Psychometric Properties of Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Iranian Bipolar Patients

Background: Cognitive impairments are common in bipolar disorder, which can negatively impact patients' psychological and psychosocial functioning, but there are no tools for assessing cognitive deficits, especially in patients with bipolar disorder in Iran. Objectives: This study assessed the psychometric properties of the Cognitive Complaint in Bipolar Disorder Rating Assessment (COBRA) scale in Iranian patients with bipolar disorder (BD). Methods: Eighty patients diagnosed with bipolar spectrum disorder were selected from Tehran's major psychiatric facilities: Razi Psychiatric Hospital and Taleghani Hospital. A purposive sampling method was followed to select 80 non-patient control individuals from the general population in Tehran. Participants were evaluated using the Beck Depression Inventory-II (BDI-II), the Bech-Rafaelsen Mania Scale (BRAMS), the Mini-Mental State Examination (MMSE), and the Cognitive Complaint in Bipolar Disorder Rating Assessment (COBRA). The data were analyzed using SPSS-24 to evaluate convergent and discriminant validity, test-retest reliability, and internal consistency. Results: The convergent validity was examined by calculating the correlation between the scores on the COBRA and those on the MMSE; the results were significant (r = - 63, P < 0.001). Discriminant validity was assessed by comparing the COBRA total scores between the patients with BD and the control group; the results indicated a significant difference between the two groups (t = 6.413, P = 0.001). The CFA and EFA showed that the one-factor structure of COBRA was the best model. The Cronbach's alpha of 0.72 indicated an internal consistency. A test-retest reliability estimate of 0.84 indicated the high reliability of the scale. The current investigation suggested a cutoff score of 28, with 0.72 sensitivity and 0.69 specificity. Conclusions: Our translated version of the COBRA in Persian in this study showed adequate psychometric properties. This test can be considered an applicable instrument in investigating cognitive complaints in patients with bipolar disorder in Iran.