Form Structure: Brief Symptoms Inventory-18 (BSI-18)
This form structure is an organized set of data definitions for a copyrighted form
Title:
Brief Symptoms Inventory-18 (BSI-18)
Short Name:
BSI18
Description:
The Brief Symptom Inventory 18 (BSI-18) is a short form of the Symptom Checklist-90-Revised. It is a brief self-report measure of psychological distress with 3 subscales (Depression, Anxiety, and Somatization) and a Global Severity Index. The BSI-18 is selected as a core measure because of its brevity, global assessment of common psychological issues in people with TBI, and sound psychometric characteristics. It can be used to monitor change in response to treatment. Recommended by CDISC for TBI (TAUG TBI)
References: Derogatis LR, Melisaratos N., The Brief Symptom Inventory: an introductory report, Psychol Med. 1983 Aug;13(3):595-605.https://www.ncbi.nlm.nih.gov/pubmed/6622612.
Copyright: Pearson, 2001, http://www.pearsonclinical.com/psychology/products/100000638/brief-symptom-inventory-18-bsi-18.html
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Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-09-26
Version:
1.4
Date Created:
2014-08-22
Owner:
Number of Data Elements:
34
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 5 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 6 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 7 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Completion (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Brief Symptom Inventory - 18 (BSI18) - Faintness scale | A scale to indicate how much the participant is distressed by faintness or dizziness. | BSI18FaintScale | Recommended | CDE |
| 2 | Brief Symptom Inventory - 18 (BSI18) - No interest scale | A scale to indicate how much a participant is distressed by feeling no interest in things. | BSI18NoInterestScale | Recommended | CDE |
| 3 | Brief Symptom Inventory - 18 (BSI18) - Nervousness scale | A scale for participant's distress by nervousness or shakiness inside. | BSINervousScale | Recommended | CDE |
| 4 | Brief Symptom Inventory - 18 (BSI18) - Chest pains scale | The scale for the participant's distress by pains in heart or chest. | BSI18ChestPainScale | Recommended | CDE |
| 5 | Brief Symptom Inventory - 18 (BSI18) - Feeling lonely scale | The scale for the participant's distress in feeling lonely. | BSI18FeelLonelyScale | Recommended | CDE |
| 6 | Brief Symptom Inventory - 18 (BSI18) - Feeling tense scale | The scale for the participant's distress in feeling tense or keyed up. | BSI18FeelTenseScale | Recommended | CDE |
| 7 | Brief Symptom Inventory - 18 (BSI18) - Nausea scale | The scale for the participant's distress from nausea or upset stomach. | BSI18NauseaScale | Recommended | CDE |
| 8 | Brief Symptom Inventory - 18 (BSI18) - Feeling blue scale | The scale for the participant's distress from feeling blue. | BSI18FeelBlueScale | Recommended | CDE |
| 9 | Brief Symptom Inventory - 18 (BSI18) - Suddenly scared scale | The scale for the participant's distress from suddenly scared for no reason. | BSI18ScaredScale | Recommended | CDE |
| 10 | Brief Symptom Inventory - 18 (BSI18) - Trouble getting breath scale | The scale for the participant's distress from trouble getting their breath. | BSI18TrblBreathScale | Recommended | CDE |
| 11 | Brief Symptom Inventory - 18 (BSI18) - Feeling worthless scale | The scale for the participant's distress from feelings of worthlessness. | BSI18FeelWorthlessScale | Recommended | CDE |
| 12 | Brief Symptom Inventory - 18 (BSI18) - terror or panic scale | The scale for the participant's distress from spells of terror or panic. | BSI18TerrorOrPanicScale | Recommended | CDE |
| 13 | Brief Symptom Inventory - 18 (BSI18) - Numbness or tingling scale | The scale for the participant's distress from numbness or tingling in parts of their body. | BSI18NumbScale | Recommended | CDE |
| 14 | Brief Symptom Inventory - 18 (BSI18) - Hopeless scale | The scale for the participant's distress from feeling hopeless about the future. | BSI18FeelHopelessScale | Recommended | CDE |
| 15 | Brief Symptom Inventory - 18 (BSI18) - Restless scale | The scale for the participant's distress from feeling so restless they couldn't sit still. | BSI18FeelRestlessScale | Recommended | CDE |
| 16 | Brief Symptom Inventory - 18 (BSI18) - Weak scale | The scale for the participant's distress from feeling weak in parts of their body. | BSI18FeelWeakScale | Recommended | CDE |
| 17 | Brief Symptom Inventory - 18 (BSI18) - Thoughts of ending life scale | The scale for the participant's distress from thoughts of ending their life. | BSI18ThoughtsEndingLifeScale | Recommended | CDE |
| 18 | Brief Symptom Inventory - 18 (BSI18) - Fearful scale | The scale for the participant's distress from feeling fearful. | BSI18FeelFearfulScale | Recommended | CDE |
| 19 | Brief Symptom Inventory - 18 (BSI18) - Somatization raw score | Raw score for somatization symptom scale. | BSI18SomScoreRaw | Recommended | CDE |
| 20 | Brief Symptom Inventory - 18 (BSI18) - Somatization area T score | Area T score for somatization symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. | BSI18SomScoreT | Recommended | CDE |
| 21 | Brief Symptom Inventory - 18 (BSI18) - Depression raw score | Raw score for depression symptom scale. | BSI18DeprScoreRaw | Recommended | CDE |
| 22 | Brief Symptom Inventory - 18 (BSI18) - Depression area T score | Area T score for depression symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. | BSI18DeprScoreT | Recommended | CDE |
| 23 | Brief Symptom Inventory - 18 (BSI18) - Anxiety raw score | Raw score for anxiety symptom scale. | BSI18AnxScoreRaw | Recommended | CDE |
| 24 | Brief Symptom Inventory - 18 (BSI18) - Anxiety area T score | Area T score for anxiety symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. | BSI18AnxScoreT | Recommended | CDE |
| 25 | Brief Symptom Inventory - 18 (BSI18) - Global Severity Index raw score | Raw score for Global Severity Index symptom scale. | BSI18GSIScoreRaw | Recommended | CDE |
| 26 | Brief Symptom Inventory - 18 (BSI18) - Global Severity Index area T score | Area T score for Global Severity Index symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. | BSI18GSIScoreT | Recommended | CDE |
Keywords
