• The Brief Symptom Inventory (BSI) is the shortened version of the Symptoms Checklist-90.
  • The BSI is a 53-item questionnaire covering nine symptom dimensions of depression:

1) Somatization
2) Obsession-compulsion
3) Interpersonal sensitivity
4) Depression
5) Anxiety
6) Hostility
7) Phobic anxiety
8) Paranoid ideation
9) Psychoticism

  • 3 global indices of distress are also used: Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total. These measure number and intensity of reported symptoms, as well as the current or past level of symptomatology.

Clinical Considerations

  • The BSI is a well-known and well-accepted instrument.
  • The BSI is best used to screen for global psychological distress.
  • The inclusion of somatic items may cause an overestimation of psychiatric symptoms in individuals with SCI.
  • Normative data are available for a variety of non-SCI populations. The Zung Self-Rating Depression Scale was found to have higher sensitivity compared to the BSI when identifying individuals with depression.
  • The BSI was not written for the SCI population, therefore, some items may not be appropriate.
  • This test is simple and easy to administer.

ICF Domain

Body Function ▶ Mental Functions


  • Self-report format
  • Respondents rank each item on a 5-point scale ranging from 0 (not at all) to 4 (extremely)
  • Rankings represent the intensity of distress over the past week
  • The scale reportedly takes less than 8-12 minutes to complete

Number of Items





Scoring is done by hand calculation. 5 point (0-5) Likert-type scale measuring the extent to which individuals have been disturbed by certain mental health symptoms.


The instrument requires only a reading knowledge equivalent to that of a sixth grade education and is available in English, Spanish & French.

Training Required

Minimal training is required to administer the BSI. A specialized degree in health care with an appropriate license or certificate is required to purchase copyrighted forms and manual from the publisher.


Can be purchased here.

# of studies reporting psychometric properties: 3


  • Scores are interpreted by comparison to age-appropriate norms but no normative data or cutoff scores have been established for the SCI population.
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).
  • Higher normative scores are recommended for SCI populations due to the somatic items.

MCID: not established for SCI
SEM: not established for SCI
MDC: not established for SCI


Internal consistency is High (Cronbach’s α=0.96).

(Tate et al. 1993)


  • Moderate correlation with Spinal Cord Injury Lifestyle Scale (SCILS):
    BSI – Depression subscale: r = -0.48
    BSI – Anxiety subscale: r = -0.42
  • Low to Moderate correlation with Health Behaviour Questionnaire (HBQ):
    BSI – Depression subscale: r = -0.33
    BSI – Anxiety subscale: r = -0.17

(Shabany et al. 2018: N=97 traumatic SCI (77 males); age range: 26+; 79.4% paraplegia, 20.6% tetraplegia; 61.9% complete injury, 38.1% incomplete injury)


No values were reported for the responsiveness of the BSI for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the BSI for the SCI population.


Dr. Janice Eng, Christie Chan, Gita Manhas

Date Last Updated

20 July 2020

Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med 1983; 13(3): 595-605.

Heinrich RK, Tate DG, Buckelew SP. Brief Symptom Inventory norms for spinal cord injury. Rehabil Psychol 1994; 39(1): 49-56.

Heinrich RK, Tate DG. Latent variable structure of the Brief Symptom Inventory in a sample of persons with spinal cord injuries. Rehab Psychol 1996; 41:131-147.

Mitchell MC, Burns NR, Dorstyn DS. Screening for depression and anxiety in spinal cord injury with DASS-21. Spinal Cord, 2008; 46, 547-551.

Morlan KK, Tan SY. Comparison of the Brief Psychiatric Rating Scale and the Brief Symptom Inventory. Journal of Clinical Psychology 1998; 54(7): 885-894.

Scherer MJ and Cushman LA. Measuring subjective quality of life for spinal cord injury: a validation study of the assistive technology devise predisposition assessment. Disability and Rehabilitation, 2001; 23(9): 387-393.

Shabany M, Nasrabadi AN, Rahimi-Movaghar V, Mansournia MA, Mohammadi N, Pruitt SD. Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behaviour questionnaire in persons with spinal cord injury. Spinal Cord 2018;56:509-515.


Schurle Bruce A, Arnett PA. Longitudinal study of the Symptom Checklist 90-Revised in Multiple Sclerosis patients. The Clinical Neuropsychologist 2006; 22:46-59.

Tate DG, Forcheimer M, Maynard F, Davidoff G, Dijkers M. Comparing Two Measures of Depression in Spinal Cord Injury. Rehabil Psychol 1993;38:53-61.