Clinical Psychology and Psychotherapy

Clin. Psychol. Psychother. 14, 221–228 (2007)

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/cpp.539

Assessment The Brief Symptom

Inventory: A Validity
Study in Two
Independent Scottish
Samples
Matthias Schwannauer1* and Phil Chetwynd2
1
Section of Clinical & Health Psychology, University of Edinburgh
2
Consultant Clinical Psychologist, Edinburgh

This study examines the validity and factor structure of the Brief
Symptom Inventory (BSI) in two Scottish samples, using both con-
firmatory factor analysis (CFA) and exploratory factor analysis (EFA).
The 53-item checklist was administered to 161 primary care attenders
and 459 clinical psychology patients. EFA revealed that only six
factors can be found, as opposed to the nine factors suggested by the
original authors. Approximately 40% of the variance is accounted for
by one major factor, ‘Depression’. Further CFA of the factor structure
demonstrated however, that the discriminating information provided
by the dimensional subscales cannot be sufficiently explained by one
single factor of general psychological distress. It is suggested that the
BSI demonstrates some more limited differentiating qualities in sep-
arating essential dimensions in a three-factor model of depression,
anxiety and general psychological distress. Copyright © 2007 John
Wiley & Sons, Ltd.

Clinical psychology has taken justifiable pride in
the development and evaluation of research-based
assessments and interventions. However, outcome
research has often been used on selected groups of
patients under highly controlled conditions that
are often difficult to reproduce in everyday clinical
practice. Moreover, elaborate extended assess-
ment procedures are necessary in basic outcome
research, which may often seem daunting to
the practising clinician, not to mention the
participants.
There remains therefore, a need for a simple,
easily administered self-report measure of psycho-
logical distress that can be used in routine clinical
* Correspondence to: Matthias Schwannauer, Section of
Clinical & Health Psychology, Old Medical School, Univer-
sity of Edinburgh, Teviot Place, Edinburgh EH8 9AG.
E-mail: M.Schwannauer@ed.ac.uk
practice. The Brief Symptom Inventory (BSI) is
claimed by its author (Derogatis, 1993) to meet
these requirements. The BSI is a shorter version of
the better known Symptom Checklist-90-R (SCL-
90-R: Derogatis, 1983), and is designed as a self-
report measure of symptoms of psychological
distress on nine independent subscales. It consists
of 53 items describing a variety of problems.
The items are rated on a 5-point scale of distress
(0–4), ranging from ‘not at all’ to ‘extremely’. The
BSI gives three slightly different ways of measur-
ing general psychological distress and also
permits profiling on nine ostensibly independent
dimensions, namely, ‘Somatisation’, ‘Obsessive–
Compulsive’, ‘Interpersonal Sensitivity’, ‘Depres-
sion’, ‘Anxiety’, ‘Hostility’, ‘Phobic Anxiety’,
‘Paranoid Ideation’ and ‘Psychoticism’. The three
general distress measures are the General Severity
Index (GSI), the Positive Symptom Distress Index
(PSDI) and the Positive Symptom Total (PST). The

Copyright © 2007 John Wiley & Sons, Ltd.

222 M. Schwannauer and P. Chetwynd

GSI is simply the mean item score. The PSDI gives Table 1. Demographic characteristics (in %) of GP and
a more specific score of the severity of symptoms, psychology sample
and is derived by computing the mean of all posi-
GP sample Psychology
tive scores (i.e., zero scores are omitted from the sample
calculation). The PST is a simple frequency count
of all items scored in the range 1–4. Age: Mean/(standard 44.23 (15.12) 37.53 (13.81)
Some problems with the item composition of the deviation)
symptom subscales have been reported in previous Sex
studies. Piersma, Boes, and Reaume (1994) investi- Male 36.6 38.7
gated the factor structure of the BSI for adult Female 63.4 61.3
and adolescent psychiatric inpatients. A principal Marital status
component analysis revealed that most variance Single 23.4 22.8
among dimension scores was accounted for by one Married/cohabiting 60.9 43.9*
principal factor, and the authors therefore con- Divorced/separated 6.3 8.3
Widowed 5.5 2.2
cluded that the BSI measures primarily a unidi- Not known 3.9 22.8
mensional construct of general psychological
distress. Boulet and Boss (1991), again using a prin- * p < 0.005, significance, chi-square test.
GP = General Practitioner.
cipal component analysis of the BSI, reported that
the first factor accounted for 71% of the variance,
with no second factor with an eigenvalue of 1.0 or 3. Are there significant variations in the measure-
more. Very few dimensions were therefore clearly ment structure derived from the normative US
defined by their subscale elements. The obvious samples and our two Scottish samples?
interpretation emerged that little more information
is gained by separating the test into nine dimen-
METHOD
sions. However, these results may be due partly to
the relatively high degree of homogeneity and the The BSI was administered to 161 routine primary
high psychopathological severity in this sample of care attenders, between the ages 18 and 65, in the
501 forensic psychiatric inpatients and outpatients. waiting room shortly before their General Practi-
Furthermore, the use of the method of principal tioner (GP) consultation. The data was collected as
component analysis is likely to produce an artifi- part of the screening procedure in an audit of the
cially prominent first factor. referral practices of primary care physicians. A
The authors of the BSI themselves (Derogatis & second sample was collected from an audit con-
Melisaratos, 1983) also reported in their paper ducted in two departments of clinical psychology
introducing the BSI that ‘. . . certain minor differ- in Edinburgh and Midlothian, Scotland. Here the
ences between the empirical factor structure and BSI was administered to 459 people immediately
the dimensional structure are rationally hypothe- prior to their first consultation with their clinical
sised’. In this comment, the authors refer to the fact psychologist. This data was collected over a half-
that in their factor analytic calculations, individual year period as part of another audit designed to
items of the constructed BSI dimensions did not measure change of psychological distress after clin-
load highest on the dimensions they describe. Nev- ical psychological intervention. The demographic
ertheless, they continued to present the BSI as an characteristics did not differ significantly apart
adequate measure of their ‘rationally hypothe- from the fact that the GP sample contained more
sised’ dimensions. married or cohabiting individuals (Table 1). It is
This study attempted to clarify further some of possible that this represented a sampling artefact,
these issues and thereby to evaluate whether the however, as the marital status of a significant pro-
BSI possesses more satisfactory psychometric portion of patients in the psychology sample was
properties than existing screening and outcome rated (by the psychologist) as ‘not known’. In the
questionnaires. Specifically, the following ques- primary care sample, marital status was recorded
tions were addressed: by the patients themselves.

1. Does the BSI discriminate between two popula-

Statistical Procedure
tions that differ in clinical severity?
2. Does the factor structure conform to the authors’ To evaluate the psychometric properties of the BSI,
claims of nine independent dimensions? a number of statistical analyses on its reliability

Copyright © 2007 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 14, 221–228 (2007)
DOI: 10.1002/cpp
The Brief Symptom Inventory: A Validation Study 223

and validity were carried out, including measures Table 2. Comparison of Brief Symptom Inventory
of internal consistency. To investigate the factor scores between groups
structure of the BSI an exploratory factor analysis
GP sample Psychology
(EFA) was carried out in the first sample, using the sample
method of maximum likelihood (ML) with orthog-
onal varimax rotation similar to the procedures Mean/(SD) Mean/(SD)
used in the original and subsequent major valida- GSI 0.67 (0.74) 1.47 (0.85)**
tion studies (e.g., Boulet & Boss, 1991; Derogatis & PSDI 1.68 (0.70) 2.23 (0.65)**
Melisaratos, 1983). We then conducted a series of PST 16.90 (12.85) 31.66 (12.53)**
confirmatory factor analyses (CFA) in the second Dimension
sample to test the fit of the original factor structure Somatisation 0.72 (0.80) 1.09 (0.94)**
Obsessive-compulsive 0.78 (0.83) 1.69 (1.08)**
and alternative structures that emerged from the Interpersonal sensitivity 0.68 (0.86) 1.75 (1.22)**
EFA. CFA allows the validation of a priori models Depression 0.59 (0.89) 1.68 (1.14)**
in testing how well a hypothesized model fits the Anxiety 0.69 (0.85) 1.90 (1.13)**
data. This fit is assessed by a conventional null Hostility 0.65 (0.80) 1.30 (1.14)**
hypothesis significance test for the goodness of fit Phobic anxiety 0.31 (0.67) 1.21 (1.16)**
(χ2) where the model is rejected as non-fitting when Paranoid ideation 0.67 (0.90) 1.29 (1.06)**
Psychoticism 0.42 (0.76) 1.27 (0.98)**
the discrepancy between the model implied covari-
ances, and the observed sample covariances is ** p < 0.001, significance, t-tests.
larger than the expected distribution by a proba- SD = standard deviation. GSI = General Severity Index. PSDI =
Positive Symptom Distress Index. PST = Positive Symptom Total.
bility usually adjusted to a 0.05 level. Model fit is GP = General Practitioner.
further assessed using a range of fit indices speci-
fying the approximate fit of a model to data. Model
χ2 and the Comparative Fit Index (CFI: Bentler,
ity coefficients are reported for the nine separate
1990) were utilized to estimate overall and
subscales on each of the two samples. Coefficients
incremental model fit of the competing models.
alpha ranged from a low of α = 0.71 for the ‘Para-
A significant χ2 suggests that the data depart sig-
noid Ideation’ dimension to a high of α = 0.87 for
nificantly from the model and a CFI of less than 0.9
the dimensions ‘Obsessive Compulsive’, ‘Depres-
indicates an inadequate fit of the model. We further
sion’, ‘Anxiety’ and ‘Phobic Anxiety’ for the GP
report the Root Mean Square of Approximation
attenders sample (median = 0.83), and from
(RMSEA: Browne & Cudeck, 1993) where a
α = 0.81 for ‘Paranoid Ideation’ to α = 0.91 for
RMSEA of 0.05 or below indicates an acceptable
‘Depression’ for the clinical psychology sample
approximate fit of the model. Due to poor multi-
(median = 0.87).
variate normality, we employed the ML method
These results are substantially in line with those
with Satorra and Bentler’s ‘robust’ correction
reported by Derogatis (1993) who found alpha
(Satorra & Bentler, 1994), which adjusts the model
coefficients ranging from α = 0.71 to α = 0.85 in a
statistical output for deviation from normality. This
sample of 719 US psychiatric outpatients.
method produces a scaled χ2 statistic and robust
Table 2 confirms that the BSI discriminates ade-
standard errors with which to test the statistical
quately between our two samples which differ in
significance of the model parameters. Other fit
terms of their clinical severity. The two groups dif-
indices employed (CFI, RMSEA) were also
fered significantly on all three composite BSI
adjusted using the Satorra–Bentler scaled chi-
scores, as well as on the nine hypothesized sub-
square statistic (S-B χ2) in their calculation. EQS 6.1
scales, which confirms Derogatis and Melisaratos’
(Bentler, 2006) was used to compute the CFA
(1983) assumptions about the discriminant validity
models. In all factor analyses, only items loading
of the BSI.
on symptom dimensions as per the original con-
struct were entered.
Factor Analysis
RESULTS Factor Structure–EFA
In order to investigate the factor structure of the
Reliability
instrument using a similar procedure to the origi-
The internal consistency reliability was determined nal construct validation reports, we used the
by utilizing Cronbach’s coefficient alpha; reliabil- technique of ML and both an orthogonal and

Copyright © 2007 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 14, 221–228 (2007)
DOI: 10.1002/cpp
224
an oblique rotation of the significant factors. Six
factors with an eigenvalue larger than 1.0 were
extracted, explaining cumulatively 69.6% of the
variance. The first factor alone accounted for 39.8%
of the variance of the questionnaire, with an eigen-
value of EV = 19.5, about five times more than
explained by the second factor (which explains
7.4% of the variance [EV = 3.6]). The instrument is
basically dominated by one factor in this popula-
tion, and later factors do not substantially add
much after the first factor is extracted. Item covari-
ation on this analysis is predominantly explained
by a single global distress factor. The item compo-
sition of the extracted factors in this independent-
factor solution is very different from the original
construct dimensions. The structure of the
obliquely rotated factors was more distinctly dif-
ferentiated, and the item composition was more
coherent and therefore much easier to interpret.
The obliquely rotated factors also approximated
more closely to some of the hypothesized dimen-
sions of the original BSI than the independent
factor solution.
The oblique rotation of six significant factors
resulted in the following factor pattern: the first
and dominating factor is a ‘Depression’ factor, con-
taining two items of the ‘Psychoticism’ subscale
(‘Feeling lonely even when you are with people’
[14], ‘Never feeling close to another person’ [44]);
the second factor, ‘Phobic Anxiety’, includes one
‘Anxiety’ item (‘Spells of terror or panic’ [45]);
factors three and four represent the original factors
‘Hostility’ and ‘Obsessive–Compulsive’; factor five
forms a new ‘Paranoia–Interpersonal Sensitivity’
dimension; and the final factor, ‘Somatisation’,
includes one ‘Anxiety’ item (‘Nervousness or shak-
iness inside’ [1]). The items representing these six
factors are illustrated in Table 3.
CFA
In order to investigate whether the suggested
structure of nine distinct dimensions reported by
the authors of the BSI is applicable to the clinical
sample studied in this paper and to validate alter-
native structures that emerged from the EFA, a
series of three confirmatory factor analyses have
been carried out. All CFA were conducted on raw
data. The obtained non-normal distributions were
expected; however, the use of non-normal data
may attenuate or distort relations among variables
and compromise model fits. Therefore, CFA in
EQS was conducted using ML estimation with
the Satorra–Bentler scaled chi-square (S-B χ2) and
adjustments to the standard errors to account for
Copyright © 2007 John Wiley & Sons, Ltd.
M. Schwannauer and P. Chetwynd
non-normality in model fit statistics and signifi-
cance testing (Bentler & Dudgeon, 1996).
A large significant value of the chi-square indi-
cates a poor reproduction of the observed covari-
ance matrix by a given model. The CFI provides an
estimate of the fit of the model for a population
with an assumed infinite number of members, and
excludes possible misspecification due to skewed
chi-square distribution in small samples. The CFI
would equal to 1.0 if the measure of misspecifica-
tion of the model is 0.
For this sample of clinical psychology patients,
the resulting chi-square value for the original nine
factor model was χ2 = 4762.08 (degrees of freedom
[df] = 1127; p < 0.001) with a robust CFI of 0.646 and
RMSEA index of 0.092. In this sample therefore, the
highly significant chi-square values and low CFI
score suggest that the Derogatis and Melarisatos
model would be unlikely to generate the observed
data.
To explore the assumption of a single general
underlying factor further, we further used CFA to
test this one-factor model suggested by the EFA.
The single factor model also provided a poor fit.
The CFA of the data resulted in a chi-square value
of χ2 = 3675.67 (df = 1325; p < 0.001) with a CFI of
0.761 and a RMSEA index of 0.069.
However, when we tested a three-factor model
based on the relative size of the eigenvalues in the
ML calculation, this model fared much better. The
construction of these three factors follows largely
the item loadings of the EFA in the first sample and
a conceptual differentiation of the items. The CFA
of this model resulted in a chi-square of χ2 = 899.11
(df = 678; p < 0.001) with a robust CFI of 0.894 and
a RMSEA index of 0.055. The three factors in this
model were allowed to correlate.
The symptom clusters that loaded highly on the
first factor were ‘Depression’ (0.91; p = 0.04), ‘Inter-
personal Sensitivity’ (0.83; p = 0.04) and ‘Psychoti-
cism’ (0.82; p = 0.04). The symptom clusters that
loaded highly on the second factor were ‘Somati-
sation’ (0.74; p = 0.04), ‘Anxiety’ (0.93; p = 0.04) and
‘Phobic Anxiety’ (0.75; p = 0.04); and the symptom
clusters that loaded on the third factor were
‘Obsessive–Compulsive’ (0.71; p = 0.04), ‘Paranoid
Ideation’ (0.86; p = 0.04) and ‘Hostility’ (0.65;
p = 0.04). The intercorrelation of these factors is
between r = 0.64 and r = 0.70 (p < 0.005).
Broadly speaking, this three-factor model seems
to differentiate symptoms of depression including
interpersonal items, from anxiety including soma-
tisation items, and from a more general symptom
cluster.
Clin. Psychol. Psychother. 14, 221–228 (2007)
DOI: 10.1002/cpp
The Brief Symptom Inventory: A Validation Study 225

Table 3. Item composition of the six major factors

Item Loading Reported dimension

Items loading on factor 1 17 0.811 Depression
18 0.780 Depression
16 0.777 Depression
14 0.734 Psychoticism
35 0.684 Depression
50 0.669 Depression
44 0.528 Psychoticism
Items loading on factor 2 8 0.850 Phobic anxiety
43 0.840 Phobic anxiety
28 0.825 Phobic anxiety
31 0.784 Phobic anxiety
45 0.620 Anxiety
Items loading on factor 3 13 0.874 Hostility
46 0.845 Hostility
41 0.825 Hostility
40 0.751 Hostility
6 0.712 Hostility
Items loading on factor 4 36 0.859 Obsessive–Compulsive
5 0.820 Obsessive–Compulsive
26 0.790 Obsessive–Compulsive
32 0.787 Obsessive–Compulsive
27 0.708 Obsessive–Compulsive
15 0.636 Obsessive–Compulsive
Items loading on factor 5 21 0.766 Interpersonal sensitivity
22 0.757 Interpersonal sensitivity
51 0.754 Paranoid ideation
20 0.751 Interpersonal sensitivity
42 0.731 Interpersonal sensitivity
48 0.722 Somatisation
24 0.669 Paranoid ideation
4 0.568 Paranoid ideation
10 0.554 Paranoid ideation
Items loading on factor 6 7 0.725 Somatisation
30 0.716 Somatisation
33 0.705 Somatisation
29 0.680 Somatisation
23 0.664 Somatisation
2 0.634 Somatisation
37 0.615 Somatisation
1 0.552 Anxiety

Intercorrelation of Construct Dimensions sion obviously showing the highest correlation

Given that the factor structure is largely dominated
by one factor, it is not surprising to find relatively
high correlations between the dimension scores
(Table 4). Correlations between the different
dimensions vary from r = 0.28 between ‘Phobic
Anxiety’ and ‘Hostility’ to r = 0.76 between ‘Para-
noid Ideation’ and ‘Interpersonal Sensitivity’.
There is also a high correlation of the nine dimen-
sions and the total score, the ‘Depression’ dimen-
with the total score (r = 0.849).
The significance of correlations among the sub-
scales was examined by factor, analyzing their cor-
relation matrix. A principal component analysis on
the subscale scores produced three factors with an
eigenvalue larger than 1.0, which explain cumula-
tively only 53.3% of the variance. The following
five factors have an eigenvalue between 0.89 and
0.71. It cannot be said, therefore, that in this
sample, only one factor of general severity would

Copyright © 2007 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 14, 221–228 (2007)
DOI: 10.1002/cpp
226 M. Schwannauer and P. Chetwynd

Table 4. Intercorrelations of Brief Symptom Inventory subdimensions and total score

Som Obs Inter Dep Anx Host Phob Para Psy Total
Somatisation – 0.710
Obsessive–compulsive 0.474 – 0.762
Interpersonal sensitivity 0.357 0.593 – 0.780
Depression 0.443 0.672 0.735 – 0.849
Anxiety 0.678 0.500 0.523 0.581 – 0.805
Hostility 0.428 0.469 0.568 0.616 0.486 – 0.731
Phobic anxiety 0.593 0.336 0.371 0.398 0.701 0.277 – 0.635
Paranoid ideation 0.378 0.581 0.751 0.668 0.467 0.645 0.318 – 0.790
Psychoticism 0.441 0.589 0.642 0.762 0.548 0.585 0.422 0.694 – 0.817
p < 0.001, significance of all correlation coefficients.
Som = somatisation. Obs = obsessive–compulsive. Inter = interpersonal sensitivity. Dep = depression. Anx = anxiety. Host =
hostility. Phob = phobic anxiety. Para = paranoid ideation. Psy = psychoticism.

explain all the information contained in the
subscales.
DISCUSSION
Previous analyses with forensic patients (Boulet &
Boss, 1991), with adult and adolescent psychiatric
inpatients (Piersma et. al., 1994), and previous
studies on the factor structure of the SCL-90 with
psychiatric inpatients (Bonynge, 1993; Dinning &
Evans, 1977; Hoffman & Overall, 1978) suggest that
the factor structure of both the SCL-90 and the BSI
do not conform to the dimensional structure
claimed by their authors in psychiatric inpatient
samples. One factor of general psychological
distress seemed to explain most of the variance
among the nine symptom dimensions in these
studies. By using CFA, a more rigorous assess-
ment of model fit, the present study was able
to confirm these early findings regarding the
validity of the suggested dimensional structure of
the BSI.
Indeed, it is unclear how Derogatis and
Melisaratos (1983) can sustain on scientific grounds
their original claim that the BSI measures nine
independent dimensions. The attempt to empiri-
cally validate their theoretically constructed
dimensions is conceptually flawed on a number of
counts.
First, the ‘Interpersonal Sensitivity’ dimension
was added to the final version without any
apparent empirical confirmation of its construct
validity. Our analysis suggest that these items do
not combine as an independent factor but come
together with some of the items on the ‘Paranoid
Ideation’ subscale to form part of an interpersonal
component, contributing to a broader dimension of
depression.
Second, the ‘Psychoticism’ dimension does not
appear to have been replicated in any subsequent
factor analytic study. It is therefore misleading to
include this dimension in any interpretation of BSI
results in the way Derogatis (1993) suggested. In
fact, Derogatis and Melisaratos’ (1983) original
factor analysis produced an initial factor of ‘Psy-
choticism’ that contained three items from other
dimensions as well as only four of their original
‘Psychoticism’ items. Derogatis (1993) was later
rather more cautious when he stated in the BSI
manual that ‘. . . this particular configuration prob-
ably represents “social alienation” more accurately
than it does “psychoticism” ’.
In our present study, however, the BSI maintains
some discriminating qualities by providing a more
limited number of clinical subscales, which are
dominated by one factor of global psychological
distress. This general factor nevertheless, cannot
adequately explain the information provided by
the derived subscales. Our meta-analysis of the
correlation coefficients of the nine dimensions
demonstrated that one general factor is unable to
represent all the derived subscales. A three-factor
model is therefore suggested, consisting of a dom-
inant factor of depression and two subsequent
factors of anxiety and general psychological dis-
tress. On a conceptual item level, these three
factors can be interpreted in line with the tripartite
model of anxiety and depression (Clark & Watson,
1991; Joiner, Brown, & Metalsky, 2003; Mineka,
Watson, & Clark, 1998). In this model, anxiety and
depression have both common and unique fea-
tures, with depression being mainly characterized
by low positive affect and anhedonia and anxiety
being uniquely characterized by physiological
hyperarousal; a third non-specific factor of general
distress is related to both symptom clusters. The
three-factor model reported for the clinical sample

Copyright © 2007 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 14, 221–228 (2007)
DOI: 10.1002/cpp
The Brief Symptom Inventory: A Validation Study
in which both symptoms of depression and anxiety
are prominent appears to differentiate between
symptoms of depression, interpersonal sensitivity
and strong negative self-appraisal on one hand and
symptoms of anxiety, phobic anxiety and somati-
sation on the other; both of these factors are highly
correlated with a factor of more mixed symptoms
of general psychological distress. The results of this
study therefore yielded limited support for a cor-
related three-factor structure of the BSI differenti-
ating depression, anxiety and general distress.
Overall, why should there be such a diversity of
outcome in the factorial studies of the BSI? One
answer to this may lie in the differences in the popu-
lations studied. The salience of a given symptom
subscale is highly affected by the extent to which the
population varies in that particular symptom com-
pared to the extent that it varies in overall symptom
intensity. Any exceptionally homogeneous group
would therefore naturally show a greater propor-
tion of variance in one particular symptom dimen-
sion than would any general clinical population. In
a general, more heterogeneous population, there
would be so many symptom groups present that for
any one of them, many of the members of the group
would be asymptomatic, and hence the specific
symptom construct would explain relatively little
variance in the group. Consequently, in a heteroge-
neous clinical population, a global intensity factor is
more likely to dominate, and particular symptom
clusters are likely to subside in importance.
Differences in the results of previous factorial
studies may also be explained in terms of differ-
ences in the factorial analyses used. Most of these
have used a principal component analysis with an
orthogonal varimax rotation of the emerging
factors. This can give a distorted picture of the rela-
tionship between the factors elicited. This could
account for the particular results of Boulet and
Boss (1991) and Piersma et al. (1994) for example,
but only a further analysis of their data would
resolve this issue. In the current study, the use of
the method of an ML analysis with an oblique
factor rotation produced a more satisfactory result,
more in keeping with the empirically derived data.
CONCLUSIONS
This study of construct validity of the BSI suggests
that the instrument could have a useful application
as both a screening and outcome measure in
routine clinical psychology practice. It is simple,
quick to administer (usual completion time rarely
exceeds 10 minutes) and easy to score.
Copyright © 2007 John Wiley & Sons, Ltd.
227
It possesses adequate internal reliability and con-
ceptual validity. However, the dimensional structure
claimed by its authors could not be validated in this
study. Only five of the original nine dimensions
were identified in an ‘Oblimin’ rotation EFA, namely,
‘Depression’, ‘Hostility’, ‘Obsessive–Compulsive’,
‘Phobic Anxiety’ and ‘Somatisation’. A further factor
emerged combining items regarding interpersonal
sensitivity, suspiciousness and difficulty in trusting
others. No evidence was found for coherent factors of
‘Psychoticism’ and ‘General Anxiety’.
Further, more stringent confirmatory analyses of
the one- and three-factor structure suggested by the
eigenvalues of the EFA appear to suggest a domi-
nant factor of depression, a second factor of anxiety
symptoms and a third factor of general psycholog-
ical distress as the most stable symptom structure
of the BSI in the clinical population studied.
ACKNOWLEDGEMENT
The authors would like to express their thanks to
Mr. Norman Fraser, Consultant Clinical Psycholo-
gist, for granting permission to use some of the
clinical audit data from his department in this
study.
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