Does the Brief Symptom Inventory-18 Case Rule Apply in Adult Survivors of Childhood Cancer?: Comparison With the Symptom Checklist-90

Merport, Anna; Recklitis, Christopher J.

doi:10.1093/jpepsy/jss050

Cited by 29 publications

(51 citation statements)

References 49 publications

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“…This case rule was originally developed for the SCL-90-R and subsequently recommended for the BSI and BSI-18, though the manual does not present any empirical support for the case-rule as applied to the BSI-18. Following common practice for the BSI (e.g., Brown, Whiteley, Harper, Nichols, & Nieves, 2015; Endermann, 2005) users of the BSI-18 in oncology (Merport & Recklitis, 2012; Michel et al, 2010; Zabora et al, 2001; Zeltzer et al, 2009) and other populations (Hart et al, 2014; Hopp, Anderson, Krumholz, Gruber-Baldini, & Shulman, 2012; Mustanski, Garofalo, Herrick, & Donenberg, 2007; Petkus et al, 2010) commonly define overall significant symptoms on the BSI-18 using the GSI scale alone, classifying respondent with GSI t-score ≥ 63 as having clinically significant symptoms. Both the published BSI-18 case-rule criteria (t-score score ≥ 63 on the GSI, or any two of symptom scales) and the conventional case-rule of GSI t-score ≥ 63 were evaluated in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Both the published BSI-18 case-rule criteria (t-score score ≥ 63 on the GSI, or any two of symptom scales) and the conventional case-rule of GSI t-score ≥ 63 were evaluated in this study. In addition, two alternative BSI-18 case rules, the GSI t-score ≥ 57 cut-off reported in a study of cancer patients (Zabora et al, 2001) and the GSI t-score ≥ 50 cut-off recommended in two studies of YACS (Merport & Recklitis, 2012; Recklitis & Rodriguez, 2007) and a study of elderly medical patients (Petkus et al, 2010) were also evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…To identify individuals requiring follow-up evaluation of this kind, the BSI-18 manual recommends the following clinical case-rule: respondents who have either 1) t-score score ≥ 63 on the Global Severity Index (GSI) or 2) a t-score ≥ 63 on any two of the three symptom scales (Somatization, Depression, and Anxiety) should be classified as having clinically significant distress (Derogatis, 2001). Although this standard BSI-18 case-rule is prescribed by the test developer, a second case-rule using the GSI scale only, classifies anyone with GSI t-score ≥ 63 as having significant psychological distress; this GSI t-score ≥ 63 case rule has been commonly applied in studies of cancer patients (Merport & Recklitis, 2012; Michel et al, 2010; Zabora et al, 2001; Zeltzer et al, 2009) and other populations (Hart et al, 2014; Hopp, Anderson, Krumholz, Gruber-Baldini, & Shulman, 2012; Petkus et al, 2010). While both the standard BSI-18 case-rule and the GSI t-score ≥ 63 case rule are widely used for cancer patients and survivors, at least three studies have reported they are not well-suited for cancer survivors and recommended alternative case-rules (Merport & Recklitis, 2012; Recklitis & Rodriguez, 2007; Zabora et al, 2001).…”

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confidence: 99%

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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.

Recklitis

Blackmon

Chang

2017

Psychological Assessment

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The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychological symptoms in cancer survivors, but the validity of conventional BSI-18 cut-off scores in this population has been questioned. This study assessed the accuracy of the BSI-18 for identifying significant anxiety and depression in young adult cancer survivors (YACS), by comparing it to a “gold standard” diagnostic interview measure. Two hundred and fifty young adult cancer survivors (YACS), age 18–40 completed the BSI-18 and the Structured Clinical Interview for DSM-IV (SCID) interview assessing anxiety and depressive disorders. BSI-18 results were compared to SCID criteria using ROC analyses. Forty-four participants (17.7%) met criteria for ≥ 1 SCID diagnoses, and an additional 20 (8.0%) met criteria for clinically significant SCID symptoms without a diagnosis. General concordance between the BSI-18 GSI scale and SCID diagnosis was good (AUC = 0.848), but the two most widely used BSI-18 case-rules failed to identify a majority of survivors with SCID diagnoses, and no alternative BSI-18 cut-off scores met study criteria for clinical screening. Analyses aimed at identifying survivors with significant SCID symptoms or a SCID diagnosis had similar results, as did analyses examining depression and anxiety separately. The BSI-18 shows good overall concordance with a psychiatric interview, but recommended cut-off scores fail to identify a majority of YACS with psychiatric diagnosis. Clinicians should not rely on the BSI-18 alone as a screening measure for YACS. Alternative BSI-18 scoring algorithms optimized for detecting psychiatric symptoms in YACS may be an important step to address this limitation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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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.

Recklitis

Blackmon

Chang

2017

Psychological Assessment

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“…After screening titles and abstracts, we excluded 108, and after screening the full texts, we excluded an additional 23 articles. We extracted the information of screening from eight articles, of which six were studies done in a US group around Christopher Recklitis [23-25, 26 && , 27,28], one in the United Kingdom [29] and one in Australia [30]. In 2014, only one study was published [26 && ].…”

Section: Resultsmentioning

confidence: 99%

“…In a second study in 2012, both questionnaires were thus administered separately [28]: the SCL-90-R was completed on paper in a larger pack of research questionnaires, whereas the BSI-18 was completed on a handheld patient assessment device. Among the 193 adult survivors of various cancers, 31 (16.1%) were identified as cases in the SCL-90-R. Again, the adapted case rule for the BSI-18 (T !…”

Section: Resultsmentioning

confidence: 99%

Screening for psychological late effects in childhood, adolescent and young adult cancer survivors

Michel

Vetsch

2015

Current Opinion in Oncology

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We identified promising screening tools to be used to detect psychological distress in childhood cancer survivors. However, there is still a lack of studies addressing applicability and effectiveness when screening is routinely implemented into follow-up care. To improve quality of follow-up care, and identify and treat survivors with psychological distress, screening tools should now be implemented and their adequacy further tested in day-to-day clinic life.

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Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

et al. 2022

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ImportanceHealth care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress.ObjectiveTo assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period.Design, Setting, and ParticipantsThis single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group).InterventionsThe TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources.Main Outcomes and MeasuresThe primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale).ResultsAmong 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (−5.6 points vs −3.8 points; between-group difference, −1.8 points; 95% CI, −4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: −8.0 points vs −2.6 points; between-group difference, −5.4 points; 95% CI, −9.2 to −1.6 points; P = .006), insomnia (Insomnia Severity Scale score: −4.1 points vs −1.9 points; between-group difference, −2.2 points; 95% CI, −4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: −3.1 points vs −0.9 points; between-group difference, −2.2 points; 95% CI, −3.8 to −0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice.Conclusions and RelevanceIn this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs.Trial RegistrationClinicalTrials.gov identifier: NCT04632368

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Does the Brief Symptom Inventory-18 Case Rule Apply in Adult Survivors of Childhood Cancer?: Comparison With the Symptom Checklist-90

Abstract: The BSI-18 is a useful measure for evaluating distress in adult survivors of childhood cancers; however, the standard BSI-18 case-rule has not been validated for this population, and an alternative case rule should be considered.

Cited by 29 publications

References 49 publications

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.

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.

Screening for psychological late effects in childhood, adolescent and young adult cancer survivors

Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

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