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

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.