Brief Symptom Inventory 18

Last Updated

August 01, 2019

Purpose

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

Link to Instrument

Instrument Details

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: Brief Symptom Inventory-18
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)

Parkinson's Disease

Older Adults and Geriatric Care

Non-Specific Patient Population

Cancer

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

Assessment kit

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.

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

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

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 psychological distress in PD patients (N = 472). Prevalence in percent.

BSI-18 subscales	Study by Abraham et al. (2017) 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 psychological distress 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 = Parkinson's disease.

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

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

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, http://link.galegroup.com/apps/doc/A479093671/AONE?u=duke_perki ns&sid=AONE&xid=6f31f29b. Accessed 23 May 2019.

Galdón MJ, Durá E, Andreu Y,Ferrando M,Murgui S, Pérez S, Ibañez 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. (http://www.sciencedirect.com/science/article/pii/S002239990800226 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, Brähler 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: http://dx.doi.org/10.1186/s12874-018-0631-6.

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://www.ncbi.nlm.nih.gov/pubmed/28080106

Last Updated

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Actual Cost

Cost Description

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Required Training Description

Instrument Reviewers

Measurement Domain

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Cut-Off Scores

Normative Data

Internal Consistency

Responsiveness

Normative Data

Responsiveness

Normative Data

Test/Retest Reliability

Internal Consistency

Test/Retest Reliability

Internal Consistency

Bibliography

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