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    The Brief Symptom Inventory-An Introductory Report-1983

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    Iepure Bianca
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    Psychological Medicine, \983, 13, 95-605 Printed in Great Britain The Brief Sympt om Inventory: an introductory report LEONARD R. DEROGATIS! anp NICK MELISARATOS, From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA synopsis This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale, Both test-retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence o of the internal structure of the scale contribute e' oriented validity studies have also been completed PSYCHOLOGICAL ASSESSMENT BY SELF-REPORT Assessment of the psychological status of individuals by self-reports dates back to the First World War, and the development of the Personal Data Sheet by Woodworth (1918). Woodworth’s scale provided a means for each man to ‘interview himself’ and created a historical benchmark for a new modality of psychological measurement. ‘The self-report mode of assessment possesses a number of unique advantages and characteris- tics to recommend it, as well as several inherent weaknesses. The first advantage, particularly concerning psychopathology, is the accessibility of exclusive information that is ordinarily unavailable through other methods ofevaluation. Self-report measures reflect information derived directly from the person experiencing the Phenomena, namely the patient himself. Sec- ‘ondly, there is the economy of professional time Wolved with the use of self-reports. The technique can be integrated into institutional foutines with relative ease and is amenable to ‘ctuarial methods of scoring and interpretation. ' Address (or correspondence: Dr L. R. Derogatis, Division of Medical Prychology, Department of Psychiat, Johns Hopkins University Schoo! of Medwzine, Adoll Meyer Balding. Room 200, 600 N Wolfe Sire, Baltimore, MD 21203. USA, $95 £ convergent validity, and factor analytic studies -vidence of construct validity. Several criterion- with this instrument. Data rising from these measures may also be directly incorporated into the clinical decision systems (Fowler, 1969; Glueck & Stroebel, 1969; Lanyon, 1972, 1974), and self-report inventories have been shown to be sensitive to a wide varicty of therapeutic interventions (Kellner, 1971; Lyerly & Abbott, 1964). It should also be appreciated, however, that the self-report method tacitly assumes the validity of the ‘inventory premise’, ie. the assumption that the individual being assessed can and will accurately describe his current symptoms and behaviour (Wilde, 1972), a premise which cannot always be supported. Social desirability (Edwards, 1957) and extreme response styles (e.g. aquiescence) can contribute to systematic distortions, although careful work has produced some serious doubts about the size and pervasiveness of these effects (Block, 1965; Fiske, 1971; Rorer, 1965). In spite of concerns about its deficiencies, the self-report method remains a useful form of clinical measurement and, as Nunnally (1978, p. 141) has stated, “even though self-inventories definitely have their problems as approaches to the measurement of personality characteristics, attitudes, values, and a variety of other non-cognitive traits, they represent by far the best approach available’. 29.2 596 THE BRIEF SYMPTOM INVENTORY @spD The Brief Symptom Inventory (Derogatis, 1975) is a 53-item self-report symptom inventory designed to assess the psychological symptom. status of psychiatric and medical patients, as well as individuals who are not patients. The BSI is, essentially the brief form of the SCL-90-R, a self-report inventory that has been developed and used in a wide variety of settings and applications (Derogatis et al. 1976; Derogatis, 1977). The instrument comprises 53. items selected to reflect best the 9 primary symptom dimensions of the SCL-90-R in a brief measure- ment scale. In addition to the 9 primary symptom dimensions, there are three global indices of distress associated with the BSI: the General Severity Index (GST), the Positive Symptom Distress Index (PSDD, and the Positive Symptom Total (PST). These same three summary measures are also utilized by the SCL-90-R, each communicating psychological distress ina somewhat different fashion (Dero: patis et al. 1975). Scale characteristics Each item of the BSI is rated on a 5-point scale of distress (0-4), ranging from ‘not-at-all’ to ‘extremely’, Test administration ordinarily takes less than 10 minutes, 1-2 minutes being devoted tothe introduction of the instrument. Instructions preceding the inventory are brief and worded in simple language, as are the 53 test items. A primary consideration in item development was the selection of phrasing and language that would be understood by a wide segment of the population and still retain the intended item meaning. The Thotndike-Lorge Word Book (1944) was used to equate the vocabulary levels of the 9 primary dimensions and to keep the general vocabulary as basic as possible. In general, the BSI can be used with individuals who have reached a reading knowledge equivalent to that of an American sixth grade education. In terms of age limitations, adolescents as young as 13 years have been evaluated via the BSI without apparent distortions, Dimensional structure of the BST The BSI, likeits parent instrument the SCL-90-R, is conceived as measuring 9 primary symptom L. R. Derogatis and N. Melisaratos dimensions or constructs. A brief definition of each construct is provided in the sections below. 1. Somatization (SOM) This dimension reflects psychological distred®™ arising from perception of bodily dysfunction Complaints typically focus on cardiovascular gastrointestinal, respiratory and other systems With strong autonomic mediation. Aches and pains, and discomfort localized in the gross musculature are also frequent manifestations I. Obsessive-compulsive (O-C) ‘The focus of this dimension is on thoughts and actions that are experienced as unremitting and irresistible by the patient but are of an ego-alien or unwanted nature. Examples are: having to check and double-check actions, difficulty in making decisions, and trouble concentrating, IU. Interpersonal sensitivity (I-S) This dimension focuses on feelings of personal inadequacy and inferiority. Self-deprecation, feelings of uneasiness, and marked discomfort during interpersonal interactions are characteris tics of persons with high levels of interpersonal sensitivity. IV. Depression (DEP) Depression reflects a broad range of signs and symptoms of the clinical depressive syndromes. Symptoms of dysphoric affect and mood, withdrawal of interest in life activities, and loss, of vital energy are reflected by this dimension, as are feelings of hopelessness and futility. V. Anxiety (ANX) The anxiety dimension subsumes a set of symptoms usually associated clinically with high fest anxiety. Restlessness, nervousness and tension are all indicative of anxiety. as are experiences reflecting free-floating anxiety and panic, e VI. Hostility (HOS) The hostility dimension is organized around three categories of hostile behaviour: thought feelings, and actions. Typical experiences cover feclings of annoyance and irritability, urges to break things, frequent arguments and uncontrol- lable outbursts of temper. Brief Symptom Inventory VU. Phobic anxiety (PHOB) The symptoms that comprise this dimension MUD have been observed to occur frequently in @nditions usually termed phobic anxiety states or agoraphobia. Phobic fears oriented towards travel, open spaces, crowds, public places or ®onveyances are all represented by this dimension VIII. Paranoid ideation (PAR) The present definition of paranoid ideation rests on the assumption that paranoid behaviour is most accurately viewed as syndromal in nature. Paranoid phenomena are conceived asa mode of thinking. The primary characteristics of paranoid thought are projection, hostility, suspiciousness, centrality, and fear of loss of autonomy. IX. Psychoticism (PSY) The present definition of psychoticism represents it as a continuum, progressing from a mildly alien life style at one extreme to floridly psychotic status at the other. Signs of a schizoid, alienated style of life are represented by this dimension ‘as are dramatic symptoms of psychosis. In most non-psychiatric populations this dimension measures social alienation. Additional items There are 4 items of the BSI which are not subsumed under any of the primary symptom dimensions; these symptoms ‘load” on several dimensions, but are not unique to any of them. ‘They are retained in the test because they represent important vegetative and other clinical indicators. Global indices of distress There are three global indices of distress associated with the BSI: the General Severity Index (GSI), the Positive Symptom Distress Index (PSDI), and the Positive Symptom Total (PST). The function of each of these global Yeasures is to communicate in a single score the level or depth of symptomatic distress currently experienced by the individual. The GSI is the ingle best indicator of current distress levels, and should be utilized in most instances where a single summary measure is required. The GSI combines information on the numbers of symptoms and the intensity of perceived distress. 597 The PSD1 is a pure intensity measure, in a sense “corrected” for the numbers of symptoms. [t functions very much as a measure of response style, communicating whether the patient is * augmenting’ or ‘attenuating’ distress in his/her manner of reporting. The PST is simply a count, of the symptoms which the patient reports experiencing to any degree. The PSDI and the PST are used in conjunction with the GSI to gain a more meaningful understanding of the clinical picture. Normative development of the BSI A fundamental procedure for the interpretation of an individual's psychological test performance is the comparison of the patient's scores or profile with some relevant group of individuals who have also completed the test. Typically, the larger the normative group of subjects, the more representative the sample will be of the population of interest. There are 3 published norms available for the BSI. These are based upon: (a) a sample of 1002 heterogeneous psychiatric out-patients; (6) a sample of 719 non-patient normal subjects; and (©) a sample of 313 psychiatric in-patients. ‘The psychiatric out-patient norm comprised 425 males and 577 females who represent psychiatric out-patients presenting for initial evaluation at four treatment facilities: (1) the Out-patient Psychiatry Division of the Johns Hopkins Medical Institutions; (2) the Out-patient Psychiatry Division of the University of Maryland School of Medicine; (3) the Out-patient Psychi- atry Clinic of the Hospital of the University of Pennsylvania; and (4) the Out-patient Psychiatry Division of the University of Wisconsin School of Medicine. The non-patient norm is based upon the responses of 344 males and 341 females. It represents a stratified random sample from a single county in one of the large eastern states. ‘The psychiatric in-patient norm is based on the intake scores of 115 males and 198 females who were admitted as in-patients to the Phipps Clinic, Johns Hopkins Hospital. All of these patients were evaluated during the first week following admission. Interpretation of the BSI Both the BSI and the SCL-90-R are designed for interpretation at three distinct but related levels. 598 LR. Derogatis and N, Melisaratos Table 1. Demographic characteristics (%) of psychiatric out-patient (N = 1002), psychiatric in-patient (N = 310) and non-patient subject (N 719) normative samples for the BSI Variable ‘Prychinric out-patient Pychiatrc in-patient Nom-patient Age (mean $5) shore Iza weal stass eons 147 Sex Male as x0 07 Femaie v6 ao 3 Race ‘White om 337 ese Black 6 86 is Other = 8 Marital statue ‘Single 457 ass ea Maree ia 26 a Otter 216 293 Single or married S 7 se Divorced - is Religion Catholic ar us - Provestant 363 ae : Jewish 13 33 Other aa 50 2 Social ease 4 78 a 242 soa Ra Initially, interpretation should focus on the global ‘scores to gain an appreciation of the degree of overall distress. The evaluation should then be refocused to integrate information at the level of the primary symptom dimensions, The BSI primary symptom dimensions are designed to provide a ‘broad brush’ profile of the respondent which can delineate and underline specific areas of psychopathology. A more specific focus is provided at the level of the discrete symptoms; these individual items com- municate detailed symptomatic manifestations which often further enhance and amplify the clinical decision process The 9 primary symptom dimensions essentially provide a profile of the patient’s psychological status in psychopathological terms. They com- municate information on the nature and intensity of the patient's distress, and provide data Concerning the pattern of the patient's sympto- matology. Table 2and Fig. I depict the mean raw scores on the 9 primary symptom dimensions and the 3 global indices in tabular and graphical forms for three normative clinical groups Fig. 1 depicts the BSI symptom profiles of the 1002 psychiatric out-patients and 310 psychiatric in-patients plotted against the non-patient norm. Focusing on the global indices first, the GSI for both groups of patients is two standard deviations above the normative mean. This magnitude of distress places the mean patient at the 98th centile of the non-patient norm. The PSDI and PST are cach elevated about 1-6 standard deviations, placing these groups in the 95th centile of the norm. The 9 symptom dimensions of the patient profiles are all clearly elevated, ranging from 1-3 to 23 standard deviations above the normative means. Reliability of the BST The reliability estimates for the 9 symptom dimensions and the 3 global indices of the BSI are essentially of two types: internal consisten and test-retest reliability. The former serves 10 measure the homogeneity or consistency of the items selected to represent cach sympton® construct. Test-retest reliability is essentially an indicator of the stability of the measurement across time. Table 3 provides internal consistency (alpha) coefficients for the 9 symptom dimensions Brief Symptom Inventory 599 Table 2. Mean raw scores on the 9 primary symptom dimensions and the 3 global indices of the mals Payehiatnic out- BSI for psychiatric out-patients, psychiatric in-patients and non-patient norn Pryehiatn im ‘tients penta Non: patients (coeant 89) (menzso) (mean tsD) ‘Spmptor dimension T SOM 0832080 Lor+091 o29s040 oc t bsigtor a3 Fo4s ra L382 105 vesatl 0322048 WV. DEP a0 108 ral WY. ANX Yet Lrosris vi HOS 1164093 00097 vil. PHOB oxeg03s Lorsta 0173036 NUE PAR 14440 95 oszoas 1X PSY 194087 oissoat Global incioes ast 1324072 136408 ox+039 Psp 2ise061 21640-73 T2¢E041 Pst somos IL-6 soso 13-40, 1145 49:29 goss do # sof — ee itn 45- 730 « dis 3s tr x0 a SoM O16 FS Fo. BS! symptei profes for {002 peychiatric outpatients (@: pp ppt DEP ANX HOS PHOB PAR PSY GSI PSDI PST ) and 310 pryehitsc in patients (@ ©) plotted against the non patient ngrm. Abbreviations are given in tb txt and test-retest coeflicients for the 9 dimensions Gnd the 3 global measures. The internal consistency reliability was estab- lished on the sample of 1002 out-patients and was determined by utilizing Cronbach's co- efficient alpha (2). Alpha coefficients for all 9 dimensions ranged from a low of 0-71 on the psychoticism dimension to a high of 0-85 for depression. Test-retest reliability reflects the stability or consistency of measurement across time. As longer periods of time clapse between measure- ments, thereis a greater opportunity for change to be effected; stability coefficients are typically related inversely to time clapsing between administrations of the measure. The stability coefficients listed in Table 3 were generated from BST data on a sample of 60 non-patient subjects 600, Table 3. Internal consistency and test-retest reliability coefficients for the 9 primary symptom L, R. Derogatis and N. Melisaratos Table 4. Correlations between like symptom dimensions of the SCL-90-R and the BST based upon S65 psychiatric out-patients dimensions and the 3 global indices of the BSI - Interaal - consistency (2) w= 719) No.of Test-retet Symptom dimension SOM 7 oo oc 6 ons urs 4 om oas Wv DEr ‘ bas one vANX, ‘ ost on vi Hos 5 7% 08) Vu. PHOB 5 O77 ost Vir PAR 5 on 079 IX. PSY 5 on 078 Global indices ‘ast - 090 PSDt 087 Pst - = 040 who were tested at a 2-week interval. Values ranged from a low of 0-68 for somatization to a maximum of 0-91 for phobic anxiety. The stability coefficient for the GSI was 0:90, strongly indicating that the BSI is a reliable measure over time. Indices of stability for psychopathological syndromes ordinarily fall between those for stable personality characteristics such as “intelli- gence’ and more labile attributes such as ‘mood’. The 9 dimensions of the BSI reflect high levels of stability, with dimensions regarded as being more state-determined, revealing some- what lower coefficients than those mediated more by the characterological (trait) structure of the individual Another traditional form of reliability for psychological tests is that of alternate forms. Alternate forms reliability is represented by the correlation between scoredistributionsdeveloped from two different forms of the test, usually administered within approximately 1-2 weeks of each other. Although the BSI and the SCL-90-R are not strictly speaking ‘alternate forms’ of the same test, they do represent two tests measuring the same symptom constructs. For this reason we felt that correlations between the two would provide useful data, and have presented them in Table 4, based upon the responses of 565 Psychiatric out-patients. Correlations between the two are uniformly very high across all 9 dimensions, demonstrating that they measure essentially the same symptom constructs. som 095 HOS 099 oc 095 PHOR 097 Ls om PAR 098 DEP 09s PSY 092 ANX 098 Validity of the BST ‘Two major issues that should be appreciated concerning the validity of psychological tests have to do with (a) the specificity of predictive validity, and (6) the programmatic nature of construct validation. The former issue refers to the observation that for the question ‘Is this test valid?" to have any scientific meaning, the conditional statement ‘ For what purpose?” must be appended. The second issue focuses on the fact that psychometric authorities have increasingly stressed construct validity as the central criterion for the validation of psychological tests and the assignment of meaning to these measures (Messick, 1975, 1981). Such assertions demand an extensive programme of related experiments that are analogous to the steps necessary for the proof of scientific theory. Data from predictive, content, convergent, discriminant and other types of validation studies contribute to the ultimate validation of the hypothetical construct that the test serves to operationalize. It is important to realize that this process should be represented by an ongoing series of experiments that constantly extend and redefine the limits of generalizability of the test as a definition of the construct Convergent and discriminant validity As Campbell & Fiske (1959) have demonstrated convergent and discriminant relationships be- tween operational measures of constructs (e.g psychological tests) and other operational mea-qe. sures are necessary to establish the network that forms the basis of construct validation. In simple terms, the concept requires that scores froma test designed to measure a particular construct should correlate highly with other measures of that construct, and show relatively low correta- tions with measures of dissimilarconstructs, Such ™ Brief Symptom Inventory 601 Table 5. Correlations between BSI symptom dimensions and MMPI clinical, Wiggins (W) and Tryon (T) scores* - © Somaisation a Body sympones 7) 038 Hapochodraes (MPD on Grbanc symptoms OW) ox Por heath OW} on . “ Obsessve-Compuiare Schisphrenia (MMPI) Pyorasinenia (MMP) Depression (W) Organs symptoms OW) ‘Autsa ‘Resentment and aggression (1) HL Inserpersonal Senivity Poor morale (W) on Payclnotenia (MMPD) 05s atroversion (7) 052 Jeophsenia (MMPD) 49 Depsession CT) O48 Depression () oar Social maladjusiment (W) oat Social otrovers.on (MMPI) ae IV. Depression Depression (4) on Depression (7) 06 Pose morale (W) 057 Sehizoptrenin (MMPI) os Resentment and aggression (T) os Pryetathenta (MMT) 046 Aniety C7) 04s ‘xatism 7) 043 ‘Aanety (F) 037 Depretion OW) 048 048 Payctasthenia (MMPI) ‘Schizophrenia CMPD os Poor morale) 4s Autism (7) oa Resentment and aggression (1) oat Orgrnie nmplowss (W) 040 Phobia (W) O48 Vt. Mositey Rescrtment ad aggression (7) 936 Manifest hostiity oa, Depression (W) oa Suspicion and miscrust (7) 038 Exmity problems OW) 03s, Anuety (7) ou VIL Phobie Anxiety Phobias CW) as Prychastenia (MMPD) 03s Anuety (7 030 Poor morale () 30, Depression (W) 030 VIN Paranoid ldeaon Steps anal serast C2) oa Rescrument and egarevion (T) oaz Manifest hosity CW) oat Family problem (W) oat Paranoia (MMED) 03s ‘Auta (D 035 1X. Payshoccom Schizophrenia (MMPI) ons Pryehopative deviate (MED, 040 Poor morale (W) oa9 ryehovasm (4) 038 Pryehaetbene (MMPL) 038, ‘Aouees (Ty 037 Paranoia (MMPD 032 + Corrtations below 0:30 are mite a pattern of relationships should hold if the test is to be considered a valid reflection of the construct under consideration. A previous study, based on a sample of 209 symptomatic volunteers, demonstrated impres- siveconvergent validity forthe SCL-90-R with the MMPI (Derogatis er af. 1976). Since the 53 items of the BSI are contained within the SCL-90-R, the data set was re-analysed, scoring for the BSI instead of the SCL-90-R. Table 5 contains the correlational results of this re-analysis, listing coefficients > 0-30 between the 9 dimensions of whe BSI, and (1) the clinical scales of the MMPI (Dahistrom, 1969), (2) the Wiggins Content Scales of the MMPI (Wiggins, 1966), and (3) the ‘Tryon Cluster Scores (Tryon, 1966). In the original SCL-90-R study (Derogatis et al. 1976), 8 of the dimensions of the SCL-90-R demonstrated directly convergent counterparis among the 30 MMPI scales evaluated, and all 8 dimensions showed excellent convergence (¢.g- ‘Somatization with “Body symptoms", Depression with ‘Depression’ and Paranoid Ideation with “Suspicion and mistrust’). Even the Obsessive- Compulsive dimension, for which there is no truly analogous construct among the MMPI scales, revealed a pattern of maximal correlations (ce. Schizophrenia, Organic symptoms, Psychas- thenia) which is highly consistent with the definition of the clinical construct. ‘The current re-analysis, in terms of the BSI, also revealed excellent convergence, although in the case of several dimensions the overall magnitudes of correlations were somewhat reduced. Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation and Psychoticism all demonstrated maximum correlations with MMPI scales that were clearly convergent (sce Table 5). The magnitudes of maximal correlation coefficients 602 L. R, Derogatis and N. Melisaratos : for the former three were almost identical with those in the SCL-90-R study. In the cases of the latter four measures, the magnitudes of correla- tions were reduced by about 0:10, although the pattern of correlations remained very similar in the two studies. In the cases of the Somatization and Obsessive~Compulsivedimensions, although the patterns of correlations were retained, the magnitudes of coefficients decreased by approxi- mately 0°15. Apparently, items deleted from the shorter form of the test were more important for convergence with the MMPI in these dimensions than in the other 7 measures. The general finding of high convergence for the dimensions of the BSI with MMPI scales, although not unexpected, confirms the fact that the reduction of the length of the SCL-90-R, dimensions has not had a significant effect upon their validity. Reductions in the magnitude of coefficients almost certainly reflect some loss of reliability associated with shortening the scales, but convergent patterns of relationship remain clearly in evidence. Internal structure and construct validity Particularly when dealing with multidimensional tests, the issue of internal structure is also critical to the question of construct validation. If the test is designed to measure a certain number of dimensions or constructs defined via specified series of item sets, then the dimensions defined in this way should emerge in the analysis of a representative empirical problem. The technique usually cmployed to test the equivalence of hypothetical versus empirical test structures is factor analysis, and we have utilized the method here in a similar fashion. To assess the reproducibility of the internal structure of the BSI, the scores of the psychiatric out-patient sample (N = 1002) described earlier were subjected to a principal components analysis with 1-00s on the diagonal of the correlation matrix. The correlation matrix analysed was 49 x 49, omitting the 4 ‘additional" items in the test since they are not hypothesized to have univocal loadings on any of the 9 primary BSI dimensions. Nine interpretable factors were derived from a normal varimax rotation of the principal components (Harman, 1967), which accounted for 44% of the variance in the matrix. A detailed representation of the factor loadings 2 0-35 is given in Table 6. The first factor generated was essentially the Psychoticism factor, with 4 of the 5 items comprising the hypothesized dimension found to load on the empirically derived factor. Twoitems @iaq assigned to the Interpersonal Sensitivity dimen@® sion also correlated highly on this factor; so did, one item from the Depression dimension. The second factor to emerge from the analysis @ was the Somatization factor, with all 7 hypothe- sized items showing marked correlations with the dimension. Loadings were high, and the pattern was consistent with previous confirmatory factor analysis of the SCL-90-R (Derogatis & Clear 1977). Analogous findings were observed with Hostility (Factor IV), Obsessive-Computsive (Factor VI), and Paranoid Ideation (Factor VIL), which also revealed well-saturated loadings for, all items derived from the @ priori rational structure. ‘Among the anxiety measures, loadings on the dimension of Phobic Anxiety were substantial and the hypothesized pattern was intact, except for the item “feeling nervous when you are alone’ which did not correlate in this sample. An additional item from the Interpersonal Sensitivity dimension, “feeling very self-conscious with others’, also loaded on the Phobic Anxiety dimension. The general Anxiety dimension split into two more specific component dimensions that were labelled ‘panic anxiety’ (Factor VII) and ‘nervous tension’ (Factor IX), a finding that was evident to a lesser degree in the confirmatory SCL-90-R study alluded to above (Derogatis & Cleary, 19774) The Depression dimension (Factor III) was well defined in the present instance, with only one item, “feelings of worthlessness’, showing a high loading on another factor. 1a addition, the fourth of the Interpersonal Sensitivity items was also observed to load on the Depression factor. There is no obvious explanation why the Interpersonal Sensitivity dimension was not reproduced in the present study. This dimension has been consistent and invariant in the context of both the SCL-90-R (Derogatis & Cleange 19774, 6) and its predecessor, the Hopkins Symptom Checklist (Derogatis et al. 1972, 1974), It is possible that some peculiarity of the sampl® composition acted to ‘unravel’ the linear composition of this dimension; however, it should also be appreciated that 4 items (the smallest factor in the BSI) may simply be too few 3 12 19. 4, sustaininvarianceacrossimportant population Brief Symptom Inventory 603 Table 6. Orthogonal varimax loadings for 9 factors determined from a principal components TE Paychoticiom “The idea that someone ese "ean control your thoughts Feeling lonely even when you are with people “The idea thai you should bbe punched for your sins [Newer feeling close 19 bother person ‘The kde that something {3 wrong with your mind ecg inferior 10 others Fecing very self contcious with others Fenings of worthless IV, Hostitty Feating cay annoyed ot Temper outbursts that {you sould aot cout Having urges to beat, jae or hart someone Having urges to break or mash things Getting into frequent arguments MIL. Anciery Nervousness or shakiness inside Suddenly scared for no Feeling fearful Feeling tense or keyed oP Spells of terror oF Feeling so restless rou could not Leading on oss oa on ose os Parameters (Gorsuch, 1966). @ Although there are certain minor differences ‘between the empirical factor structure and the dimensional structure rationally hypothesized, there is more agreement than disagreement between the two. Essentially, 7 of the 9 analysis of 49 items of the BSI 2 2. 29 s ¥. Symptom dimension Loading 1, Somatization Faininest of diceiness Paine in heart or chert Nausea or upat stomach ‘Trouble geting your breath Hot or eoid spells ‘Numboess of tnglig in pars of your body Feeling weak i parts of your body V. Phobie Anaiety esting afraid io open spaces Feeling afraid to travel ‘on buses, subways or Having to avoid certais things places or ett hecnaue they frighten you Fecing uneasy in crowds Feeling nervous wen you are ao Feeling very slFconscious ‘with others VINE Poronotd fdeation Feaing others are to lage Tor most of your toubles Feeling that most people cannot be usted Feiag thc you are ‘watched or talked bout by thers Others not giving you Droper credit for our Schevements Feeling thst people will take advantage of ou if you let them Feeling that people are ly oF dlsike you 04s 50 ae 068 oe 056 056 oat oa o” oss 056 03s 6 6 38 26. n 2 Xe 2, 6. BY 4s Symptom Simention i Depression “Thoughts of ending your ie Peeing lonely Pealing Blue FFecing ao snters! ia things Fecling hopeless about the fue Feelings of worthessness ‘Your feelings being easily art Mi Obsesine-Compulrire Trouble remembering things Feving blocked getting things done having to check and double-check what you do Diticulty making decione ‘Your miad going blank Trouble concentrating 1X. Ansicty Nervousness or thakiness inde Suddenly cared for 20 Feeling fearful Feeling tente of keyed up ‘Spalls of trror t panic Feeling so restless you coulda’s at sl, oe oe oe oss 053 hypothesized symptom constructs were repro- duced with little or no disjuncture of items; an eighth dimension simply split into two well- defined clinical component dimensions. The ninth dimension did not stay together as a linear combination, but the set of only 4 items that define this dimension may well be too small to 604 ensure invariance. It may be necessary to add two or three additional items from the dimension as defined in the SCL-90-R. Results from the structure-comparing factor analysis lend strong additional weight to the construct validation of the BST Predictive validity In spite of the scientific vaiue of construct validation, the average clinician/investigator is usually interested in the more practical side of test validity, i.e. predictive validity. Most test users are interested in the practical issues of how well a test can register changes in psychological status arising from mental disorders, treatment interventions, stress-inducing life events, or a host of other factors. The sensitivity of a measuring instrument to factors effecting such changes is reflected in its correlations with various relevant criterion measures which, in turn, represent summary statements concerning its specific predictive validities. Although during the 1970s research with the SCL-90-R tended to take precedence over work with the BSI in our laboratory, this situation has now changed substantially. Several predictive validation studies with the BSI will soon be completed, and a number of other investigators have also begun to use the brief form of the scate. Several have published reports showing high sensitivity for the BSI. Marshal & Bougsty (1981) have published an interesting epidemiological Feport on psychological disorders in one com- munity, and Amenson & Lewinsohn (1981) have completed a detailed investigation of sex differen- ces in unipolar depression with the BSI. Kremer & Atkinson (1981) have shown high convergent validity for the BSI with a number of other scales in predicting affective status among chronic pain patients, and Peterson and his colleagues (1981) have reported the BSI to have substantial predictive value in a counselling centre popula- tion, The utilization of the BSI in a broad range of substantive contexts indicates that a number of additional criterion-oriented validity studies will soon be forthcoming. REFERENCES Amemion,€ S.& Lewinsoha, P.M. (1981). An investigation nto the lbserved sex difference in prevalence of unipolar depres Journal of abnormal Psychologs BO), {18 ‘Block. (1965) ‘The Change of Response Sers, Appeton-Cemtury Crotte: New York. L. R. Derogatis and N. Melisaratos ‘Campbell, D. de Fiske, D. W. (1959). Convergent snd discriminant ‘abdation by the multtrat ouluimethod matrix: Poycholapeny Bulerin 86, 81-105. Dablatrom, W. G. 0969). Recurrent issues athe development ofthe (GiI.N. Baten) pp. 40, McGraw Hil New York Derogatis, LR (1913) Bruf Symptom ImenioryChaial Psycho. vnetne Researeh: Baltimore Derouatis, LR (1977. The SCL-90 Manual [ Scorng, Admint. stration and Procedures for the SCLL90. Clnlesl Poychomerne. Research Baltinore Deroptin ERB Chay. PA. (1977) Confirmation of the ‘dimensional stucture of the SCL0" A. study in coniaset validation Journal of Clinical Prychology 342), 951-988 Derogti:- R& Clery, PA. (19776) Factor ivaneace across ‘rode forthe primary synptm dimensions ofthe SCL-90, Bak Fouemal of Social and Chaat Piychologs Ye, 347-396 Derogatis, L, Ry Lipman, RS. Covi, L. & Rickey K. (972) Factorial invanance of simpiom dincadone in Sokous ach depressive neuroses Archies of General Poyenutry 2 850-668 Deropaiy LI Lipman, RS, Rickes, K Ueabuth, BH & Covi, £. 97%, The Hopkins Symptom ‘Cheeta (HSCL): A s

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