Cross-cultural validation and measurement invariance of anxiety and depression symptoms: A study of the Brief Symptom Inventory (BSI) in 42 countries

Quintana GR 1 , Ponce FP 2 , Escudero-Pastén JI 3 , Santibáñez-Palma JF 3 , Nagy L 4 , Koós M 5 Show all authors , Kraus SW 6 , Demetrovics Z 7 , Potenza MN 8 , Ballester-Arnal R 9 , Batthyány D 10 , Bergeron S 11 , Billieux J 12 , Briken P 13 , Burkauskas J 14 , Cárdenas-López G 15 , Carvalho J 16 , Castro-Calvo J 17 , Chen L 18 , Ciocca G 19 , Corazza O 20 , Csako RI 21 , Fernandez DP 22 , Fernandez EF 23 , Fujiwara H 24 , Fuss J 25 , Gabrhelík R 26 , Gewirtz-Meydan A 27 , Gjoneska B 28 , Gola M 29 , Grubbs JB 30 , Hashim HT 31 , Islam MS 32 , Ismail M 33 , Jiménez-Martínez MC 34 , Jurin T 35 , Kalina O 36 , Klein V 37 , Költő A 38 , Lee CT 39 , Lee SK 40 , Lewczuk K 41 , Lin CY 42 , Lochner C 43 , López-Alvarado S 44 , Lukavská K 45 , Mayta-Tristán P 46 , Miller DJ 47 , Orosová O 36 , Orosz G 48 , Sungkyunkwan University's research team NA 49 , Quintero Garzola GC 50 , Ramos-Diaz J 51 , Rigaud K 48 , Rousseau A 52 , Scanavino MT 53 , Schulmeyer MK 54 , Sharan P 55 , Shibata M 56 , Shoib S 57 , Sigre-Leirós V 58 , Sniewski L 59 , Spasovski O 60 , Steibliene V 61 , Stein DJ 62 , Ünsal BC 4 , Vaillancourt-Morel MP 63 , Van Hout MC 64 , Bőthe B 65

Affiliations 

  • 1 Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile. Electronic address: gquintanaz@academicos.uta.cl
  • 2 Facultad de Psicología, Universidad de Talca, Chile
  • 3 Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile
  • 4 Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
  • 5 Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
  • 6 Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
  • 7 Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
  • 8 Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA
  • 9 Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain
  • 10 Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria
  • 11 Département de psychologie, Université de Montréal, Montréal, Canada
  • 12 Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
  • 13 Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
  • 14 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
  • 15 Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico
  • 16 William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
  • 17 Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain
  • 18 Department of Psychology, College of Humanity and Social Science, Fuzhou University, China
  • 19 Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
  • 20 Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom; Department of Psychology and Cognitive Science, University of Trento, Italy
  • 21 Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
  • 22 Nottingham Trent University, United Kingdom
  • 23 HELP University, Malaysia
  • 24 Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
  • 25 Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
  • 26 Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; General University Hospital in Prague, Department of Addictology, Czech Republic
  • 27 School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
  • 28 Macedonian Academy of Sciences and Arts, North Macedonia
  • 29 Institute of Psychology, Polish Academy of Sciences, Poland; Institute for Neural Computations, University of California San Diego, USA
  • 30 Center on Alcohol, Substance use, Addictions University of New Mexico, Albuquerque, USA; Department of Psychology, University of New Mexico, Albuquerque, USA
  • 31 University of Baghdad, College of Medicine, Iraq; University of Warith Al-anbya, College of Medicine, Karbala, Iraq
  • 32 Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh
  • 33 University of Baghdad, College of Medicine, Iraq
  • 34 Universidad Pedagógca y Tecnológica de Colombia, Colombia; Grupo de Investigación Biomédica y de Patología, Colombia
  • 35 Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia
  • 36 Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia
  • 37 School of Psychology, University of Southampton, United Kingdom
  • 38 Health Promotion Research Centre, University of Galway, Ireland
  • 39 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 40 Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea; Chuncheon Addiction Management Center, South Korea
  • 41 Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
  • 42 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 43 SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa
  • 44 University of Cuenca, Ecuador
  • 45 Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; Charles University, Faculty of Education, Department of Psychology, Prague, Czech Republic
  • 46 Facultad de Medicina, Universidad Científica del Sur, Lima, Peru
  • 47 College of Healthcare Sciences, James Cook University, Australia
  • 48 Artois University, France
  • 49 Department of Psychology, Sungkyunkwan University, South Korea
  • 50 Florida State University, Republic of Panama; Sistema Nacional de Investigación (SNI), SENACYT, Panama
  • 51 Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
  • 52 Leuven School For Mass Communication, KU Leuven, Leuven, Belgium
  • 53 Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, St. Joseph's Health Care London and London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada
  • 54 Universidad Privada de Santa Cruz de la Sierra, Bolivia
  • 55 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
  • 56 Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 57 Department of Psychology, Shardha University, India; Department of Health Services, Srinagar 190001, India
  • 58 Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  • 59 Compassionate Inquiry, Canada
  • 60 Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, North Macedonia; Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovakia
  • 61 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health sciences, Palanga, Lithuania
  • 62 SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry, Neuroscience Institute, University of Cape Town, South Africa
  • 63 Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
  • 64 Public Health Institute, Faculty of Health, Liverpool John Moores University, United Kingdom
  • 65 Département de Psychologie, Université de Montréal, Montréal, Canada; Centre de recherche interdisciplinaire sur les problèmes conjugaux et les agressions sexuelles (CRIPCAS)
J Affect Disord, 2024 Apr 01;350:991-1006.
PMID: 38244805 DOI: 10.1016/j.jad.2024.01.127

Abstract

BACKGROUND: Depression and anxiety are among the most prevalent mental health issues experienced worldwide. However, whereas cross-cultural studies utilize psychometrically valid and reliable scales, fewer can meaningfully compare these conditions across different groups. To address this gap, the current study aimed to psychometrically assess the Brief Symptomatology Index (BSI) in 42 countries.

METHODS: Using data from the International Sex Survey (N = 82,243; Mage = 32.39; SDage = 12.52; women: n = 46,874; 57 %), we examined the reliability of depression and anxiety symptom scores of the BSI-18, as well as evaluated evidence of construct, invariance, and criterion-related validity in predicting clinically relevant variables across countries, languages, genders, and sexual orientations.

RESULTS: Results corroborated an invariant, two-factor structure across all groups tested, exhibiting excellent reliability estimates for both subscales. The 'caseness' criterion effectively discriminated among those at low and high risk of depression and anxiety, yielding differential effects on the clinical criteria examined.

LIMITATIONS: The predictive validation was not made against a clinical diagnosis, and the full BSI-18 scale was not examined (excluding the somatization sub-dimension), limiting the validation scope of the BSI-18. Finally, the study was conducted online, mainly by advertisements through social media, ultimately skewing our sample towards women, younger, and highly educated populations.

CONCLUSIONS: The results support that the BSI-12 is a valid and reliable assessment tool for assessing depression and anxiety symptoms across countries, languages, genders, and sexual orientations. Further, its caseness criterion can discriminate well between participants at high and low risk of depression and anxiety.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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