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Rehab Measures: Brief Symptom Inventory

Link to instrument

Instrument Link 

Title of Assessment

Brief Symptom Inventory  

Acronym

BSI

Instrument Reviewer(s)

Initially reviewed by Timothy P. Janikowski, PhD and his University at Buffalo Rehabilitation Counseling Master’s students, Kellie Talebkhah & Chad Nordin (4/27/2015)

Summary Date

9/3/2015 

Purpose

The BSI evaluates psychological distress and psychiatric disorders in people. It collects data reported by patients for the evaluation. The test can be used for areas such as patient progress, treatment measurements, and psychological assessment.

Description

  • A 53 item patient reported 5 point (0-5) Likert-type scale measuring the extent to which individuals have been disturbed by certain mental health symptoms
  • Self or interview administered on paper and pencil, or computer administration
  • Final score reported into separate subscales
  • Reports client symptomatology across 9 domains
    • Somatization
    • Obsessive compulsive
    • Interpersonal sensitivity
    • Depression
    • Anxiety
    • Hostility
    • Phobia
    • Paranoia
    • Psychoticism

Area of Assessment

Behavior; Cognition; Depression; Mental Health; Personality; Social Relationships 

Body Part

Not Applicable 

ICF Domain

Activity; Participation 

Domain

Cognition; Emotion 

Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

10-15 Minutes

Number of Items

53 

Equipment Required

Paper & Pencil for Standard Administration
Computer, Keyboard, & Mouse for Computerized Administration

Training Required

Level B qualification (Masters degree and formal training) required for purchase. Training available where test is purchased.

Type of training required

Reading an Article/Manual; Training Course 

Cost

Not Free 

Actual Cost

BSI hand-scoring starter kit costs $124.

Age Range

Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Geriatrics; Traumatic Brain Injury 

Populations Tested

  • Cardiovascular Disease
  • Homebound older adults
  • Depression in Iranian populations
  • Psychiatric Outpatient
  • Intellectual Disabilities
  • Temporomandibular disorder
  • College Students
  • Breast Cancer in Spanish populations
  • Drug users (from China)
  • Traumatic Brain Injury
  • Central American Adults

Standard Error of Measurement (SEM)

Depression (Mohammadkhani et al. 2010; n=354)

 

      SEM=.665 (GSI)

 

Traumatic Brain Injury (Meachen et al. 2008; n=34)

 

      SEM= .57 (GSI)

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Homebound Older Adults (Petkus et al. 2010; n=142)

 

·         T-score of 63 indicating significant distress

 

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

 

·         Depressive Symptoms: 0.28 or higher

·         Anxiety Symptoms: 0.35 or higher

 

Spanish Speaking (Asner-Self et al. 2006; n=100)

 

·         .40 to categorize strong versus weak loadings for factor analysis within each structures

 

Breast Cancer (Galdón et al. 2008; n=175)

 

·         for general distress and anxiety

Normative Data

(Derogatis, 1983) Adult non-patients (n=719), heterogeneous adult psychiatric outpatients (n=1002), psychiatric inpatients (n=313)

Test-retest Reliability

Depression (Mohammadkhani et al. 2010; n=354)

 

Symptom Dimensions Range:

  • Adequate to Excellent: ICC= .68 (Somatization) to .91 (Phobia anxiety)

Three Global Indices:

  • Excellent: ICC= .87 (PSDI) to .90 (GSI)

 

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • Adequate to Excellent: ICC= .68 to .91

Traumatic Brain Injury (Meachen et al. 2008; n=34)

  • GSI Adequate: ICC=.66
  • Somatization Adequate: ICC= .67
  • Depression Adequate: ICC= .63
  • Anxiety Adequate: ICC=.57 (P<.01)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • Adequate to Excellent: Cronbach's alpha= .71-.85

Homebound Older Adults (Petkus et al. 2010; n=142)

  • Somatization: Poor (Cronbach's alpha= .69)
  • All other subscales: Excellent (Cronbach's alpha= .81-.89)

Depression (Mohammadkhani et al. 2010; n=354)

  • All subscales: Adequate to Excellent (Cronbach's alpha= .75-.87)
  • GSI: Excellent (Cronbach's alpha= .96)

**(Values >.90 may indicate redundancy)

 

Intellectual Disabilities (Wieland et al. 2012; n=224)

  • Adequate to Excellent (Cronbach's alpha= .70-.86)
  • BSI: Excellent (Cronbach's= .96)

Temporomandibular Disorders (Durá et al. 2006; n=114)

  • Subscales Adequate to Excellent: (Cronbach's alpha .73-.86)
  • BSI: Excellent (Cronbach's alpha .89)

College Students (Houghton et al. 2013; n=28)

  • Somatization: Poor (Cronbach's alpha= .52)
  • All other Subscales: Adequate to Excellent (Cronbach's alpha= .70-.87)

Chinese Drug Users (Wang et al. 2013; n=303)

  • Subscales: Adequate to Excellent (Cronbach's Alpha= .76-.83)
  • GSI: Excellent (Cronbach's alpha= .91)

** Values >.9 may indicate redundancy

 

Breast Cancer (Galdón et al. 2008; n=175)

  • Subscales: Poor to Adequate (Cronbach's alpha= .62-.70)

Spanish Speaking (Asner-Self et al. 2006; n=100)

  • Subscales: Excellent (Cronbach's alpha= .81-.82)
  • GSI : Excellent (Cronbach's alpha= .91)

** Values >.9 may indicate redundancy

 

Traumatic Brain Injury (Meachen et al. 2008; n=81 outpatient n=176 follow-up)

      Excellent consistency for GSI follow-up participants (Cronbach’s alpha .91) and inpatients (Cronbach’s alpha .84)

      Poor to Excellent consistency for subscales (Cronbach’s alpha= .61–.84)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity
 
Spanish Speaking (Asner-Self et al. 2006; n=100)
 
The separate dimensions tend to be good with other measures of distress such as the Minnesota Multiphasic Personality Inventory [MMPI].
 
 

Construct Validity (Convergent/Discriminant)

Convergent

 

Depression & Anxiety (Khalil et al. 2011; normal renal function n=495, renal dysfunction n=95)

  • SCL-90-R: Excellent (r=.92)

Depression (Mohammadkhani et al. 2010; n=354)

  • SCL-90-R: Excellent (r=.92)

Traumatic Brain Injury (Meachen et al. 2008; n=81 outpatient n=176 follow-up)

  • NFI Depression: Excellent (r=.68)
  • NFI Aggression: Adequate (r=.55)
  • PANAS negative affectivity: Adequate (r=.49)

Content Validity

  • The BSI was developed, in part, from content taken from the Symptom Checklist-90-R.
  • The Thorndike-Lorge Word Book (1944) was used to equate vocabulary levels of the 9 primary dimensions

Face Validity

Homebound Older Adults (Petkus et al. 2010; n=142)

 

May have less face validity with homebound elders because the BSI does not contain items assessing suicide ideation or loneliness which are especially salient to homebound older adult populations.

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

None provided within the reviewed studies.

Considerations

  • BSI as a self-reported measure, thus results can be swayed by patients accurate reporting and subjectivity in responses
  • BSI as an interviewer administered measure can be influenced as well as social desirability
  • Authors reported high reliability and acceptability of BSI as an accurate measure of symptomatology
  • Shortened versions make for easy administration with consistent result
  • GSI score is very useful when assessing a patient for psychological distress, but not for psychiatric diagnoses (Asner-Self et al. 2006)
  • Too general for assessing psychological distress for medically complex samples (Meachen et al. 2008)

Bibliography

Asner-Self, K.K., Schrieber, J.B., Marotta, S.A. (2006). A cross-cultural analysis of the Brief Symptom Inventory-18. Cultural Diversity and Ethnic Minority Psychology, 12 (2), 367-375.

Derogatis, L.R., Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine 13. 595-605.

Durá, E., Andreu, Y., Galdón, M. J., Ferrando, M., Murgui, S., Poveda, R., & Jimenes, Y. (2006). Psychological assessment of patients with temporomandibular disorders: Confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18. Journal of Psychosomatic Research, 60(4), 365-370.

Galdón, M.J., Durá, E, Andreu, Y, Ferrando, M, Murgui, S, Pérez, S, Ibañez, E. (2008).    Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer    sample. Journal of Psychosomatic Research, 65(6). 533-539.

Houghton, F., Keane, N., Lewis, C.A., Murphy, N., Houghton, S., Dunne, C., (2013).         Temporal stability of the Brief Symptom Inventory 18 among Irish college students             over four weeks. Social Behavior and Personality, 41 (2), 197-198.

Khalil, A. A., Hall, L. A., Moser, D. K., Lennie, T. A., & Frazier, S. K. (2011). The psychometric properties of the Brief Symptom Inventory Depression and Anxiety subscales in patients with heart failure and with or without renal dysfunction. Archives of Psychiatric Nursing, 25(6), 419-429.

Meachen, S, Hanks, R.A., Millis, S.R., Rapport, L.J. (2008). The Reliability and Validity of

      the Brief Symptom Inventory-18 in Persons with Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 89(5), 958-965.

Mohammadkhani, P., Dobson, K. S., Amiri, M., & Ghafari, F. H. (2010). Psychometric properties of the Brief Symptom Inventory in a sample of recovered Iranian depressed patients. International Journal of Clinical and Health Psychology, 10(3), 541-551.

Petkus, A. J., Gum, A. M., Small, B., Malcarne, V. L., Stein, M. B. & Wetherell, J. L. (2010). Evaluation of the factor structure and psychometric properties of the Brief Symptom Inventory- 18 with homebound older adults. International Journal of Geriatric Psychiatry, 25(6), 578-587.

Wang, J,  Kelly, B.C., Liu, T, Zhang, G, Hao, W. (2013). Factorial structure of the Brief     Symptom Inventory (BSI)-18 among Chinese drug users. Drug and Alcohol Dependence,   133(2), 368, 375.

Wieland, J., Wardenaar, K. J., Fontein, E., & Zitman, F. G. (2012). Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities. Journal of Intellectual Disability Research, 56(9), 843-853.

Year published

1992 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 9/3/2015 10:09 AM  by Jason Raad 
Last modified at 5/17/2016 3:37 PM  by Jason Raad