Skip to main content
PMC home page
International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2008 Sep 12;17(4):198–209. doi: 10.1002/mpr.262

Development of the Bipolar Inventory of Symptoms Scale: concurrent validity, discriminant validity and retest reliability

Jodi M Gonzalez 1,✉, Charles L Bowden 1, Martin M Katz 1, Peter Thompson 1, Vivek Singh 1, Thomas J Prihoda 1, Martha Dahl 1
PMCID: PMC6878587  PMID: 18792087

Abstract

Scales used in studies of bipolar disorder have generally been standardized with major depressive or hospitalized manic patients. A clinician rated scale based on a semi‐structured interview for persons with bipolar disorder, with comprehensive coverage of bipolar symptomatology, is needed. We report concurrent, divergent and convergent psychometric reliability, discriminant validity and relationship to a measure of overall function for a new psychometric rating instrument. A primarily outpatient sample of 224 subjects was assessed using the Bipolar Inventory of Symptoms Scale (BISS). The BISS total score and depression and mania subscales were compared to the Young Mania Rating Scale (YMRS), the Montgomery Asberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning Scale (GAF). Clinical mood states were also compared using the BISS. The BISS scores demonstrated good concurrent validity, with estimates (Pearson correlations) ranging from 0.74 to 0.94 for YMRS and MADRS and test–retest reliability from 0.95 to 0.98. BISS concurrent validity with the GAF was significant for four clinical states, but not mixed states. The BISS discriminated primary bipolar mood states as well as subjects recovered for eight weeks compared to healthy controls. In conclusion, the BISS is a reliable and valid instrument broadly applicable in clinical research to assess the comprehensive domains of bipolar disorder. Future directions include factor analysis and sensitivity to change from treatment studies. Copyright © 2008 John Wiley & Sons, Ltd.

Keywords: psychiatric status rating scales, psychometrics, bipolar disorder, psychological assessment

Full Text

The Full Text of this article is available as a PDF (176.8 KB).

REFERENCES

  1. Akiskal HS, Benazzi F (2005). Toward a clinical delineation of dysphoric hypomania – operational and conceptual dilemmas. Bipolar Disord 7(5): 456–464. [DOI] [PubMed] [Google Scholar]
  2. Altshuler LL, Suppes T, Black DO, Nolen WA, Leverich G, Keck PE Jr, Frye MA, Kupka R, McElroy SL, Grunze H, Kitchen CM, Post R (2006). Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second‐generation antidepressants. Am J Psychiatry 163: 313–315. [DOI] [PubMed] [Google Scholar]
  3. Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). The Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psychiatry 161: 2163–2177. [DOI] [PubMed] [Google Scholar]
  4. Benazzi F (2004). Depressive mixed state: a feature of the natural course of bipolar II (and major depressive) disorder? Psychopathology 37(5): 207–212. [DOI] [PubMed] [Google Scholar]
  5. Benazzi F, Koukopoulos A, Akiskal HS (2004). Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression). Eur Psychiatry 19: 85–90. [DOI] [PubMed] [Google Scholar]
  6. Berk M, Malhi GS, Mitchell PB, Cahill CM, Carman AC, Hadzi‐Pavlovic D, Hawkins MT, Tohen M (2004). Scale matters: the need for a Bipolar Depression Rating Scale (BDRS). Acta Psychiatr Scand 110(Suppl): 39–45. [DOI] [PubMed] [Google Scholar]
  7. Bowden CL, Singh V, Thompson P, Gonzalez JM, Katz MM, Dahl M, Prihoda T, Chang X (2007). Development of the Bipolar Inventory of Symptoms Scale. Acta Psychiatr Scand 116: 189–194. [DOI] [PubMed] [Google Scholar]
  8. Cassidy F, Forest K, Murry E, Carroll BJ (1998). A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatry 55: 27–32. [DOI] [PubMed] [Google Scholar]
  9. Cohen J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edition. Hillsdale, NJ: Lawrence Erlbaum Associates. [Google Scholar]
  10. Dennehy EB, Suppes T, Crismon ML, Toprac M, Carmody TJ, Rush AJ (2004). Development of the Brief Bipolar Disorder Symptom Scale for patients with bipolar disorder. Psychiatry Res 127: 137–145. [DOI] [PubMed] [Google Scholar]
  11. Endicott J, Spitzer R (1978). A diagnostic interview: the Schedule of Affective Disorders and Schizophrenia. Arch Gen Psychiatry 35: 837–844. [DOI] [PubMed] [Google Scholar]
  12. Frye MA, Yatham LN, Calabrese JR, Bowden CL, Ketter TA, Suppes T, Adams BE, Thompson TR (2006). Incidence and time course of subsyndromal symptoms in patients with bipolar I disorder: an evaluation of 2 placebo‐controlled maintenance trials. J Clin Psychiatry 67: 1721–1728. [DOI] [PubMed] [Google Scholar]
  13. Frye MA, Grunze H, Suppes T, McElroy SL, Keck PE Jr, Walden J, Leverich GS, Altshuler LL, Nakelsky S, Hwang S, Mintz J, Post RM (2007). A placebo‐controlled evaluation of adjunctive modafinil in the treatment of bipolar depression. Am J Psychiatry 164: 1242–1249. [DOI] [PubMed] [Google Scholar]
  14. Kasper S, Lemming OM, de Swart H (2006). Escitalopram in the long‐term treatment of major depressive disorder in elderly patients. Neuropsychobiology 54: 152–159. [DOI] [PubMed] [Google Scholar]
  15. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005). Prevalence, severity, and comorbidity of 12‐month DSM‐IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62: 617–627. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Khan A, Brodhead AE, Kolts RL (2004). Relative sensitivity of the Montgomery‐Asberg depression rating scale, the Hamilton depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials: a replication analysis. Int Clin Psychopharmacol 19: 157–160. [DOI] [PubMed] [Google Scholar]
  17. Loo CK, Mitchell PB, McFarquhar TF, Malhi GS, Sachdev PS (2007). A sham‐controlled trial of the efficacy and safety of twice‐daily rTMS in major depression. Psychol Med 37(3): 341–349. [DOI] [PubMed] [Google Scholar]
  18. Mantere O, Melartin TK, Suominen K, Rytsala HJ, Valtonen HM, Arvilommi P, Leppamaki S, Isometsa ET (2006). Differences in Axis I and II comorbidity between bipolar I and II disorders and major depressive disorder. J Clin Psychiatry 67: 584–593. [DOI] [PubMed] [Google Scholar]
  19. Parabiaghi A, Bonetto C, Ruggeri M, Lasalvia A, Leese M (2006). Severe and persistent mental illness: a useful definition for prioritizing community‐based mental health service interventions. Soc Psychiatry Psychiatr Epidemiol 41(6): 457–463. [DOI] [PubMed] [Google Scholar]
  20. Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP, Bowden CL, Sachs GS, Nierenberg AA (2004). Long‐term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP‐BD). Biol Psychiatry 55: 875–881. [DOI] [PubMed] [Google Scholar]
  21. Ruggeri M, Leese M, Thornicroft G, Bisoffi G, Tansella M (2000). Definition and prevalence of severe and persistent mental illness. Br J Psychiatry 177: 149–155. [DOI] [PubMed] [Google Scholar]
  22. Sachs GS (1990). Use of clonazepam for bipolar affective disorder. J Clin Psychiatry 51(Suppl.): 31–34, discussion 50–53. [PubMed] [Google Scholar]
  23. Sachs GS, Thase ME, Otto MW, Bauer M, Miklowitz D, Wisniewski SR, Lavori P, Lebowitz B, Rudorfer M, Frank E, Nierenberg AA, Fava M, Bowden C, Ketter T, Marangell L, Calabrese J, Kupfer D, Rosenbaum JF (2003). Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP‐BD). Biol Psychiatry 53: 1028–1042. [DOI] [PubMed] [Google Scholar]
  24. Schaffer A, Zuker P, Levitt A (2006). Randomized, double‐blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression. J Affect Disord 96: 95–99. [DOI] [PubMed] [Google Scholar]
  25. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998). The Mini‐International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM‐IV and ICD‐10. J Clin Psychiatry 59(Suppl. 20): 22–33. [PubMed] [Google Scholar]
  26. Singh V, Bowden CL (2005). Concepts surrounding the diagnosis and treatment of mixed states in bipolar disorders. Clin Approaches Bipolar Disorders 4: 35–43. [Google Scholar]
  27. Thase ME, Macfadden W, Weisler RH, Chang W, Paulsson B, Khan A, Calabrese JR (2006). Efficacy of quetiapine monotherapy in bipolar I and II depression: a double‐blind, placebo‐controlled study (the BOLDER II study). J Clin Psychopharmacol 26: 600–609. [DOI] [PubMed] [Google Scholar]
  28. Tohen M, Bowden CL, Calabrese JR, Lin D, Forrester TD, Sachs GS, Koukopoulos A, Yatham L, Grunze H (2006). Influence of sub‐syndromal symptoms after remission from manic or mixed episodes. Br J Psychiatry 189: 515–519. [DOI] [PubMed] [Google Scholar]
  29. Trivedi MH, Rush AJ, Ibrahim HM, Carmody TJ, Biggs MM, Suppes T, Crismon ML, Shores‐Wilson K, Toprac MG, Dennehy EB, Witte B, Kashner TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS‐C) and Self‐Report (IDS‐SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS‐C) and Self‐Report (QIDS‐SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 34: 73–82. [DOI] [PubMed] [Google Scholar]
  30. Vatnaland T, Vatnaland J, Friis S, Opjordsmoen S (2007). Are GAF scores reliable in routine clinical use? Acta Psychiatr Scand 115: 326–330. [DOI] [PubMed] [Google Scholar]
  31. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978). A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133: 429–435. [DOI] [PubMed] [Google Scholar]

Articles from International Journal of Methods in Psychiatric Research are provided here courtesy of Wiley

RESOURCES