Abstract
The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychiatric distress but has not been verified in the Chinese population. From March to April 2019, 293 hospitalized cancer patients, aged 20–87, completed the cross-sectional survey with demographics questionnaire, BSI-18, and PHQ-9. We analyzed the single suicide-related item of PHQ-9 with the full score clinical outpoint for BSI-18 and PHQ-9 using SPSS 22.0 and R 2.15, including Pearson's χ2 test and ROC curve analyses. A Pearson's χ2 test was carried out to compare the three different methods with the gold screening criteria. The p-value was correspondingly to .006, .066, .838. When the PHQ-9 ≥ 10 criteria for the BSI-18, receiver operating characteristic analysis revealed that AUC values were 0.839, optimal cut-off points for both BSI-18 ≥ 50, the sensitivity of 85.8%, and 62.5%, respectively. The BSI-18 is suitable for a screening tool for psychological distress and could also be used in clinical settings for preliminary screening of hospitalized cancer patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abraham, D. S., Gruber-Baldini, A. L., Harrington, D., & Shulman, L. M. (2017). The factor structure of the Brief Symptom Inventory-18 (BSI-18) in Parkinson disease patients. Journal of Psychosomatic Research, 96, 21–26. https://doi.org/10.1016/j.jpsychores.2017.03.002
Altura, K. C., Patten, S. B., Fiest, K. M., Atta, C., Bulloch, A. G., & Jette, N. (2016). Suicidal ideation in persons with neurological conditions: Prevalence, associations, and validation of the PHQ-9 for suicidal ideation. General Hospital Psychiatry, 42, 22–26. https://doi.org/10.1016/j.genhosppsych.2016.06.006
Andreu Vaillo, Y., Murgui Perez, S., Martinez Lopez, P., & Romero Retes, R. (2018). Mini-Mental Adjustment to Cancer Scale: Construct validation in Spanish breast cancer patients. Journal of Psychosomatic Research, 114, 38–44. https://doi.org/10.1016/j.jpsychores.2018.09.004
Anguiano, L., Mayer, D. K., Piven, M. L., & Rosenstein, D. (2012). A literature review of suicide in cancer patients. Cancer Nursing, 35, E14–E26. https://doi.org/10.1097/NCC.0b013e31822fc76c
Biggs, M. A., Gould, H., Barar, R. E., & Foster, D. G. (2018). Five-year suicidal ideation trajectories among women receiving or being denied an abortion. American Journal of Psychiatry, 175, 845–852. https://doi.org/10.1176/appi.ajp.2018.18010091
Calderon, C., Ferrando, P. J., Lorenzo-Seva, U., Hernández, R., Oporto-Alonso, M., & Jiménez-Fonseca, P. (2020). Factor structure and measurement invariance of the Brief Symptom Inventory (BSI-18) in cancer patients. International Journal of Clinical and Health Psychology, 20, 71–80. https://doi.org/10.1016/j.ijchp.2019.12.001
Choi, J., Lee, M., Ki, M., Lee, J. Y., Song, Y. J., Kim, M., …, Lim, J. (2017). Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: Findings from nationwide cross-sectional study (KNHANES IV–VI). BMJ Open, 7, e016130.https://doi.org/10.1136/bmjopen-2017-016130.
Dour, H. J., Wiley, J. F., Roy-Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., …, Craske, M. G. (2014). Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depression and Anxiety, 31, 436–442.https://doi.org/10.1002/da.22216.
Fang, C. K., Chang, M. C., Chen, P. J., Lin, C. C., Chen, G. S., Lin, J., …, Li, Y. C. (2014). A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Support Care Cancer, 22, 3165–3174.https://doi.org/10.1007/s00520-014-2290-4.
Franke, G. H., Jaeger, S., Glaesmer, H., Barkmann, C., Petrowski, K., & Braehler, E. (2017). Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample. BMC Medical Research Methodology, 17, 14. https://doi.org/10.1186/s12874-016-0283-3
Granek, L., Nakash, O., Ariad, S., Shapira, S., & Ben-David, M. (2019). Strategies and barriers in addressing mental health and suicidality in patients with cancer. Oncology Nursing Forum, 46, 561–571. https://doi.org/10.1188/19.Onf.561-571
Grassi, L., Caruso, R., Mitchell, A. J., Sabato, S., & Nanni, M. G. (2018). Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview). Cancer, 124, 2415–2426. https://doi.org/10.1002/cncr.31340
Harris, K. M., & Goh, M. T. (2017). Is suicide assessment harmful to participants? Findings from a randomized controlled trial. International Journal of Mental Health Nursing, 26, 181–190. https://doi.org/10.1111/inm.12223
King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide risk screening in healthcare settings: Identifying males and females at risk. Journal of Clinical Psychology in Medical Settings, 24, 8–20. https://doi.org/10.1007/s10880-017-9486-y
Kozel, B., Grieser, M., Abderhalden, C., & Cutcliffe, J. R. (2016). Inter-rater reliability of the German version of the Nurses’ Global Assessment of Suicide Risk scale. International Journal of Mental Health Nursing, 25, 409–417. https://doi.org/10.1111/inm.12193
Li, M., Wang, M. C., Shou, Y., Zhong, C., Ren, F., Zhang, X., & Yang, W. (2018). Psychometric properties and measurement invariance of the Brief Symptom Inventory-18 among Chinese insurance employees. Frontiers in Psychology, 9, 519. https://doi.org/10.3389/fpsyg.2018.00519
Louzon, S. A., Bossarte, R., McCarthy, J. F., & Katz, I. R. (2016). Does suicidal ideation as measured by the PHQ-9 predict suicide among VA patients? Psychiatric Services, 67, 517–522. https://doi.org/10.1176/appi.ps.201500149
Massetti, G. M., Holland, K. M., Jack, S. P. D., Ragan, K. R., & Lunsford, N. B. (2018). Circumstances of suicide among individuals with a history of cancer. Psycho-oncology, 27, 1750–1756. https://doi.org/10.1002/pon.4720
Merport, A., Bober, S. L., Grose, A., & Recklitis, C. J. (2012). Can the distress thermometer (DT) identify significant psychological distress in long-term cancer survivors? A comparison with the Brief Symptom Inventory-18 (BSI-18). Supportive Care in Cancer, 20, 195–198. https://doi.org/10.1007/s00520-011-1269-7
Merport, A., & Recklitis, C. J. (2012). Does the Brief Symptom Inventory-18 case rule apply in adult survivors of childhood cancer? Comparison with the Symptom Checklist-90. Journal of Pediatric Psychology, 37, 650–659. https://doi.org/10.1093/jpepsy/jss050
Petkus, A. J., Gum, A. M., Small, B., Malcarne, V. L., Stein, M. B., & Wetherell, J. L. (2010). Evaluation of the factor structure and psychometric properties of the Brief Symptom Inventory-18 with homebound older adults. International Journal of Geriatric Psychiatry, 25, 578–587. https://doi.org/10.1002/gps.2377
Petrowski, K., Schmalbach, B., Jagla, M., Franke, G. H., & Brahler, E. (2018). Norm values and psychometric properties of the brief symptom inventory-18 regarding individuals between the ages of 60 and 95. BMC Medical Research Methodology, 18, 164. https://doi.org/10.1186/s12874-018-0631-6
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., …, Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.https://doi.org/10.1176/appi.ajp.2011.10111704.
Recklitis, C. J., Blackmon, J. E., & Chang, G. (2017). Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview. Psychological Assessment, 29, 1189–1200. https://doi.org/10.1037/pas0000427
Recklitis, C. J., & Rodriguez, P. (2007). Screening childhood cancer survivors with the brief symptom inventory-18: Classification agreement with the symptom checklist-90-revised. Psycho-oncology, 16, 429–436. https://doi.org/10.1002/pon.1069
Siemerink, E. J., Jaspers, J. P., Plukker, J. T., Mulder, N. H., & Hospers, G. A. (2011). Retrospective denial as a coping method. Journal of Clinical Psychology in Medical Settings, 18, 65–69. https://doi.org/10.1007/s10880-011-9223-x
Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G., & Mehnert, A. (2017). The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer, 123, 3394–3401. https://doi.org/10.1002/cncr.30749
Wan, Q., Ding, X., Hu, D., Han, Y., Wang, S., Liu, Y., …, Xu, K. (2019). A study of the epidemiology and risk factors for attempted suicide and suicide among non-psychiatric inpatients in 48 general hospitals in Hubei Province, China, 2015–2017. General Hospital Psychiatry. https://doi.org/10.1016/j.genhosppsych.2019.06.003.
Wang, J., Kelly, B. C., Liu, T., Zhang, G., & Hao, W. (2013). Factorial structure of the Brief Symptom Inventory (BSI)-18 among Chinese drug users. Drug Alcohol Dependence, 133, 368–375. https://doi.org/10.1016/j.drugalcdep.2013.06.017
Zaorsky, N. G., Zhang, Y., Tuanquin, L., Bluethmann, S. M., Park, H. S., & Chinchilli, V. M. (2019). Suicide among cancer patients. Nature Communication, 10, 207. https://doi.org/10.1038/s41467-018-08170-1
Zeltzer, L. K., Recklitis, C., Buchbinder, D., Zebrack, B., Casillas, J., Tsao, J. C., …, Krull, K. (2009). Psychological status in childhood cancer survivors: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 27, 2396–2404.https://doi.org/10.1200/jco.2008.21.1433.
Zhang, X., Zhang, J., Procter, N., Chen, X., Su, Y., Lou, F., & Cao, F. (2017). Suicidal ideation and psychological strain among patients diagnosed with stomach cancer: The mediation of psychopathological factors. Journal of Nervous and Mental Disease, 205, 550–557. https://doi.org/10.1097/nmd.0000000000000679
Zhong, B.-L., Li, S.-H., Lv, S.-Y., Tian, S.-L., Liu, Z.-D., Li, X.-B., …, Zhuo, C.-J. (2017). Suicidal ideation among Chinese cancer inpatients of general hospitals: Prevalence and correlates. OncoTarget, 8, 25141–25150.https://doi.org/10.18632/oncotarget.15350.
Acknowledgements
We would like to thank the Cancer Center of Union Hospital Tongji Medical College Huazhong University of Science and Technology for supporting this work. We also thank the participants and nursing staff for their willingness and motivation, as they made this study possible.
Funding
National Natural Science Foundation of China (No. 71673100).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors reported no potential conflict of interest.
Ethical Approval
The Medical Ethics Committee of the Union Hospital Tongji Medical College Huazhong University of Science and Technology approved this study (REC Number 2016/S171). The project was carried out in line with all participating Institutional Review Committees, which require all participants to provide written informed consent before the start of the intervention and evaluation. All participants gave informed consent before the study began. They were told that their responses were anonymous and that they could withdraw at any time.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Teng, F., Hu, D., Zhou, Y. et al. Psychiatric Distress and Suicidal Tendencies in Adult Cancer Survivors: Verifying the Validity of the Brief Symptom Inventory-18 for Identifying Suicidal Ideation in the Hospitalized Population of Mainland China. J Clin Psychol Med Settings 29, 403–411 (2022). https://doi.org/10.1007/s10880-021-09779-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-021-09779-z