Special section: Original article
The Reliability and Validity of the Brief Symptom Inventory−18 in Persons With Traumatic Brain Injury

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Abstract

Meachen S-J, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory−18 in persons with traumatic brain injury.

Objective

To investigate the psychometric properties of the Brief Symptom Inventory−18 (BSI-18) among persons with traumatic brain injury (TBI).

Design

Inception cohort design with cross-sectional follow-up of 6 months to 15 years.

Setting

Rehabilitation hospital.

Participants

Adults (N=257) with moderate to severe TBI (81 inpatients and 176 follow-up participants, analyzed separately).

Interventions

Not applicable.

Main Outcome Measures

The BSI-18 is a brief screen of psychologic distress with a Global Severity Index (GSI), and 3 clinical subscales: somatization, anxiety, and depression.

Results

Internal consistency of the GSI was high in both follow-up participants (α=.91) and inpatients (α=.84), whereas estimates for the somatization, anxiety, and depression subscales were more variable (α range, .61–.84). As would be expected for a measure of affective state, retest reliability estimates were only moderate. The BSI-18 GSI correlated with multiple measures of psychosocial adjustment. After accounting for demographics, injury severity, inpatient functional status, years since injury, and various psychosocial factors, the BSI-18 showed incremental validity in predicting concurrent functional, psychosocial, and psychologic status.

Conclusions

The BSI-18 GSI had excellent reliability and validity among inpatients and follow-up participants. Modest reliability estimates may place an upper bound on the validity of the BSI-18 clinical subscales in inpatient TBI populations.

Section snippets

Participants

Participants were people who sustained a TBI and were enrolled in the Southeastern Michigan Traumatic Brain Injury Systems (SEMTBIS) which is part of the Traumatic Brain Injury Model Systems (TBIMS) project. The BSI-18 was added to the standard battery in 2002; thus, the BSI-18 has been administered only to a subset of the SEMTBIS participants, and only at the evaluation points that have occurred since that date. A total of 81 SEMTBIS participants have completed the BSI-18 during their

Descriptive Statistics

The average total BSI-18 score (summation of all 18 items) was 13.9±12.5 for follow-up participants, and 10.7±8.8 for inpatients (P<.05). Table 2 summarizes the item and scale means and standard sdeviations for both the inpatient (n=81) and follow-up (n=176) samples separately. Examination of sex-corrected T scores (see table 2) shows that, on average, both inpatients and follow-up participants in the current study were not clinically distressed. Clinically significant levels of distress was

Discussion

The present findings provide evidence that the BSI-18 is a reliable measure of general psychologic distress for use with mild-complicated to severe TBI samples during inpatient rehabilitation and at follow-up points. On average, scale sex-corrected T scores were normal for both inpatients and follow-up participants. However, the proportion of subjects in the sample showing clinically significant levels of distress (32% of inpatients, 47% of follow-up participants) was considerable. These

Conclusions

Future inquiry should focus on the impact of somatic items on the psychometric properties of the BSI-18 in persons with TBI. The current results could be more informative if compared with results in a different trauma sample (eg, persons with spinal cord injury). The use of a trauma control group would allow researchers to test predictions about the direct role played by injury to the brain in outcome (as opposed to the role of trauma in general). In addition, it would be worthwhile to consider

Acknowledgment

We thank Robert Kotasek, MA, for his assistance preparing the database that was used for this study.

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    Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133A020515).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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    Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.