Copyright 1991 by the American Psychological Association, Inc.

1040-3590/91/$3,00

Psychological Assessment:
A Journal of Consulting and Clinical Psychology
1991, Vol. 3, No. 3,433-437

Reliability and Validity of the Brief Symptom Inventory

Jack Boulet and Marvin W Boss
University of Ottawa
Ottawa, Ontario, Canada

The reliability and validity of the Brief Symptom Inventory (BSI) was examined for a group of 501
forensic psychiatric inpatients and outpatients. Alpha coefficients for the 9 primary symptom
dimensions revealed a high degree of consistency among the items that compose each scale. Scores
on the 9 BSI dimensions were found to correlate with both analogous and nonanalogous measures
of the Minnesota Multiphasic Personality Inventory (MMPI), indicating a limited convergent
validity and a poor discriminant validity for the instrument. Reactivity to response bias was demonstrated by prominent correlations between the BSI dimensions and the MMPI validity scales. The
significant intercorrelations among the BSI symptom subscales indicated the inappropriateness of
BSI profile analysis in this sample. The BSI may hold some promise as a general indicator of
psychopathology but further research is needed to justify its use as a clinical psychiatric screening tool.

The Brief Symptom Inventory (BSI) is a self-report symptom

reliability was established using Cronbach's coefficient alpha

scale that was designed to measure levels of psychopathology

with a sample of 1,002 psychiatric outpatients. Alpha coeffi-

(Derogatis & Melisaratos, 1983). It is a shortened form of the

revised version of the Symptom Checklist-90 (SCL-90-R),

cients ranged from a low of .71 on the PSY dimension to a high

which has a long developmental history (Derogatis, 1977; Derogatis & Cleary, 1977; Derogatis, Lipman, & Covi, 1973; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974).

Little empirical psychometric research on the BSI has been

conducted by researchers other than the test authors. There

The BSI consists of 53 items describing a variety of problems

and complaints (e.g., trouble remembering things, feeling lonely).

dimensional structure and other related validity issues con-

The items are rated on a 5-point scale (0 to 4), reflecting degrees

of distress ranging from not at all to extremely. The inventory

tis and Melisaratos (1983) have reported that correlations be-

can be used with individuals who have a minimum of a sixth-

range from .92 to .99. These correlations are likely inflated in

grade reading level and takes approximately 10 to 12 min to

complete. Scores are obtained on the following nine dimensions: Somatization (SOM), Obsessive-Compulsive (OC), In-

that it appears that the same sample was previously used to

terpersonal Sensitivity (INT), Depression (DEP), Anxiety

expect fairly consistent patterns of reliability and validity be-

(ANX), Hostility (HOS), Phobic Anxiety (PHOB), Paranoid

Ideation (PAR), and Psychoticism (PSY).

tween the two instruments.

There are three global indexes that can be calculated from

the raw scores on the BSI: (a) the General Severity Index (GSI), a

mented in several studies. Using a sample of 209 "symptomatic

of .85 for DEP.

have, however, been a number of studies that have explored the

cerning its parent scales, the SCL-90 and SCL-90-R. Derogatween similar symptom dimensions on the SCL-90 and the BSI

make the decision as to which of the SCL-90-R items should

be retained for inclusion in the BSI. Nevertheless, one would

The validity of the SCL-90 and SCL-90-R has been docuvolunteers," Derogatis, Rickels, and Rock (1976) have found a

weighted frequency score based on the sum of the ratings the

subject has assigned to each symptom; (b) the Positive Symptom Total (PST), a frequency count of the number of symptoms
the subject reported; and (c) the Positive Symptom Distress Index (PSDI), a score reflecting the intensity of distress, corrected

high convergent validity for the nine primary symptom scales

of the SCL-90-R and a set of 30 Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley (1983)) scales.
Sizable correlations with like constructs were reported on eight
of the nine symptom scales. Derogatis and Melisaratos (1983)

for the number of symptoms endorsed.

Derogatis and Melisaratos (1983) have reported both the

have reanalyzed the data for the same sample, scoring for the
BSI instead of the SCL-90-R. The anah/sis revealed a similar
pattern of convergence with the analogous scales of the MMPI.

test-retest and internal consistency reliabilities of the BSI. The

test-retest values ranged from a low of .68 for SOM to a maxi-

Although the overall magnitude of the correlations was reduced

mum of .91 for PHOB. The stability coefficient of the GSI was
calculated to be .90, leading the authors to conclude that the

on several dimensions, the authors concluded that the reduction in length of the SCL-90-R symptom scales did not compromise their validity.

BSI is a reliable measure over time. The internal consistency

Dinning and Evans (1977) have reported that, for a sample of

113 short-term psychiatric inpatients, scores on the nine SCL90 dimensions correlated with analogous MMPI scales, but

We thank the anonymous reviewers for their comments and suggestions on earlier drafts of this article.
Correspondence concerning this article should be addressed to Jack
Boulet, Department of Epidemiology and Community Medicine, 451
Smyth, Ottawa, Ontario, Canada, K1H 8M5.

also correlated with presumably unrelated measures. Brophy,

Norvell, and Kiluk (1988) have also found that several of the
SCL-90-R dimensions had their highest correlation with a sim433

434

JACK BOULET AND MARVIN W BOSS

ilar clinical scale on the MMPI. In addition, their principalcomponents analysis of the SCL-90-R revealed that the first
factor accounted for a large proportion of the variance, suggesting that the instrument measures a general dimension of psychopathology. Kass, Charles, Klein, and Cohen (1983) have
found a low Pearson product-moment correlation (r = . 17) between the SCL-90 and the SCL analogue (a matched psychopathology rating scale completed by the clinician). In their sample
of 180 psychiatric outpatients, the most common discordance
in ratings was due to the patients' underreporting of symptoms.
It was concluded that the SCL-90 was especially susceptible to
malingering and faking, discounting its utility as a clinical psychopathology measure. Clark and Friedman (1983) have administered the SCL-90 to 442 veterans undergoing psychiatric
treatment. A comparison of the scores for groups of patients
diagnosed with depression, anxiety, and schizophrenia yielded
no differences in the shapes of the SCL-90 symptom profiles
across these diagnostic categories. The groups did differ in
overall symptom intensity, but this gave little support to the
establishment of discriminant validity based on distinct symptomatic dimensions.
Researchers using the BSI have generally concentrated on the
use of the three global scores in the assessment of psychological
disorders (e.g., Pekarik, 1983; Zuckerman, Oliver, Hollingsworth, Harvey, & Austrin, 1986). In contrast, Cella and Tross
(1986) have used all of the BSI symptom scales to assess differences in psychological distress between cancer survivors and
healthy control subjects. Nevertheless, the nine-dimensional
profile suggested by the test developers has yet to achieve widespread acceptance as a differential diagnostic tool.

because of time constraints involved in the assessment process, it was

only administered to 351 of the 501 subjects. Thirteen MMPI protocols were deemed to be clinically invalid, and these scores were not
included in the analysis.
Information on age and number of years of education was gathered
for all patients. No data on ethnic origin or racial composition was
collected. The Weschler Adult Intelligence Scale (WAIS-R; Wechsler,
(1981)) was used to collect information on cognitive ability. The mean
age of the subjects was 34.0 years (SD = 12.13), their mean number of
years of education was 10.22 (SD = 3.31), and their mean Full Scale
Intelligence Quotient (FSIQ) was 92.65 (SD = 14.64). There was no
significant difference in the mean values for age, years of education, or
FSIQ between the sample of 338 individuals who provided valid
MMPI scores and the 150 individuals who were not administered the
test. Likewise, there were no significant mean differences in age, years
of education, or FSIQ between inpatients and outpatients.
The BSI was scored according to the guidelines specified by Derogatis and Spencer (1982). The MMPI was scored by one of several trained
psychometrists. MMPI scores for the 3 validity scales (L, fund K) and
the 10 clinical scales were derived, and /^corrections were made on
Scales 1,4, 7, 8, and 9.
On the basis of the 338 valid MMPI protocols, the prevalence of
multiple-scale elevations was indicative of heightened levels of psychopathology. There were significant elevations on Scales 2 (M= 70.0), 4
(M = 72.6), and 8 (M = 73.8). Only 71 profiles were entirely within the
normal range, with all 7"scores less than or equal to 70. In contrast, 240
individuals had at least two scale elevations of greater than 70.

Results
Reliability
A multiple administration of the assessment package was not

The review of the literature regarding the SCL-90, the SCL-

feasible for the majority of the subject sample. Thus, no mea-

90-R, and the BSI suggests that further research is needed to

justify their use as clinical psychiatric screening tools. Studies

sure of the stability of BSI scores was derived. The internal

of the validity of the SCL-90 and SCL-90-R have revealed

serious discrepancies in the nature and independence of the
nine dimensions of abnormality that are being measured by the
instrument. Likewise, the convergent and discriminant validities of the BSI have only been marginally investigated. The

consistency of the BSI dimensions was estimated using Cronbach's coefficient alpha. Coefficients alpha ranged from a low
of .75 on the PSY dimension to a high of .89 on the DEP dimension (see Table 1).

Validity

purpose of the present study is to assess the reliability and validity of the BSI through an analysis of its measurement properties
in a homogeneous clinic population that consists of both psychi-

The MMPI was used as the criterion instrument with which

to assess the convergent validity of the BSI. Although the clini-

atric inpatients and outpatients.

Table 1

Method
Subjects
The subjects were 501 male psychiatric inpatients and outpatients
who presented for evaluation at the forensic service of a psychiatric
hospital. This sample consisted of 350 consecutive outpatients and 151
consecutive inpatients. All subjects had purportedly been involved in
some form of deviant sexual activity that required a psychiatric assessment and possible treatment, yet not all had outstanding criminal
charges. Although a number of psychiatric ailments were indicated, a
large portion of the sample (n = 284) was diagnosed with paraphilic
disorders according to the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IH-R; American Psychiatric Association, 1987).
After written informed consent was obtained, all of the subjects
completed the BSI as part of a larger psychological assessment package. The MMPI was included as a segment of this evaluation but,

Coefficients Alpha for Brief Symptom Inventory

Symptom Dimensions (N= 501)
Dimension

Number of items

Somatization
Obsessive-Compulsive
Interpersonal Sensitivity
Depression
Anxiety
Hostility
Phobic Anxiety
Paranoid Ideation
Psychoticism
Total

7
6
4
6
6
5
5
5
5
49

.85
.87
.79
.89
.86
.78
.79
.79
.75

Note. There are four additional items that load on several of the dimensions above but are not added to any of the dimensional scores.

435

RELIABILITY AND VALIDITY OF THE BSI

cal scales of the MMPI and the BSI symptom dimensions do
not measure some of the same psychopathological domains,
one would expect fairly high correlations between like constructs on the two instruments. As shown in Table 2, some BSI
dimensions correlate highly with one of the MMPI clinical
scales considered to measure a corresponding symptom construct. For example, DEP showed a moderate correlation with
the MMPI Depression scale (r= .50). Likewise, PAR showed a
substantial correlation with the MMPI Paranoia scale (r = .51).
In addition, SOM exhibited a sizable correlation with the
MMPI Hypochondriasis scale (r = .53). The expected convergence (r = .51) between PSY and the MMPI Schizophrenia
scale was also realized. It was also found that each of the BSI
dimensions correlated significantly with each of the MMPI
clinical scales, with the exception of the Masculinity-Femininity scale (two-tailed p < .01 for all r). In addition, most BSI
dimensions showed meaningful correlations with unrelated
MMPI measured traits. For example, the highest correlates of
the BSI OC dimension, after the MMPI Psychasthenia scale,
were Scales 8 (r = -50), 2 (r= .46), and 6 (r= .41) of the MMPI.
Although the correlations shown in Table 2 demonstrate the
possibility of convergent validity for some BSI dimensions, they
also suggest a low degree of discriminant validity. The high
intercorrelations among the nine BSI symptom scales reveals
the nonindependent nature of the nine dimensions (see Table
3). Intercorrelations among dimensions ranged from a low of
.5 5 to a high of. 80, indicating that the nine scales share a significant proportion of variance. In addition, there were notable
correlations between the nine dimension scores and the total
score for the test (r= .73 to .91). These nine correlation coefficients were individually determined by using a total score based
on the sum of all BSI Hems minus the sum of the items for the
specific dimension of interest.
A principal-components analysis of the dimension scores
was conducted to assess the independence of the subscales. An

extraction criterion of eigenvalues of greater than or equal to 1

was used to determine the number of components to retain.
One component was derived that accounted for 71 % of the variance among score totals. The second principal component had
an eigenvalue of .53 and accounted for 5.9% of the variance.
From the present sample, it appears that little information is
gained by separating the test scores into nine dimensions of
psychopathology.
An examination of the correlations between the individual
BSI items and the BSI dimensions revealed the general inadequacy of most items in measuring the appropriate hypothetical
construct. Although moderate item-subscale intercorrelations
would be expected, one would anticipate that the items composing each subscale would have peak correlations with that
dimension. It was found that very few dimensions were unambiguously defined by then- subscale elements. For example,
each item measuring INT or PSY correlated more highly with
another dimension. The DEP dimension demonstrated the
most suitable item-subscale correlation; all 6 of the scale items
showed the highest correlation with the total score for DER
Overall, only 29 of the 49 BSI items displayed peak correlations
with the appropriate subscale score. The difficulty of interpreting the item-subscale correlations was further complicated
when the magnitudes of these correlations were taken into account. Items defining each dimension should not only correlate
most prominently with that dimension but should also exhibit
sizably greater correlations with that dimension than with any
of the others. Items were defined as appropriate if they displayed a correlation with the proper dimension that was a minimum of .10 greater than the item correlation with any of the
other eight dimensions. On the basis of these criteria, only 7 of
the 49 items could be classified as characterizing the assigned
dimension.
The extent to which various response sets might affect scores
on the dimensions was investigated through an inspection of

Table 2
Correlations of Brief Symptom Inventory (BSI) Symptom Dimensions With Minnesota
Multiphasic Personality Inventory (MMPI) Clinical and Validity Scales (N= 338)
BSI dimensions
MMPI
subscale

SOM

OC

INT DEP ANX HOS PHOB PAR PSY GSI

L
-.17 -.25 -.23 -.25 -.21 -.24
F
.47
.46
.51
.46
.46
.47
K
-.40 -.44 -.44 -.43 -.44 -.47
.34
Hypochondriasis
.53
.35
.38
.26
.31
.47
.39
.41
.32
Depression
.46
.50
.42
.24
.39
.21
Hysteria
.33
.38
.34
.27
.30
.29
.33 .39
Psychopathic Deviate
it
Masculinity-Femininity
.12
.24
.27
.32
.15
.41
.47
.40
Paranoia
.49
.49
.47
.49
Psychasthenia
.49
.54 .47
.46
.49
Schizophrenia
.53
.50 .48 .50
.48
.48
.31
.24 .18 .21
.18
.30
Hypomania
Social Introversion
.31
.44 .40
.39
.37
.39

-.12
.51
-.41
.34
.43
.27
.28
.16
.49
.50
.51
.14
.47

PST PSDI

-.16 -.20 -.24 -.27 -.13

.57
.53 .50
.51
.50
-.52 -.46 -.52 -.54 -.39
.41
.34
.28
.29
.35
.33
.46
.51
.42
.46
.38
.32
.32
.18
.29
.30
.39
.35
.38
.35
.11
.26
.18
28 .26
.51
.55
.52
.47
.49
.57
.38
.50
.51
.50
.58
.44
.51
.50
.52
.27
.24
.27
.27
.25
.46
.40
.39
.40
.40

Note. SOM = Somatization; OC = Obsessive-Compulsive; INT = Interpersonal Sensitivity, DEP =

Depression; ANX = Anxiety; HOS = Hostility; PHOB = Phobic Anxiety; PAR = Paranoid Ideation;
PSY = Psychoticism; GSI = General Severity Index; PST = Positive Symptom Total; PSDI = Positive
Symptom Distress Index;

436

JACK BOULET AND MARVIN W BOSS

Table 3
Intercorrelations Among the Brief Symptom Inventory Symptom
Dimensions and the Total Score (N= 501)
Dimension

Somatization
Obsessive-Compulsive
Interpersonal Sensitivity
Depression
Anxiety
Hostility
Phobic Anxiety
Paranoid Ideation
Psychoticism

Total
.67

.63
.69

.61
.75
.76

.71
.75
.75
.80

.55
.57
.59
.59
.63

.65
.67
.70
.63
.74
.59

.63
.65
.71
.65
.68
.62
.67

.61
.72
.74
.80
.76
.58
.69
.67

.80
.86
.85
.89
.91
.73
.82
.81
.87

the correlation between the BSI subscale scores and the MMPI

moderate-to-high

L, and K scales (see Table 2). The BSI dimensions, as well as

the GSI, were found to correlate significantly with the F and K
scales of the MMPI. This indicates that defensive individuals

scores indicate that the dimensions are not independent, and

intercorrelations among

the

dimension

that the scale items are affected by the same intensity factor.

tended to obtain lower scores on the nine dimensions. In addi-

The fact that one principal component explained over 70% of

the variance of the scale scores suggests that perhaps the de-

tion, patients who were predisposed to exaggerating their psy-

gree, but not the precise nature, of psychopathology may be

chopathological symptomatology, as measured by the MMPI F

scale, were inclined to obtain higher scores on a number of BSI

measured by the BSI.

There are a number of mitigating factors that may have in-

dimensions. These results indicate that the BSI dimensions are

partially reactive to various response sets common to psychiat-

fluenced the results of the present investigation. First, the sample was relatively extreme in terms of psychopathology. Consequently, it may not be surprising that most of the variance in the
BSI scores was accounted for by a single dimension. Although
the degree of psychopathology manifested by the clients in the

ric patients.

Discussion

present investigation was typical of that reported in other re-

There are many issues involved in evaluating the clinical potential of the BSI for use with psychiatric inpatients and outpa-

search involving forensic clientele (e.g, Hall, Maiuro, Vitaliano,

& Proctor, 1986; Quinsey, Arnold, & Pruesse, 1980), it may be

tients. The establishment of reliability and concurrent validity

of the instrument are both important steps in determining the
proper uses of this self-report rating scale.
The internal consistency of the instrument was established

difficult to generalize the findings of this study to forensic popu-

for a relatively homogeneous sample of forensic psychiatric inpatients and outpatients. The resulting measures of reliability

lations that are more heterogeneous in their psychopathology

Second, the implied assumption that the MMPI measures several distinct dimensions of psychopathology may not hold
within this sample. The possibility of scale overlap on this criterion measure may have contributed to the apparent lack of

revealed a high degree of consistency among the items that

compose each dimension. The stability of measurement across

discriminant validity of the BSI. Nevertheless, the utility of the

time was not investigated in this study. If one considers the

nine-dimensional model as valid, then the establishment of the

appeared to be uniquely measuring their intended dimension.

There are also several inherent problems with the self-report
method of assessing psychological distress. Above all, is the

test-retest reliability of the BSI for heterogeneous samples of

psychiatric inpatients and outpatients should definitely be a

BSI subscale scores is questionable, given the fact that few items

focus of future investigations.

assumption that the research participant or patient will accurately describe his or her symptoms and behaviors (Derogatis &

The convergent and discriminant validity of the BSI were

investigated through an examination of the correlations be-

Melisaratos, 1983). It is conceivable that forensic psychiatric

patients would approach assessment with a somewhat more

tween the BSI dimension scores and like constructs from the
MMPI. The correlation of BSI dimensions with nonanalogous

defensive response set than would general psychiatric patients.

Similarly, there may be a tendency for clients to "fake bad" in

MMPI measures, combined with the prevalence of prominent

order to pursue treatment and avoid punishment conditions. As

correlations between BSI dimensions and the majority of

MMPI scales, is reflective of both poor discriminant validity
and of limited convergent validity. The fact that few items

a result, the reported BSI-MMPI correlations may be due, in

part, to the influence of social desirability or social antipathy
on both tests. Nevertheless, the adequacy of a self-report instru-

seemed to be uniquely measuring the intended dimension further attests to the lack of discriminant validity. It thus appears
that little reliance should be placed on the subscale scores.
The total score on the BSI was highly correlated with each
dimension score, suggesting that a single global score might
well be used as an index of psychopathology. In addition, the

ment is functionally related to its ability to perform in a variety

of measurement situations as well as its facility to detect some of
the effects due to dissimulation. Unlike the MMPI, the BSI has
no scale attributes designed to detect the respondent's willingness or unwillingness to admit to pathology. The fact that defensive individuals tended to have lower BSI scores reveals that the

RELIABILITY AND VALIDITY OF THE BSI

dimension scores and global indexes are somewhat reactive to
response sets. Brophy et al. (1988) have suggested that a validity
scale be added to the SCL-90-R to improve the clinical usefulness of the instrument. A similar augmentation of the BSI also
appears to be indicated.
In conclusion, these results indicate that, in terms of differential clinical diagnosis, the BSI has limited utility for screening
forensic psychiatric inpatients and outpatients. The instrument
may have some use in terms of evaluating the changes in psychological distress, but this was not investigated in the present
study. The BSI may also hold some promise as a global index of
psychopathology or psychological distress but little reliance
should be placed on the subscale profiles. Additional criterionoriented validity studies covering a wide range of assessment
circumstances and subject samples are needed to establish the
BSI as a valid clinical assessment device.

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Received February 28,1990
Revision received July 26,1990
Accepted Januarys, 1991