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

Gonzalo R. Quintana, Fernando P. Ponce, Javier I. Escudero-Pastén, Juan F. Santibáñez-Palma, Léna Nagy, Mónika Koós, Shane W. Kraus, Zsolt Demetrovics, Marc N. Potenza, Rafael Ballester-Arnal, Dominik Batthyány, Sophie Bergeron, Joël Billieux, Peer Briken, Julius Burkauskas, Georgina Cárdenas-López, Joana Carvalho, Jesús Castro-Calvo, Lijun Chen, Giacomo CioccaOrnella Corazza, Rita I. Csako, David P. Fernandez, Elaine F. Fernandez, Hironobu Fujiwara, Johannes Fuss, Roman Gabrhelík, Ateret Gewirtz-Meydan, Biljana Gjoneska, Mateusz Gola, Joshua B. Grubbs, Hashim T. Hashim, Md. Saiful Islam, Mustafa Ismail, Martha C. Jiménez-Martínez, Tanja Jurin, Ondrej Kalina, Verena Klein, András Költő, Chih-Ting Lee, Sang-Kyu Lee, Karol Lewczuk, Chung-Ying Lin, Christine Lochner, Silvia López-Alvarado, Kateřina Lukavská, Percy Mayta-Tristán, Dan J. Miller, Oľga Orosová, Gábor Orosz, Gabriel C. Quintero Garzola, Jano Ramos-Diaz, Kévin Rigaud, Ann Rousseau, Marco De Tubino Scanavino, Marion K. Schulmeyer, Pratap Sharan, Mami Shibata, Sheikh Shoib, Vera Sigre-Leirós, Luke Sniewski, Ognen Spasovski, Vesta Steibliene, Dan J. Stein, Berk C. Ünsal, Marie-Pier Vaillancourt-Morel, Marie Claire Van Hout, Beáta Bőthe

Research output: Contribution to journalArticlepeer-review


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
Early online date18 Jan 2024
Publication statusE-pub ahead of print - 18 Jan 2024


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


Dive into the research topics of 'Cross-cultural validation and measurement invariance of anxiety and depression symptoms: A study of the Brief Symptom Inventory (BSI) in 42 countries'. Together they form a unique fingerprint.

Cite this