In recent years, the study of auditory hallucinations associated with schizophrenia spectrum disorders has gained renewed attention in psychiatric research. One widely used tool for understanding these hallucinations is the Beliefs About Voices Questionnaire-Revised (BAVQ-R), which evaluates how patients perceive the voices they hear and their behavioral responses to them. However, despite the BAVQ-R’s extensive usage globally, its psychometric properties across different languages and cultural contexts remain underexplored. A groundbreaking study conducted in Iran now sheds light on the reliability and validity of the Persian adaptation of this instrument, opening new avenues for clinical assessment and research in non-Western populations.
The initiative, spearheaded by Iranian researchers, involved a meticulous translation and cultural adaptation process of the BAVQ-R. The original instrument was carefully translated into Persian, ensuring that linguistic nuances and cultural relevance were maintained. This adaptation is crucial because beliefs and reactions to auditory hallucinations are influenced not only by individual psychopathology but also by cultural factors. By validating this tool in Iran, mental health professionals can now have a culturally sensitive instrument to assess and understand patients’ experiences with voice hearing, which in turn can influence therapeutic approaches and outcomes.
A comprehensive sample of 298 patients diagnosed with schizophrenia spectrum disorders was recruited from Razi Hospital in Tehran. The participants ranged in age from 19 to 50 years old, with an average age of approximately 37 years. More than 85% of the sample was male, reflecting the demographic characteristics of the patient population in this clinical setting. These patients completed the Persian BAVQ-R alongside a battery of other self-report and clinician-administered assessments, including measures of depression, quality of life, and the severity of psychotic symptoms. This rigorous methodological approach ensured that the findings about the BAVQ-R’s psychometric properties were grounded in robust clinical data.
Confirmatory factor analysis, a statistical method used to verify the structure of psychometric instruments, supported a four-factor model for the Persian BAVQ-R. This model comprised two belief subscales—Malevolence/Omnipotence and Benevolence—and two corresponding response subscales—Resistance and Engagement. The high-quality model fit indices, including Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) approaching 0.99, alongside a Root Mean Square Error of Approximation (RMSEA) of 0.042, all indicate a near-perfect fit. This result confirms that the questionnaire’s conceptual dimensions translate well into the Persian-speaking context and retain their theoretical coherence.
Beyond structural validity, the study demonstrated exceptional internal consistency for all subscales, as indicated by Cronbach’s alpha and McDonald’s omega values ranging between 0.91 and 0.95. These metrics reflect that the questions within each subscale reliably measure the same underlying construct, reinforcing the questionnaire’s precision and usefulness in clinical and research environments. The robustness of these psychometric properties is particularly striking given the complexities involved in capturing subjective experiences such as beliefs about voices, which are notoriously difficult to quantify.
The Persian BAVQ-R also showed significant correlations with other established measures, aligning well with theoretical expectations. For example, higher malevolent voice beliefs corresponded with elevated scores on depression inventories and poorer quality of life indices. Similarly, patients who exhibited greater resistance to voices reported more intense and distressing hallucinations. These convergent validity findings underscore the instrument’s sensitivity in detecting clinically relevant associations between voice hearing experiences and mental health outcomes in this population.
Culturally, this validation holds special importance. In Iranian society, as in many non-Western cultures, experiences of hearing voices might be interpreted through religious or spiritual frameworks. The nuanced differentiation between malevolent and benevolent voice beliefs helps clinicians distinguish pathological voices from culturally sanctioned phenomena, facilitating more accurate diagnosis and treatment planning. Consequently, the Persian BAVQ-R is more than just a translated questionnaire; it becomes a culturally attuned clinical tool enhancing psychiatrists’ and psychologists’ ability to engage with patients’ lived experiences authentically.
This study’s methodological rigor and sample size add weight to its conclusions and set a benchmark for future cross-cultural adaptations of psychiatric assessments. While numerous psychological scales have Latin or Anglo-American origins, their uncritical application across diverse cultural settings risks misinterpretation or loss of validity. The Iranian researchers’ commitment to psychometric validation highlights the necessity of localizing mental health measurement tools to uphold both scientific and cultural integrity.
Looking ahead, the confirmation of the Persian BAVQ-R’s reliability and validity paves the way for more widespread clinical and research use throughout the Middle East and Persian-speaking communities worldwide. It also invites further studies investigating the instrument’s sensitivity to treatment effects, longitudinal behavioral changes, and applicability across other psychiatric disorders with hallucinatory phenomena. Such future research will deepen our understanding of auditory hallucinations’ phenomenology and improve personalized care strategies.
Moreover, the study serves as a model for adapting other essential psychiatric instruments into non-Western languages. As mental health awareness and service provision expand globally, precise and culturally informed assessment tools are indispensable for equitable healthcare delivery. Researchers and clinicians are encouraged to build on this work by integrating the Persian BAVQ-R into longitudinal and interventional studies, leveraging its psychometric strengths to explore the mechanisms of voice hearing and recovery trajectories.
In sum, the validation of the Persian version of the Beliefs About Voices Questionnaire-Revised marks a significant advancement in schizophrenia research and clinical practice. It not only fills a critical gap by providing a standardized measure for voice hearing beliefs but also embodies an inclusive approach to psychiatric evaluation that respects cultural diversity. This breakthrough will likely influence how auditory hallucinations are studied and treated among Persian-speaking populations and potentially inspire analogous efforts across other languages and regions.
The findings highlight the imperative of recognizing cultural context in psychiatric assessment tools. Auditory hallucinations are complex phenomena entwined with personal beliefs and broader cultural narratives. Tools like the Persian BAVQ-R enable clinicians to appreciate this complexity, ensuring that diagnostic and therapeutic interventions resonate with patients’ realities. As the global mental health community strives toward more personalized and culturally competent care, such validated instruments become indispensable.
The Iranian study’s contribution resonates beyond its immediate clinical implications. It exemplifies a broader trend in psychiatric research that emphasizes cross-cultural validation and methodological transparency. By rigorously testing and confirming the psychometric properties of widely used assessments across diverse settings, researchers enhance the reproducibility and generalizability of psychiatric knowledge. This fosters a more nuanced and global understanding of mental illnesses and their subjective manifestations.
In closing, the work by Yousefi Asl, Pourshahbaz, Nazeri Astaneh, and colleagues inaugurates a new chapter in the study of auditory hallucinations within Persian-speaking contexts. Their thorough and innovative research underscores the importance of culturally sensitive tools in psychiatric practice and serves as a testament to the collaborative effort between culture, science, and clinical care. As auditory hallucinations remain among the most perplexing symptoms in mental health, the Persian BAVQ-R promises to be a beacon guiding future research and treatment paradigms.
Subject of Research: Psychometric evaluation of the Persian version of the Beliefs About Voices Questionnaire-Revised (BAVQ-R) in patients with schizophrenia spectrum disorders
Article Title: Psychometric evaluation of the Persian version of the Beliefs About Voices Questionnaire: revised in patients with schizophrenia spectrum disorders
Article References:
Yousefi Asl, V., Pourshahbaz, A., Nazeri Astaneh, A. et al. Psychometric evaluation of the Persian version of the Beliefs About Voices Questionnaire: revised in patients with schizophrenia spectrum disorders. BMC Psychiatry 25, 667 (2025). https://doi.org/10.1186/s12888-025-07080-z
Image Credits: AI Generated
