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Arabic validation of the VAGUS insight into psychosis scale among Lebanese patients with schizophrenia
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  • Published: 06 March 2026

Arabic validation of the VAGUS insight into psychosis scale among Lebanese patients with schizophrenia

  • Carl Jalkh1,
  • Chadia Haddad2,3,4,5,
  • Hala Sacre3,9,
  • Adam Khoreich2 &
  • …
  • Pascale Salameh3,6,7,8 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Health care
  • Medical research
  • Psychology

Abstract

Several tools have been developed to assess insight, which can be measured using either clinician-rated or self-reported tools, each with advantages and limitations. The VAGUS Insight into Psychosis clinician-rated (VAGUS-CR) and the VAGUS self-report (VAGUS-SR) scales are brief clinician-rated and self-report measures assessing several dimensions of insight. This study aimed to translate, adapt, and validate the VAGUS scale in Arabic for use among Arabic-speaking psychotic populations. A cross-sectional study was conducted between June and July 2025 at the Psychiatric Hospital of the Cross, Lebanon. The study included 121 inpatients diagnosed with schizophrenia disorder, including a small number with schizoaffective disorder. The VAGUS Insight Scale was used to assess different dimensions of insight through the clinician-rated version and the self-report version. A principal component analysis revealed a one-factor construct for the VAGUS-CR explaining 47.96% of the total variance (Cronbach’s α = 0.668). For the VAGUS-SR, a three-factor structure was identified, accounting for 54.55% of the variance (Cronbach’s α for the total VAGUS-SR scale = 0.636). Test–retest reliability for the VAGUS-SR was good (ICC = 0.920, p < 0.001). For the VAGUS-CR, the total score displayed good test–retest reliability (ICC = 0.896, p < 0.001). The inter-rater reliability of the VAGUS-CR total score reached excellent agreement (ICC = 0.854, p < 0.001). Convergent validity showed moderate positive correlations between VAGUS-SR, VAGUS-CR, and BIS total scores. The VAGUS-SR and VAGUS-CR are brief and valid tools for assessing insight in Arabic-speaking patients with schizophrenia. Their value is particularly notable given the scarcity of such tools within the Arabic population.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ITAQ:

Insight and Treatment Attitudes Questionnaire

SUMD:

Scale to assess unawareness of mental disorder

SAI:

Schedule for the assessment of insight

SAIQ:

Self-Appraisal of Illness Questionnaire

VAGUS-CR:

VAGUS insight into psychosis scale clinician-rated

VAGUS-SR:

VAGUS insight into psychosis self report

BIS:

Birchwood Insight Scale

PANSS:

Positive and Negative Syndrome Scale

SPSS:

Statistical Package for the Social Sciences

EFA:

Exploratory factor analysis

CFA:

confirmatory factor analysis

RMSEA:

Root mean square error of approximation

GFI:

Goodness of fit index

CFI:

Comparative fit index

TLI:

Tucker Lewis index

ICC:

intraclass correlation coefficient

SD:

Standard deviation

KMO:

Kaiser-Meyer-Olkin

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Acknowledgements

The authors would like to thank the administration of the Psychiatric Hospital of the Cross, as well as the members of the Research and Ethics Committee, for their approval and for providing the necessary facilities to conduct this study. We are also deeply grateful to the patients who kindly agreed to participate in this research.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Faculty of Letters and Human Sciences , Lebanese University, Fanar, Lebanon

    Carl Jalkh

  2. Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon

    Chadia Haddad & Adam Khoreich

  3. INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon

    Chadia Haddad, Hala Sacre & Pascale Salameh

  4. Faculty of Public Health, Lebanese University, Fanar, Lebanon

    Chadia Haddad

  5. Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Global Health– Michel Dumas, OmegaHealth, Limoges, France

    Chadia Haddad

  6. School of Medicine, Lebanese American University, Byblos, Lebanon

    Pascale Salameh

  7. Faculty of Pharmacy, Lebanese University, Hadat, Lebanon

    Pascale Salameh

  8. Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus

    Pascale Salameh

  9. Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon

    Hala Sacre

Authors
  1. Carl Jalkh
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  2. Chadia Haddad
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Contributions

PS, CH designed the study; CJ, CH drafted the manuscript; PS, CH carried out the analysis and interpreted the results; CJ, AK conducted the data collection, HS, PS, AK assisted in drafting and reviewing the manuscript; HS revised and edited the article for English language, PS supervised the course of the article. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Chadia Haddad.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Ethical approval was obtained from the Ethics and Research Committee of the Psychiatric Hospital of the Cross (reference number: HPC-001-05-25). Participants were asked to provide written consent; however, some declined signing due to their conditions, such as paranoid delusions, tremors, or vision problems, and, in those cases, they gave their consent orally. They were made aware of their right to discontinue their involvement at any time without consequences. Informed consent was obtained by a trained clinical psychologist, who explained the study procedures, ensured participants’ comprehension, and confirmed voluntariness. The participants’ clinical doctors were informed about the study, and since this was an observational study, the clinical doctors provided approval for their patients to be included. All data were anonymized and stored securely to ensure participant confidentiality. All procedures were approved by the Ethics and Research Committee of the Psychiatric Hospital of the Cross, in accordance with the principles of the Declaration of Helsinki.

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This work has been done on behalf of the Psychiatric Hospital of the Cross Research Team (PHCRT) and INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban) research group.

Supplementary Information

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Supplementary Material 1 (download DOCX )

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Jalkh, C., Haddad, C., Sacre, H. et al. Arabic validation of the VAGUS insight into psychosis scale among Lebanese patients with schizophrenia. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42930-0

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  • Received: 02 January 2026

  • Accepted: 28 February 2026

  • Published: 06 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-42930-0

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Keywords

  • Insight
  • Schizophrenia patients
  • VAGUS
  • Psychosis
  • Validation
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