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  2. Brief Symptom Inventory 18

Brief Symptom Inventory 18

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Purpose

The BSI-18 allows for Assessment of psychological distress and psychiatric disorders in the general population.

Link to Instrument

Acronym BSI-18

Area of Assessment

Depression
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$70.00

Cost Description

https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Personality-%26-Biopsychosocial/Brief-Symptom-Inventory-18/p/100000638.html

CDE Status

Availability
Please visit this website for more information about the instrument:
Classification
Supplemental – Highly Recommended: Sport-Related Concussion (SRC) Acute (time of injury until 72 hours)
Supplemental: Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion) and Traumatic Brain Injury (TBI)
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)

Populations

Parkinson's Disease
Older Adults and Geriatric Care
Non-Specific Patient Population
Cancer

Key Descriptions

  • 18 item questionnaire divided into 3 sections (6 questions each)
    - 3 sections: “Somatization”, “Depression”, “Anxiety”
    - 5-point Likert scale
    - 0: “not at all” - 4: “extremely”
  • Scores:
    - 3 raw subscale scores range 0-24
    - Global severity index (GSI) of distress represents sum across the 3 subscales
    - Ranges from 0-72
    - Higher scores indicate higher levels of psychological distress

Number of Items

18

Equipment Required

  • Assessment kit

Time to Administer

4 minutes

Required Training

Reading an Article/Manual

Required Training Description

Please visit: https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Personality-%26-Biopsychosocial/Brief-Symptom-Inventory-18/p/100000638.html for more information.

Age Ranges

Adolescents

13 - 17

years

Adults

18 - 64

years

Older Adults

+

years

Instrument Reviewers

Melanie Mortham, Caroline Schanche, Sarah Peters, Matt Wilson, Dan Fleming

Measurement Domain

General Health
Quality of Life

Considerations

  • Being able to communicate psychological distress to complete the survey
  • Cognitively able to understand questions

Cancer

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Cut-Off Scores

Cancer survivors: (Recklitis, 2017; n = 250; Mean age = 29.45 (9.77)

  • Global Severity Index sub-scale t-score cutoff: > 50 recommended as optimal for identifying survivors with significant psychological distress.

 

Cancer survivors: (Zabora, 2001; n=1543; Mean age 55.5 +/- 14.5 (range= 14-90 years)

  • Global Severity Index sub-scale t-score cutoff: > 57 case rule optimal for identifying significant psychological symptoms in a group of pediatric and adult cancer patients    

Normative Data

Cancer survivors: (Recklitis, 2017; n = 250; Mean age = 29.45 (9.77)

BSI-18 Global Severity Index t-scores    
  GSI t-score < 50 163 65.2
  GSI t-score 50 – 56 43 17.2
  GSI t-score 57 – 62 20 8.0
  GSI t-score ≥ 63 24 9.6

 

Breast cancer survivors: (Galdón, 2008; n = 175; Mean age= 52.7 (10.12)

Mean (S.D.) and item–total scale correlation for items in three BSI-18 dimensions (N=175)

  Mean (S.D.) Item–total scale correlation
Factor I: somatization dimension 4.62 (4.26)  
 1. Faintness or dizziness 0.50 (1.03) .42
 4. Pain on heart or chest 0.91 (1.24) .38
 7. Nausea or upset stomach 0.90 (1.33) .42
 10. Trouble getting one's breath 0.50 (1.06) .25
 13. Numbness or tingling in parts of one's body 1.01 (1.29) .30
 16. Feeling weak in parts of one's body 0.77 (1.25) .37
Factor II: depression dimension 4.68 (4.60)  
 2. Feeling no interest in things 0.80 (1.36) .38
 5. Feeling lonely 0.71 (1.34) .51
 8. Feeling blue 2.04 (1.44) .53
 11. Feeling worthless 0.17 (0.66) .63
 14. Feeling hopeless about the future 0.85 (1.33) .55
 17. Thoughts of ending one's life 0.13 (0.58) .26
Factor III: anxiety dimension 7.27 (5.10)  
 3. Nervousness or shakiness inside (GA) 2.62 (1.31) .63
 6. Feeling tense or keyed up (GA) 1.85 (1.60) .69
 15. Feeling so restless that one could not sit still (GA) 0.86 (1.41) .37
 9. Suddenly scared for no reason (P) 0.85 (1.36) .37
 12. Spells of terror or panic (P) 0.10 (0.48) .26
 18. Feeling fearful (P) 1.01 (1.47) .42
General distress 16.64 (10.96)  

P=item with saturation in the panic factor in the empirical model; GA=item with saturation in the general anxiety factor in the empirical model.

Internal Consistency

Cancer survivors: (Zabora, 2001; n=1543; Mean age 55.5 +/- 14.5 (range= 14-90 years)

  • Excellent internal consistency α = 0.89

 

Breast cancer survivors: (Galdón, 2008; n = 175; Mean age= 52.7 (10.12)

  • Adequate Somatization sub-scale: α = .62
  • Adequate Depression sub-scale: α = .73
  • Adequate  Anxiety sub-scale: α = .72

Responsiveness

 

Parkinson's Disease

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Normative Data

Parkinson ’s disease:  (Carrozzino, 2019; n = 472; Mean age = 65.2 (10.3)) years, 60% male)

Mean (sd) for the individual subscales and the corresponding effect size.

BSI-18 subscales Italian PD-patients N?=?472 Italian general population N?=?333 Effect size
Depression-6 0.95 (0.79) 0.50 (0.57) 0.64
Anxiety-6 0.95 (0.73) 0.49 (0.54) 0.70
Somatization-6 0.99 (0.64) 0.41 (0.52) 0.98
GSI-18 0.97 (0.61) 0.47 (0.46) 0.90
SCL-90-R subscales      
 Phobic anxiety-7 0.63 (0.64) 0.14 (0.29) 0.93
 Somatization-12 1.16 (0.64) 0.54 (0.52) 1.04
 Psychoticism-10 0.60 (0.52) 0.26 (0.35) 0.74

Abbreviations throughout the table. BSI-18?=?Brief Symptom Inventory. GSI-18?=?Global Severity Index.

Parkinson ’s disease: (Abraham, 2017; n = 1067; Mean age = 65.3 (10.85), 61.8% male)

 

Transformation to normalized T-scores including cut off for ≥63 as well as ≥65 to indicate percentage of symptoms of  in PD patients (N?=?472). Prevalence in percent.

BSI-18 subscales

Study by  N?=?1067

T-scores

Prevalence %

≥63

Depression-6

50.8

15.4%

Anxiety-6

52.1

15.0%

Somatization-6

54.6

22.5%

GSI-18

53.4

18.7%

 

 

 

Parkinson ’s disease:  (Carrozzino, 2019; n = 472; Mean age = 65.2 (10.3)) years, 60% male)

  • Effect size: (>/+ 0.8 is significant)

 

Transformation to normalized T-scores including cut off for ≥63 as well as ≥65 to indicate percentage of symptoms of  in PD patients (N?=?472). Prevalence in percent.

BSI-18 subscales

Present study PD patients?=?472

T-scores

Prevalence %

≥63

≥65

Depression-6

56.7

27.5%

22.0%

Anxiety-6

57.3

29.6%

23.3%

Somatization-6

61.8

47.7%

38.8%

GSI-18

59.5

36.4%

28.4%

SCL-90-R subscales

      

 Phobic anxiety-7

64.4

55.5%

55.5%

 Somatization-12

61.6

45.1%

36.2%

 Psychoticism-10

59.5

36.9%

29.9%

Abbreviations throughout the table. BSI-18?=?Brief Symptom Inventory. GSI-18?=?Global Severity Index.

NA?=?Not Available. PD?=?.

Responsiveness

Parkinson ’s disease:  (Carrozzino, 2019; n = 472; Mean age = 65.2 (10.3)) years, 60% male)

Effect size: (>/+ 0.8 is significant)

  • Somatization-6: 0.98

  • Depression-6: 0.64

  • Anxiety-6: 0.70

  • GSI-18: 0.90

Older Adults and Geriatric Care

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Normative Data

 

Elderly community-based adults in Germany: (Petrowski, 2018); n=884; Mean Age= 70.75 (7.08); age range =60-95 years

Items

M (SD)

Scale 1: Somatization (ω?=?.826)

∑2.36?±?3.07

1 Faintness or dizziness

0.31?±?0.62

4 Pains in heart or chest

0.41?±?0.70

7 Nausea or upset stomach

0.34?±?0.66

10 Trouble getting your breath

0.39?±?0.72

13 Numbness or tingling in parts of your body

0.34?±?0.69

16 Feeling weak in parts of your body

0.57?±?0.82

Scale 2: Depression (ω?=?.890)

∑2.04?±?3.34

2 Feeling no interest in things

0.42?±?0.73

5 Feeling lonely

0.55?±?0.92

8 Feeling blue

0.34?±?0.72

11 Feelings of worthlessness

0.27?±?0.65

14 Feeling hopeless about the future

0.38?±?0.79

17 Thoughts of ending your life

0.08?±?0.34

Scale 3: Anxiety (ω?=?.857)

∑1.55?±?2.72

3 Nervousness or shakiness inside

0.31?±?0.62

6 Feeling tense or keyed up

0.45?±?0.74

9 Suddenly scared for no reason

0.23?±?0.57

12 Spells of terror or panic

0.13?±?0.43

15 Feeling so restless you could not sit still

0.23?±?0.61

18 Feeling fearful

0.21?±?0.55

Global Severity Index (ω?=?.929)

∑5.96?±?8.08

 

Test/Retest Reliability

Elderly community-based adults in Germany: (Petrowski, 2018); n=884; Mean Age= 70.75 (7.08); age range =60-95 years

  • Adequate to Excellent Test retest-reliability: r = .68 - .82

Internal Consistency

Elderly community-based adults in Germany: (Petrowski, 2018); n=884; Mean Age= 70.75 (7.08); age range =60-95 years

  • α = .82 for somatization, α=.87 for depression, α= .84 for anxiety and α= .93 for the GSI

 

Non-Specific Patient Population

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Test/Retest Reliability

Random sample of German Citizens: (Franke, 2017; n = 2516; Mean Age= 50.5 (18.6)

  • Adequate to Excellent test-retest reliability: r = .68 - .82

Internal Consistency

Random sample of German Citizens: (Franke, 2017; n = 2516; Mean Age= 50.5 (18.6)

  • Excellent Internal consistency
    • Somatization α =  .82 
    • Depression α =  .87
    • Anxiety α =  .84
    • GSI α =  .93

Bibliography

Abraham, Danielle S., et al. “The Factor Structure of the Brief Symptom Inventory-18 (BSI-18) in Parkinson Disease Patients.” Journal of Psychosomatic Research, vol. 96, 2017, pp. 21–26., doi:10.1016/j.jpsychores.2017.03.002.

Carrozzino, Danilo, et al. “The Prevalence of Psychological Distress in Parkinson's Disease Patients: The Brief Symptom Inventory (BSI-18) versus the Hopkins Symptom Checklist (SCL-90-R).” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 88, 2019, pp. 96–101., doi:10.1016/j.pnpbp.2018.07.012.

Franke, Gabriele Helga, et al. "Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample." BMC Medical Research Methodology, vol. 17, no. 1, 2017. Academic OneFile, ns&sid=AONE&xid=6f31f29b. Accessed 23 May 2019.

Galdón MJ, Durá E, Andreu Y,Ferrando M,Murgui S, Pérez S, Iba?ez E,Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample, Journal of Psychosomatic Research, Volume 65, Issue 6, 2008,Pages 533-539,ISSN 0022-3999, https://doi.org/10.1016/j.jpsychores.2008.05.009. ( 2)

Hakami RM. Prevalence of psychological distress among undergraduate students at Jazan University: A cross-sectional study. Saudi J Med Med Sci 2018;6:82-8.

Meachen, Sarah-Jane, et al. “The Reliability and Validity of the Brief Symptom Inventory?18 in Persons With Traumatic Brain Injury.” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 5, 2008, pp. 958–965., doi:10.1016/j.apmr.2007.12.028.

Petrowski K, Schmalbach B, Jagla M, Franke GH, Br?hler E. Norm values and psychometric properties of the brief symptom inventory-18 regarding individuals between the ages of 60 and 95. BMC Medical Research Methodology. 2018;18. https://login.proxy.lib.duke.edu/login?url=https://search.proquest.co m/docview/2158329978?accountid=10598. doi:

Recklitis CJ, Blackmon JE, Chang G. Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview. Psychological Assessment. 2017;29(10):1189-1200. doi:10.1037/pas0000427.supp (Supplemental). https://

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