A New Routine for Analyzing Brief Symptom Inventory Profiles in Chronic Pain Patients to Evaluate Psychological Comorbidity

Question: Comorbidity, i.e., additional psychological distress in patients already suffering from chronic somatic diseases (e.g., orthopedic conditions) is of growing importance. The quality of analyzing and interpreting the often used Brief Symptom Inventory (BSI) used with orthopedic patients should improve by employing a new “case definition” of four groups (instead of two) of differentially psychologically distressed patients instead of two groups as before. Methods: Four groups with the different psychological distress definitions of “no,” “mild,” “remarkable,” and “severe” were to be analyzed from a group of 639 orthopedic patients in inpatient rehabilitation clinics. The BSI is transformed into T values (M=50, SD=10). There is “no” distress if no T [two scales] is ≥60 and “mild” distress if T [two scales] and/or T [GSI] is ≥60 and <63. If T [two scales] and/or T [GSI] is ≥63 and <70, it is “remarkable,” and if T [two scales] and/or T [GSI] ≥70, it speaks for “severe” psychological distress. Results: The new tool for analyzing psychological distress based on the T-scores of the BSI resulted in the following four groups: No psychological distress (41.9%): unspecific health-related information stands for a useful intervention. About 13.3% demonstrated low psychological distress: shorter diagnostic interviews and a few more diagnostic examinations led to a low-level outpatient group program to improve health and well-being in a preventive sense; one repeated measurement in 4weeks is advised. Remarkable psychological distress (26%): in-depth exploration using interviews, tests, and questionnaires to choose specific interventions in a single and/or group setting, outpatient or inpatient treatment; repeated measurements and process control. About 18.8% reported severe psychological distress: in-depth exploration led to specific interventions in a single and/or group setting, almost an inpatient setting; immediately crisis intervention and high-frequent process control. Conclusion: The new evaluation strategy of the BSI should improve practice and research; further investigation is necessary.