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

Sungkyunkwan University's research team NA

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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.

Original languageEnglish
Pages (from-to)991-1006
Number of pages16
JournalJournal of Affective Disorders
Volume350
DOIs
StatePublished - 1 Apr 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 Elsevier B.V.

Funding

C-YL was supported by the WUN Research Development Fund (RDF) 2021 and the Higher Education Sprout Project, the Ministry of Education at the Headquarters of University Advancement at the National Cheng Kung University (NCKU); GO was supported by the ANR grant of the Chaire Professeur Junior of Artois University and by the Strategic Dialogue and Management Scholarship (Phase 1 and 2); GQG was supported by the SNI # 073–2022 ( SENACYT , Rep. of Panama); HF was supported by Grant-in-Aid for Transformative Research Areas (A) ( Japan Society for The Promotion of Science , JP21H05173 ), Grant-in-Aid for Scientific Research (B) (Japan Society for The Promotion of Science, 21H02849 ), Grant-in-Aid for Scientific Research (C) (Japan Society for The Promotion of Science, 23K07013 ), and the Smoking Research Foundation .; J.Billieux received support from the WUN Research Development Fund (RDF) 2021; JBG was supported by grants from the Kindbridge Research Institute , the International Center for Responsible Gaming , and the Problem Gambling Network of Ohio; K. Lukavská was supported by Charles University institutional support programme Cooperatio-Health Sciences; K. Lewczuk was supported by Sonatina grant awarded by National Science Centre, Poland, grant number: 2020/36/C/HS6/00005 .; KR was supported by a funding from the Hauts-de-France Regional Council (France) called “Dialogue Stratégique de Gestion 2 (DSG2)”; LJC was supported by the National Social Science Foundation of China (Grant No. 19BSH117 ); LN was supported by the ÚNKP-22-3 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.; MG was supported by National Science Centre, Poland grant no. 2021/40/Q/HS6/00219 ; MK was supported by the ÚNKP-22-3 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.; R.I.C. was supported by Auckland University of Technology , 2021 Faculty Research Development Fund; RG was supported by Charles University institutional support programme Cooperatio-Health Sciences; SB was supported by a Tier 1 Canada Research Chair ; S.U.s.r.t. was supported by Brain Korea 21 (BK21) program of National Research Foundation of Korea .; SWK was supported by the Kindbridge Research Institute.; ZD was supported by the Hungarian National Research, Development, and Innovation Office (Grant number: KKP126835 ).

FundersFunder number
Artois University
Kindbridge Research Institute.
Ministry for Culture and Innovation
Problem Gambling Network of Ohio
WUN Research Development FundRDF) 2021
Univerzita Karlova v Praze
Auckland University of Technology, New Zealand
International Center for Responsible Gaming
Agence Nationale de la Recherche
Japan Society for the Promotion of Science23K07013, JP21H05173, 21H02849
Ministerio de Educación, Gobierno de Chile
National Research Foundation of Korea
Narodowe Centrum Nauki2020/36/C/HS6/00005
Smoking Research Foundation
Narodowym Centrum Nauki2021/40/Q/HS6/00219
Secretaría Nacional de Ciencia, Tecnología e Innovación
National Cheng Kung University
Nemzeti Kutatási Fejlesztési és Innovációs HivatalKKP126835
National Office for Philosophy and Social Sciences19BSH117
Nemzeti Kutatási, Fejlesztési és Innovaciós Alap
Sistema Nacional de Investigadores073–2022
Conseil Régional Hauts-de-France

    Keywords

    • Anxiety
    • Brief Symptom Inventory
    • Cross-cultural
    • Depression
    • Measurement invariance
    • Psychometric

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