on the Expression of Psychopathology in Mexican American Psychiatric Patients. Hispanic J. Behav. Sci. 1981, 3, 145–160. [Google Scholar] [CrossRef]
- Paradis, M. Bilingualism and neuropsychiatric disorders. J. Neurolinguistics 2008, 21, 199–230. [Google Scholar] [CrossRef]
- Grosjean, F. Life with Two Languages: An Introduction to Bilingualism; Harvard University Press: Cambridge, MA, USA, 1982. [Google Scholar]
- IOM. World Migration Report. 2018; International Organization for Migration: Geneva, Switzerland, 2017. [Google Scholar]
- Xiaobo, L.; Branch, C.; De Lisi, L. Language pathway abnormalities in schizophrenia: A review of fMRI and other imaging studies. Curr. Opin. Psychiatr. 2009, 22, 131–139. [Google Scholar] [CrossRef]
- Bearden, C.E.; Rosso, I.M.; Hollister, J.M.; Sanchez, L.E.; Hadley, T.; Cannon, T.D. A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia. Schizophr. Bull. 2000, 26, 395–410. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Arciniegas, D.B. Psychosis. Behav. Neurol. Neuropsychiatry 2015, 21, 15–736. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Seeman, M.V. Bilingualism and schizophrenia. World J. Psychiatry 2016, 6, 192–198. [Google Scholar] [CrossRef] [PubMed]
- Malo, P.; Medrano, J.; Uriarte, J. Auditory hallucinations in bilingual subjects. Arch. Neurobiol. 1991, 54, 15–19. [Google Scholar]
- Del Castillo, J.C. The influence of language upon symptomatology in foreign-born patients. Am. J. Psychiatry 1970, 127, 242–244. [Google Scholar] [CrossRef] [PubMed]
- Marcos, L.R.; Alpert, M.; Urcuyo, L.; Kesselman, M. The Effect of Interview Language on the Evaluation of Psychopathology in Spanish-American Schizophrenic Patients. Am. J. Psychiatry 1973, 130, 549–553. [Google Scholar] [CrossRef] [PubMed]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences; Lawrence Erlbaum Associates: Mahwah, NJ, USA, 1988. [Google Scholar]
- McGraw, K.O.; Wong, S.P. A common language effect size statistic. Psychol. Bull. 1992, 111, 361–365. [Google Scholar] [CrossRef]
- Rice, K.; Higgins, J.P.T.; Lumley, T. A re-evaluation of fixed effect(s) meta-analysis. J. R. Statist. Soc. A 2018, 181, 205–227. [Google Scholar] [CrossRef]
- Higgins, J.; Thompson, S.; Deeks, J.; Altman, D. Measuring inconsistency in meta-analyses. Br. Med. J. 2003, 327, 557–560. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Schünemann, H.; Brozek, J.; Guyatt, G.; Oxman, A. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. Available online: https://gdt.gradepro.org/app/handbook/handbook.html (accessed on 9 December 2019).
- Schwarzer, G. Meta: An R package for meta-analysis. R News 2007, 7, 40–45. [Google Scholar]
- R Core Team. R: A Language and Environment for Statistical Computing. Available online: https://www.R-project.org/ (accessed on 6 December 2019).
- Viechtbauer, W. Conducting meta-analyses in R with the metafor package. J. Stat. Softw. 2010, 36, 1–48. [Google Scholar] [CrossRef][Green Version]
- Smirnova, D.; Walters, J.; Fine, J.; Muchnik-Rozanov, Y.; Paz, M.; Lerner, V.; Belmaker, H.; Bersudsky, Y. Second language reflects more psychopathology but compensates the verbal fluency in bilinguals with schizophrenia. Eur. Neuropsychopharmacol. 2014, 24, 500–501. [Google Scholar] [CrossRef]
- Smirnova, D.; Walters, J.; Fine, J.; Muchnik-Rozanov, Y.; Paz, M.; Lerner, V.; Belmaker, H.; Bersudsky, Y. Schizophrenia in bilingual immigrants: Is verbal fluency preserved in second language acquisition? Eur. Psychiatry 2015, 30, 1681. [Google Scholar] [CrossRef]
- Smirnova, D.; Walters, J.; Fine, J.; Muchnik-Rozanov, Y.; Paz, M.; Lerner, V.; Belmaker, H.; Bersudsky, Y. Second language as a compensatory resource for maintaining verbal fluency in bilingual immigrants with schizophrenia. Neuropsychologia 2015, 75, 597–606. [Google Scholar] [CrossRef] [PubMed]
- González, J. Language factors affecting treatment of bilingual schizophrenics. Psychiatr. Ann. 1978, 8, 68–70. [Google Scholar] [CrossRef]
- Haasen, C.; Yagdiran, O.; Mass, R. Differenzen zwischen der psychopathologischen evaluation in deutscher und türkischer Sprache bei türkischen Migranten. Nervenarzt 2000, 71, 901–905. [Google Scholar] [CrossRef] [PubMed]
- Haasen, C.; Yagdiran, O.; Mass, R.; Krausz, M. Potential for misdiagnosis among Turkish migrants with psychotic disorders a clinical controlled study in Germany. Acta Psychiatr. Scand. 2000, 101, 125–129. [Google Scholar] [CrossRef] [PubMed]
- Zayas, L.H.; Torres, L.R.; Cabassa, L.J. Diagnostic, symptom, and functional assessments of Hispanic outpatients in community mental health practice. Community Ment. Health J. 2009, 45, 97–105. [Google Scholar] [CrossRef] [PubMed]
- De Zulueta, F.; Gene-Cos, N.; Grachev, S. Differential psychotic symptomatology in polyglot patients: Case reports and their implication. Br. J. Med. Psychol. 2001, 74, 277–292. [Google Scholar] [CrossRef] [PubMed]
- Schoeman, R.; Chiliza, B.; Emsley, R.; Southwood, F. Bilingualism and psychosis: A case report. Schizophr. Res. 2008, 103, 333–335. [Google Scholar] [CrossRef] [PubMed]
- Bengoetxea, E.; Burton, C.; Mausbach, B.; Patterson, T.; Twamley, E. The effect of language on functional capacity assessment in middle-aged and older U.S. Latinos with schizophrenia. Psych. Res. 2014, 218, 31–34. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Díaz, E.; Miskemen, T.; Vega, W.; Gara, M.; Wilson, D.; Lesser, I.; Escamilla, M.; Neighbors, H.; Arndt, S.; Strakowski, S. Inconsistencies in diagnosis and symptoms among bilingual and English-speaking Latinos and Euro-Americans. Psychiatr. Serv. 2009, 60, 1379–1382. [Google Scholar] [CrossRef] [PubMed]
- Brown, C.A.; Weisman de Mamani, A. A comparison of psychiatric symptom severity in individuals assessed in their mother tongue versus an acquired language: A two-sample study of individuals with schizophrenia and a normative population. Prof. Psychol. Res. Pract. 2017, 48, 1–10. [Google Scholar] [CrossRef]
- Malgady, R.G.; Costantino, G. Symptom severity in bilingual hispanics as a function of clinician ethnicity and language of interview. Psychol. Assess. 1998, 10, 120–127. [Google Scholar] [CrossRef]
- Milun, M.; Daneel, M.H.; Smart, D.; Beumont, P.J. Language medium and schizophrenic thought disorder. S. Afr. Med. J. 1980, 57, 996–997. [Google Scholar] [PubMed]
- Southwood, F.; Schoeman, R.; Emsley, R. Bilingualism and psychosis: A linguistic analysis of a patient with differential symptom severity across languages. S. Afr. Linguist. Appl. Lang. Stud. 2009, 27, 163–171. [Google Scholar] [CrossRef]
- Palomar-García, M.Á.; Bueichekú, E.; Ávila, C.; Sanjuán, A.; Strijkers, K.; Ventura-Campos, N.; Costa, A. Do bilinguals show neural differences with monolinguals when processing their native language? Brain Lang. 2015, 142, 36–44. [Google Scholar] [CrossRef] [PubMed]
- Kuzmina, E.; Goral, M.; Norvik, M.; Weekes, B.S. What Influences Language Impairment in Bilingual Aphasia? A Meta-Analytic Review. Front. Psychol. 2019, 10, 445. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Berken, J.A.; Gracco, V.L.; Klein, D. Early bilingualism, language attainment, and brain development. Neuropsychologia 2017, 98, 220–227. [Google Scholar] [CrossRef] [PubMed]
- Costa, A.; Sebastián-Gallés, N. How does the bilingual experience sculpt the brain? Nat. Rev. Neurosci. 2014, 15, 336–345. [Google Scholar] [CrossRef] [PubMed]
- Sebastian, R.; Laird, A.R.; Kiran, S. Meta-analysis of the neural representation of first language and second language. Appl. Psycholinguist. 2011, 32, 799–819. [Google Scholar] [CrossRef]
- Perani, D.; Abutalebi, J. The neural basis of first and second language processing. Curr. Opin. Neurobiol. 2005, 15, 202–206. [Google Scholar] [CrossRef] [PubMed]
|Study Country Official Language||Design. Participants Diagnosis||Gender Age Education||Outcome Scale||Languages (L1/L2)||Comments|
|Marcos et al., 1973|
N = 10
|6 males/4 females|
Mean age 30.9 years (SD 6.3)
Mean education 8.7 years (SD 2.2)
|18-item BPRS||Spanish/English||Half of the patients participated first in one language interview and then in the other. Interviews were recorded with a closed-circuit television.|
Outcome data is available in Figure 1, and was extracted with WebPlotDigitizer (https://automeris.io/WebPlotDigitizer).
SMD estimated from t-test paired analysis.
|Milun et al., 1980|
|Non-randomized within-group design|
N = 10
|Gender no reported|
Mean age 34.6 years (SD 14.5)
Education no reported
|Bannister-Fransella Grid test of Schizophrenic Thought Disorder||Afrikaans/English||Half of the patients participated first in one language interview and then in the other.|
SMD estimated from paired analysis, correlation between study sequences was not provided and estimated to be 0.70.
|Malgady et al., 1998|
|Randomized between-groups design|
N = 45
|Data disaggregated by diagnosis no reported||18-item BPRS||Spanish/English||Participants with Spanish as L1 were randomized to Spanish diagnostic interviews (two conditions collapsed) or to English diagnostic interviews (two conditions collapsed).|
SMD estimated from unpaired analysis. The number of participants by condition is not provided, only total number of participants by psychiatric diagnosis. We have assumed equal allocation to conditions and restricted analysis to schizophrenia diagnosis (N = 45).
|Brown et al., 2017|
|Non-randomized between-groups design|
N = 218
Schizophrenia, schizoaffective disorder, other psychotic disorders
|30.8 % female|
Mean age 41.05 years (SD 11.5)
Most high school level or higher (94.5%)
|24-item BPRS||Spanish/English||Assessment language was made by individual preference of interview (78% assessed in Spanish, 22% assessed in English).|
SMD estimated from unpaired analysis for the BPRS Thought Disturbance Scale. Number of participants by condition were estimated from reported percentages and total number of participants.
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Erkoreka, L.; Ozamiz-Etxebarria, N.; Ruiz, O.; Ballesteros, J. Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 4137. https://doi.org/10.3390/ijerph17114137
Erkoreka L, Ozamiz-Etxebarria N, Ruiz O, Ballesteros J. Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 17(11):4137. https://doi.org/10.3390/ijerph17114137Chicago/Turabian Style
Erkoreka, Leire, Naiara Ozamiz-Etxebarria, Onintze Ruiz, and Javier Ballesteros. 2020. "Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 17, no. 11: 4137. https://doi.org/10.3390/ijerph17114137