Evidence-based assessment/Instruments/General Behavior Inventory
The General Behavior Inventory (GBI) is a questionnaire designed by Richard Depue and colleagues to measure manic and depressive symptoms in adults, as well as to assess for cyclothymic disorder. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder in research, and it also can track the fluctuation of symptoms over time. The GBI was first designed for use with adults; however, it has been adapted into versions that allow parents to rate their children. Multiple short versions are available that are often more convenient to use. Current versions include the original full length GBI (self-report), the Parent GBI (P-GBI), the Parent GBI-10-item Mania Scale (P-GBI-10M) and two Parent GBI-10-item Depression Scales (Form A & B), and the 7 Up-7 Down Inventory, as well as a Sleep scale. A version was tested as a teacher-report version, but it proved not to be practical for general use.
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Access and UseEdit
The General Behavior Inventory is free to use in both research and clinical work. Some of the short forms have been formally CC-BY-SA licensed. The original author, Richard Depue, asks that you contact him to let him know about the project (email@example.com). The GBI has been translated into several languages (in short forms as well as full length, and parent as well as self-report); see the External Links section for a link to an extensive repository.
Suggested citations are:
Self report, full length versionEdit
Depue, R. A., Slater, J. F., Wolfstetter-Kausch, H., Klein, D. N., Goplerud, E., & Farr, D. A. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies. Journal of Abnormal Psychology, 90, 381-437. https://doi.org/10.1037/0021-843X.90.5.381
and if using specifically in teens:
Danielson, C. K., Youngstrom, E. A., Findling, R. L., & Calabrese, J. R. (2003). Discriminative validity of the General Behavior Inventory using youth report. Journal of Abnormal Child Psychology, 31, 29-39.
Parent report about youth symptoms (full length version):Edit
Youngstrom, E. A., Findling, R. L., Danielson, C. K., & Calabrese, J. R. (2001). Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychological Assessment, 13, 267-276.
Teacher report (not recommended for clinical use):Edit
Youngstrom, E. A., Joseph, M. F., & Greene, J. (2008). Comparing the psychometric properties of multiple teacher report instruments as predictors of bipolar disorder in children and adolescents. Journal of Clinical Psychology, 64, 382-401. http://dx.doi.org/10.1002/jclp.20462
Meyers, O. I., & Youngstrom, E. A. (2008). A Parent General Behavior Inventory subscale to measure sleep disturbance in pediatric bipolar disorder. Journal of Clinical Psychiatry, 69, 840-843. https://doi.org/ej07m03594
10 Item Mania and Depression formsEdit
Youngstrom, E. A., Van Meter, A. R., Frazier, T. W., Youngstrom, J. K., & Findling, R. L. (2018). Developing and validating short forms of the Parent General Behavior Inventory Mania and Depression Scales for rating youth mood symptoms. Journal of Clinical Child & Adolescent Psychology. https://doi.org/https://doi.org/10.1080/15374416.2018.1491006
Youngstrom, E. A., Perez Algorta, G., Youngstrom, J. K., Frazier, T. W., & Findling, R. L. (2020). Evaluating and Validating GBI Mania and Depression Short Forms for Self-Report of Mood Symptoms. Journal of Clinical Child & Adolescent Psychology, 1-17.
7 Up-7 DownEdit
Youngstrom, E. A., Murray, G., Johnson, S. L., & Findling, R. L. (2013). The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory. Psychological Assessment, 25, 1377-1383. https://doi.org/10.1037/a0033975
Note that the 7 Up has less content coverage, and small but significant differences in reliability and validity compared to the 10 item mania scale. Another practical (and sometimes ethical) consideration is that the 7 Down includes the suicidal ideation item, whereas the 10 item depression short forms do not ask about suicidal ideation.
Other short forms have not been extensively published or replicated.
Scoring and interpretationEdit
The current GBI questionnaire includes 73 Likert-type items which reflect symptoms of different moods, and six additional validity items at the end. The original version of the GBI used "case scoring" where items were coded as "threshold" or "not at threshold." Symptoms that were rated as 1 or 2 were considered to be absent and symptoms rated as 3 or 4 were considered to be present. However, Likert scaling would be a better scoring option. The items on the GBI are now scaled from 0-3 rated as 0 (never or hardly ever present), 1 (sometimes present), 2 (often present), and 3 (very often or almost constantly present). All versions that we are circulating now use the 0 to 3 anchors. The scoring for the self-report and parent report versions are the same for the full length, sleep, and 10 and 7 item short forms.
The Depression Scale consists of the sum of items:
01, 03, 05, 06, 09, 10, 12, 13, 14, 16, 18, 20, 21, 23, 25,
26, 28, 29, 32, 33, 34, 36, 37, 39, 41, 44, 45, 47, 49, 50, 52,
55, 56, 58, 59, 60, 62, 63, 65, 67, 68, 69, 70, 71, 72, 73.
The Hypomanic/Biphasic scale sums these items:
02, 04, 07, 08, 11, 15, 17, 19, 22, 24, 27, 30, 31, 35, 38, 40, 42, 43, 44, 46, 48, 51, 53, 54, 57, 61, 64, 66. (Note that Depue's scoring includes item 44 on both the depression and the hypomanic/biphasic scale).
To compare scores to data offered by Youngstrom et al. (any publication), just add the items (if scored 0 to 3), or add the items and subtract the number of items on the scale (if scored 1 to 4). To compare scores to college student and adult data (published by Depue, Klein, and others), check carefully whether to use the 0/1 case scoring method versus a form of Likert scoring, as appropriate.
GBI Short FormsEdit
There are several short forms that have been carved from the GBI. These include the 10-item mania and depression scales, as well as the 7-item versions (the 7 Up-7 Down scale), and a sleep scale.
For all of these, the score is simply the sum of the items. If these are given as standalone scales, the the 10 item scales are the sum of the ten items.
If the 73-item version is given, then these are the items to extract for each short form:
- Sleep (7 items): 5, 15, 18, 25, 31, 37, 52.
- 5 and 18 load on a lassitude factor, and 52 crossloads
- 15, 25, 31, 37 and 52's main loading are on the larger insomnia factor
- 10 item Mania: 53, 54, 4, 11, 22, 40, 27, 19, 64, 31.
- 10 item Depression Form A: 3, 45, 68, 16, 56, 13, 5, 20, 50, 59.
- 10 item Depression Form B: 34, 14, 63, 72, 62, 9, 23, 6, 32, 18).
- 7 Down: 23, 34, 63, 47, 56, 62, 73.
- 7 Up: 22, 31, 30, 64, 43, 46, 38.
- Hypomania (Depue's scoring): 4, 7, 8, 11, 15, 17, 22, 27, 30, 31, 38, 42, 43, 44, 46, 51, 54, 57, 61, 64, 66.
- Mixed (Depue's scoring): 2, 19, 24, 35, 40, 48, 53).
Note that researchers have used other sets of items as short forms.
A sortable table below shows the overlap between items across the different forms, along with the item content:
Additional research versions:
- LAMS 12 Item self report: 52, 40, 44, 59, 19, 29 (factor 1); 11, 7, 31, 38, 22, 4 (factor 2).
- Lewinsohn used a 12 item version in the Oregon epidemiological study: 4, 8, 11, 15, 30, 44, 51, 64 (all from Depue's hypomanic set); 2, 19, 24, 48 (from Depue's mixed set). Boldfaced items overlap with the 10M scale and could be used in a calibration study.
- Jensen et al. rationally derived a 7 item impulsive aggression scale: 27, 42, 44, 51, 14, 39, 53, 54.
|Item #||Variable||Depue 2 scale||Depue 3 scale||7Up-7D||Sleep||10 item Forms||LAMS 12||Impulsive Aggression||Parcel||Parcel Label||Content|
|22||agbi22||HB||hyp||u||M||F2||4||elated mood||Has your child had periods of extreme happiness and intense energy lasting several days or more when he/she also felt much more anxious or tense (jittery, nervous, uptight) than usual (other than related to the menstrual cycle)?|
|31||agbi31||HB||hyp||u||sleep||M||F2||4||elated mood||Has your child had periods of extreme happiness and intense energy (clearly more than his/her usual self) when, for several days or more, it took him/her over an hour to get to sleep at night?|
|64||agbi64||HB||hyp||u||M||7||racing thoughts, cog disturb (up)||Has your child had times when his/her thoughts and ideas came so fast that he/she couldn’t get them all out, or they came so quickly others complained that they couldn’t keep up with your child ideas?|
|4||agbi04||HB||hyp||M||F2||3||Increased energy||Has your child experienced periods of several days or more when, although he/she was feeling unusually happy and intensely energetic (clearly more than your child’s usual self), he/she was also physically restless, unable to set still, and had to keep moving or jumping from one activity to another?|
|11||agbi11||HB||hyp||M||F2||5||high drive||Have there been periods of several days or more when your child’s friends or other family members told you that your child seemed unusually happy or high – clearly different from his/her usual self or from a typical good mood?|
|19||agbi19||HB||mix||M||F1||2||Mood never in middle||Has your child’s mood or energy shifted rapidly back and forth from happy to sad or high to low?|
|27||agbi27||HB||hyp||M||ImpAgg||6||rage, manic irritability||Have there been times of several days or more when, although your child was feeling unusually happy and intensely energetic (clearly more than his/her usual self), he/she also had to struggle very hard to control inner feelings of rage or an urge to smash or destroy things?|
|40||agbi40||HB||mix||M||F1||2||Mood never in middle||Have you found that your child’s feelings or energy are generally up or down, but rarely in the middle?|
|53||agbi53||HB||mix||M||ImpAgg||2||Mood never in middle||Has your child had periods lasting several days or more when he/she felt depressed or irritable, and then other periods of several days or more when he/she felt extremely high, elated, and overflowing with energy?|
|54||agbi54||HB||hyp||M||ImpAgg||6||rage, manic irritability||Have there been periods when, although your child was feeling unusually happy and intensely energetic, almost everything got on his/her nerves and make him/her irritable or angry (other than related to the menstrual cycle?|
|23||agbi23||dep||dep||d||Db||9||feels sad||Have there been times of several days or more when your child was so sad that it was quite painful for him/her, or he/she felt that he/she couldn’t stand it?|
|34||agbi34||dep||dep||d||Db||18||rumination(?)||Over the past year, have there been long periods in your child’s life when he/she felt sad, depressed, or irritable most of the time?|
|62||agbi62||dep||dep||d||Db||10||hopeless, low self-esteem||Has your child had periods when it seemed that the future was hopeless and things could not improve?|
|63||agbi63||dep||dep||d||Db||9||feels sad||Have there been periods lasting several days or more when your child was so down in the dumps that he/she thought he/she might never snap out of it?|
|6||agbi06||dep||dep||Db||20||tearful, sad appearance||Have people said that your child looked sad or lonely?|
|9||agbi09||dep||dep||Db||11||loss of interest||Have there been periods lasting several days or more when your child lost almost all interest in people close to him/her and spent long times by himself/herself?|
|14||agbi14||dep||dep||Db||ImpAgg||15||dep irritable mood||Has your child had periods of sadness and depression when almost everything gets on his/her nerves and makes him/her irritable or angry (other than related to the menstrual cycle)?|
|18||agbi18||dep||dep||sleep||Db||19||atypical dep features||Have there been times of several days or more when your child was so tired and worn out that it was very difficult or even impossible to do his/her normal everyday activities (not including times of intense exercise, physical illness, or heavy work schedules)?|
|32||agbi32||dep||dep||Db||18||rumination||Over the past year, have there been times when your child looked back over his/her life and could see only failures or hardships?|
|72||agbi72||dep||dep||Db||18||rumination||Have there been periods of time when your child felt a persistent sense of gloom?|
|56||agbi56||dep||dep||d||Da||10||hopeless, low self-esteem||Have there been times of several days or more when your child really got down on himself/herself and felt worthless?|
|3||agbi03||dep||dep||Da||9||feels sad||Has your child become sad, depressed, or irritable for several days or more without really understanding why?|
|5||agbi05||dep||dep||sleep||Da||14||sleep disturb (dep)||Have there been periods of several days or more when your child felt he/she needed more sleep, even though he/she slept longer at night or napped more during the day (not including times of exercise, physical illness, or heavy work schedules)?|
|13||agbi13||dep||dep||Da||11||loss of interest||Have there been times when your child lost almost all interest in the things that he/she usually likes to do (such as hobbies, school, work, entertainment)?|
|16||agbi16||dep||dep||Da||17||somatic sx (appetite & sleep)||Has your child had long periods in which he/she felt that he/she couldn’t enjoy life as easily as other people?|
|20||agbi20||dep||dep||Da||18||rumination||Have there been periods lasting several days or more when your child spent much of his/her time brooding about unpleasant things that have happened?|
|45||agbi45||dep||dep||Da||9||feels sad||Over the past year, have there been times of several days or more when your child was so down that nothing (not even friends or good news) could cheer him/her up?|
|50||agbi50||dep||dep||Da||16||excess guilt & paranoia||Has your child had sad and depressed periods lasting several days or more when he/she also felt much more anxious or tense (jittery, nervous, uptight) than usual (other than related to the menstrual cycle)?|
|59||agbi59||dep||dep||Da||F1||12||low energy/anhedonia||Have there been periods of several days or more when your child was slowed down and couldn’t move as quickly as usual?|
|68||agbi68||dep||dep||Da||19||atypical dep features||Has your child had long periods when he/she was down and depressed, interrupted by brief periods when his/her mood was normal or slightly happy?|
|30||agbi30||HB||hyp||u||4||elated mood||Have there been times lasting several days or more when your child felt he/she must have lots of excitement, and he/she actually did a lot of new or different things?|
|38||agbi38||HB||hyp||u||F2||8||grandiosity||Has your child had periods of extreme happiness and high energy lasting several days or more when what your child saw, heard, smelled, tasted, or touched seemed vivid or intense?|
|43||agbi43||HB||hyp||u||8||grandiosity||Have there been periods of several days or more when your child’s thinking was so clear and quick that it was much better than most other people’s?|
|46||agbi46||HB||hyp||u||8||grandiosity||Have there been times of several days or more when your child felt that he/she was a very important person or that his/her abilities or talents were better than most other people’s?|
|47||agbi47||dep||dep||d||10||hopeless, low self-esteem||Have there been times when your child hated himself/herself or felt that he/she was stupid, ugly, unlovable, or useless?|
|73||agbi73||dep||dep||d||10||hopeless, low self-esteem||Have there been times when your child felt that he/she would be better off dead?|
|1||agbi01||dep||dep||13||cog disturb (dep)||Have there been periods in your child’s life over the past year when it was almost impossible to make small decisions even though this may not be generally true of him/her?|
|2||agbi02||HB||mix||1||Extremes of Mood & Energy||Have you found your child’s enjoyment in being with people changes -- from times when he/she enjoys them immensely and wants to be with them all the time, to times when he/she does not want to see them at all?|
|7||agbi07||HB||hyp||F2||3||Increased energy||Have there been periods of several days or more when your child was almost constantly active such that others told you they couldn’t keep up with him/her or that he/she wore them out?|
|8||agbi08||HB||hyp||7||racing thoughts, cog disturb (up)||Have there been periods of several days or more when your child could not keep his/her attention on any one thing for more than a few seconds, and his/her mind jumped rapidly from one thought to another or to things around him/her?|
|10||agbi10||dep||dep||11||loss of interest||Has your child had periods of several days or more when food seemed rather flavorless and he/she didn’t enjoy eating at all?|
|12||agbi12||dep||dep||13||cog disturb (dep)||Have there been times when your child’s memory or concentration seemed especially poor and he/she found it difficult, for example, to read or follow a TV program, even though he/she tried?|
|15||agbi15||HB||hyp||sleep||3||Increased energy||Have there been times of several days or more when your child did not feel the need for sleep and was able to stay awake and alert for much longer than usual because he/she was full of energy?|
|17||agbi17||HB||hyp||5||high drive||Has your child had periods of several days or more when he/she wanted to be with people so much of the time that they asked your child to leave them alone for awhile?|
|21||agbi21||dep||dep||12||low energy/anhedonia||Have there been times when your child felt that he/she was physically cut off from other people or from himself/herself, or felt as if he/she was in a dream, or felt that the world looked different or had changed in some way?|
|24||agbi24||HB||mix||1||Extremes of Mood & Energy||Have you found that your child’s enjoyment in eating changes – from periods of two or more days when food tastes exceptionally good, clearly better than usual, to other periods of several days or more when food seems rather flavorless and perhaps your child doesn’t enjoy eating at all?|
|25||agbi25||dep||dep||sleep||14||sleep disturb (dep)||Have there been times of several days or more when your child wakes up much too early in the morning and has problems getting back to sleep?|
|26||agbi26||dep||dep||19||atypical dep features||Has your child had periods when he/she was so down that he/she found it hard to start talking or that talking took too much energy?|
|28||agbi28||dep||dep||20||tearful, sad appearance||Have there been periods other than when your child was physically ill that he/she had more than one of the following:|
|29||agbi29||dep||dep||F1*||16||excess guilt & paranoia||Has your child experienced periods of several days or more when he/she was feeling down and depressed, and he/she also was physically restless, unable to sit still, and had to keep moving or jumping from one activity to another?|
|33||agbi33||dep||dep||12||low energy/anhedonia||Has your child experienced times of several days or more when he/she felt as if he/she was moving in slow motion?|
|35||agbi35||HB||mix||1||Extremes of Mood & Energy||Has it seemed that your child experiences both pleasurable and painful emotions more intensely than other people?|
|36||agbi36||dep||dep||16||excess guilt & paranoia||Have there been periods of several days or more when your child felt guilty and thought he/she deserved to be punished for something he/she had or had not done?|
|37||agbi37||dep||dep||sleep||14||sleep disturb (dep)||Has your child had times of several days or more when he/she woke up frequently or had trouble staying asleep during the middle of the night?|
|39||agbi39||dep||dep||ImpAgg||15||dep irritable mood||Have there been times when your child was feeling low and depressed, and he/she also had to struggle very hard to control inner feelings of rage or an urge to smash or destroy things?|
|41||agbi41||dep||dep||13||cog disturb (dep)||Has your child had periods of several days or more when it was difficult or almost impossible to think and his/her mind felt sluggish, stagnant, or “dead”?|
|42||agbi42||HB||hyp||ImpAgg||5||high drive||Have there been times when your child had a strong urge to do something mischievous, destructive, risky, or shocking?|
|44||agbi44||dep||dep||F1||ImpAgg||6||rage, manic irritability||Have there been times when your child exploded at others and afterwards felt bad about himself/herself?|
|48||agbi48||HB||mix||1||Extremes of Mood & Energy||Have you found that your child’s thinking changes greatly – that there are periods of several days or more when he/she thinks better than most people, and other periods when his/her mind doesn’t work well at all?|
|49||agbi49||dep||dep||12||low energy/anhedonia||Have there been times of a day or more when your child had no feelings or emotions and seemed cut off from other people?|
|51||agbi51||HB||hyp||5||high drive||Have there been times when your child has done things – like perhaps driving recklessly, taking a trip on the spur of the moment, creating a public disturbance, being more sexually active than usual, getting into fights, destroying property, or getting into trouble with the law – which he/she later thought showed poor judgment?|
|52||agbi52||dep||dep||sleep||F1||14||sleep disturb (dep)||Has your child had periods of sadness and depression when, for several days or more, it took him/her over an hour to get to sleep at night, even though he/she was very tired?|
|55||agbi55||dep||dep||15||dep irritable mood||Have there been times when upsetting or bad thoughts kept going through your child’s mind and he/she couldn’t stop them?|
|57||agbi57||HB||hyp||7||racing thoughts, cog disturb (up)||Have there been times when your child had blank spells in which his/her activities were interrupted, and he/she did not know what was going on around him/her?|
|58||agbi58||dep||dep||19||atypical dep features||Has your child had sad and depressed periods of several days or more, interrupted by periods lasting between an hour to a day when he/she felt extremely happy and intensely energetic?|
|60||agbi60||dep||dep||17||somatic sx (appetite & sleep)||Has your child experienced weight changes (increases, decreases, or both) of five (5) pounds or more in short periods of time (three weeks or less), not including changes due to physical illness, menstruation, exercise, or dieting?|
|61||agbi61||HB||hyp||8||grandiosity||Have there been periods of a couple days or more when your child’s sexual feelings and thoughts were almost constant, and he/she couldn’t think about anything else?|
|65||agbi65||dep||dep||17||somatic sx (appetite & sleep)||Have there been times of several days or more when your child felt very down and depressed during the early part of the day, but then less so during the evening?|
|66||agbi66||HB||hyp||4||elated mood||Have then been times when your child began many new activities with lots of enthusiasm and then found himself/herself quickly losing interest in them?|
|67||agbi67||dep||dep||17||somatic sx (appetite & sleep)||Have you found that your child’s mood consistently follows the seasons, where he/she has long periods of depression during the winter but mostly happy periods during the summer?|
|69||agbi69||dep||dep||20||tearful, sad appearance||Have there been times of several days or more when your child has struggled to control an urge to cry, has had frequent crying spells, or found himself/herself crying without really understanding why (other than related to the menstrual cycle)?|
|70||agbi70||dep||dep||11||loss of interest||Have there been times of several days or more when almost all sexual interest was lost?|
|71||agbi71||dep||dep||16||excess guilt & paranoia||Has your child found himself/herself at times feeling fearful or suspicious or his/her environment or people around him/her?|
For all versions of the GBI, the full length scales have exceptionally high internal consistency reliability. This is due to a combination of the scale length (28 or 46 items) and the items asking about related symptoms, often in blends. The length of the scales and the high reading level make them less useful in many clinical settings. Item Response Theory (IRT) provides a different way of estimating the reliability of test scores that is not tied to the length of the scale. The IRT approach also has the advantage of seeing how reliable scores are across the range of the underlying trait. For the GBI, IRT would show whether the reliability stays at acceptable levels even at low levels of depression or manic symptoms (as would often be seen if using the scale in a general community setting or screening), as well as at the high end of mood symptom severity (as might be encountered in a hospital).
These figures compare the reliability for several of the short forms based on self report (i.e., teenagers using the GBI to describe themselves).
|10 Item Short Forms||7 Item Short Forms|
The GBI or P-GBI for assessing the probability of mood disordersEdit
The diagnostic accuracy of the test depends on the base rate of disorders for your sample. The positive and negative predictive value are directly influenced by base rate. However, the sensitivity and specificity of a test also can vary from sample to sample (Kraemer, 1992). For this reason, the cut scores published in any article cannot be assumed to be equally valid in new contexts. Please refer to the GBI Manual (available from Depue) and the monograph published in the Journal of Abnormal Psychology, for additional information about the measure. Two meta-analyses have included the GBI, one in youths under age 18, and the other as a self-report measure in adults. The GBI was in the top tier of measures in terms of diagnostic accuracy in both meta-analyses. However, the short forms have not had their diagnostic accuracy published in adult samples (i.e., all published work used the 73 item version).
Bipolar disorder is rare in most clinical settings (e.g., prevalence of less than 10% in outpatient and private practices, and 2-4% in the general population). Because of the low “base rate,” most people scoring high on any screening test are likely to not have the condition. Put another way, the “false positives” will outnumber the “true positives” in most situations unless bipolar disorder is fairly common where one is using the test.
The preferred method for using these tools would be to focus on the change in likelihood of a bipolar diagnosis based on high and low scores. Low scores on a good test decrease the odds that a given youth has a bipolar disorder, just as high scores should increase the odds. It is possible to formally combine (1) the change in odds associated with a test score and (2) the prior probability that the youth had a bipolar diagnosis to obtain a new estimate of the probability that the child has bipolar disorder. This can be done visually (using a “nomogram”), mathematically, by use of a table containing the posterior probabilities for a fixed prevalence, or using an online calculator. There are several excellent sources for clinicians who are interested in learning more about using changes in odds as a way of refining diagnosis, including the Prediction section in the materials about Evidence Based Assessment on Wikiversity.
The changes in odds (or diagnostic likelihood ratios) associated with scores on six different tests (the P-GBI, the P-YMRS, the Achenbach CBCL, TRF, and YSR, and the self-report GBI) based on a large sample of outpatients, and an update based a more recent review is available. We also are including a table here that is based on these likelihood ratios, estimating the probability that a child has bipolar disorder assuming a base rate of 5% in combination with a test score in the particular range. We chose the 5% base rate estimate for three reasons: (1) because other colleagues are estimating that 5% of the youths evaluated at outpatient academic research centers meet criteria for a bipolar spectrum disorder (e.g., 6-7% of outpatient cases evaluated in the TEAM multi-site NIMH grant; Geller et al., 2002); (2) because 5% is low enough to serve as a reminder that bipolar disorder is likely to be rare in community mental health, outpatient, and private practice settings, yet high enough to act as a reminder that the disorder can occur and should be assessed; (3) because a 5% base rate will be reduced to negligible probabilities by low or moderate scores on good tests, and raised to intermediate probabilities (30% to 50% range) by high scores on the same tests.
If bipolar disorder is substantially more rare or more common at your site than 5%, we strongly recommend using a rate compared to benchmarks from similar settings as the starting point.
|Target Diagnosis:||Bipolar||Bipolar||Bipolar||Any Mood|
(.54 to .67)
(.58 to .67)
(.56 to .65)
(.62 to .70)
|Sensitivity at Specificity=.9||.20||.22||.20||.23|
|DiLR+||2.0 raw 9+||2.2 raw 19+||2.0 raw 11+||2.3 raw 16+|
|Time Frame||Lifetime||Past year||Past year||Past year|
aFlesch-Kincaid estimate of grade level.
|Target Diagnosis:||Bipolar||Bipolar||Bipolar||Any Mood|
|Length (items)||10*||10*||1/2 page||10*|
(.80 to .84)
(.66 to .80)
(.54 to .72)
(.80 to .84)
|Sensitivity at Specificity=.9||.47||.21||.28||.52|
|DiLR+||4.7 raw 15.5+||2.1 raw 12+||2.8 raw 8+||5.2 raw 10+|
|Time Frame||Past year||Lifetime||Lifetime
Using the GBI to measure treatment responseEdit
The GBI has been used in several treatment studies, and it shows good sensitivity to treatment effects. The 10 item versions in particular are brief enough to be repeated during the course of treatment, but show similar effect sizes to interview-based ratings in research studies. The 7 Up-7 Down scales have not been tested in an extracted, standalone format in treatment studies yet.
Here are benchmarks for evaluating change during treatment:
|Minimal Important Difference|
*The benchmarks are based on clinical and nonclinical norms, following the "clinically significant change" model by Jacobson and colleagues.
Interpretive example for measuring treatment progress and outcomeEdit
Juan's mother fills out a PGI-10M and PGBI-10Da as part of an evaluation. Both of these have raw scores that range from 0 to 30. Juan initially scores a 21, which is in a high risk range for potential bipolar disorder. After the feedback and first therapy session, the score comes down to a 17 (4 point drop). This is larger than the "Minimally Important Difference" (MID) of 3, suggesting that this is large enough for the person to believe that treatment might be helping some.
However, the amount of change needed to be be confident that treatment is actually contributing to reliable change would need to be larger: The 95% confidence in change target is 6 points for this measure (equating to a reliable change index > 1.96 in Jacobson's approach).
After several months of treatment, Juan's score according to his mother's report is down to a 7. This is enough to be confident that treatment is helping. The 14 point reduction (21-7 = 14 point difference) not only exceeds the targets for MID and reliable change, but it also is lower than the "Back" into the normal range threshold of 9. The Back threshold is the 95th percentile for a reference group without bipolar disorder (in this case often with other mild or moderate clinical issues, as there is no nonclinical standardization sample for the PGBI, like most clinical symptom assessments). Scores this high are likely to still be noticeable and may be concerning to others, but they are also within the range of what could also occur for other reasons besides having a bipolar disorder, including problems in daily living as a youth or adult. The Back threshold is the most liberal of the "clinically significant change" definitions proposed by Jacobson and colleagues.
Reducing the score to a 6 or lower would satisfy Jacobson's "Closer" definition -- reliable change combined with a score more typical of the nonbipolar than bipolar reference groups (operationally defined as the weighted mean of the two groups). Again, scores of 5-6 may be noticeable and sometimes irritating, but they also are a marked improvement compared to where Juan started. This would be an even more impressive example of clinically significant change.
If treatment continued and succeeded in getting his score down to a 0 or 1, that would not only show near complete elimination of the symptoms, but it also would satisfy Jacobson's most stringent definition of clinically significant change -- getting the score Away from the clinical reference group (e.g., below the 2.5th percentile of the clinical reference group). This is an exceptionally stringent definition, and impossible to achieve with many outcome measures, where two SDs below average would require negative raw scores.
Peer Reviewed ResearchEdit
The first paper published on the GBI was in 1981, and research has appeared steadily since then. The GBI consistently has exceptional evidence of reliability, due to its combination of length and well-written (but complex) items. It has showed excellent evidence of discriminative validity in two meta-analyses, one focused on self-report in adults and the other looking at performance with children and teenagers. Miller et al. (2009) noted, in their review of assessment instruments for adult bipolar spectrum disorders:
As a diagnostic screening tool, the scale with the best support is the GBI, as it has consistently demonstrated sensitivity of approximately .75 and specificity above .97. Readers should be cautious, however, because multiple versions of the scale exist, and cutoffs for a positive screen have not been firmly established.
PubMed Search: Click here for a current search on PubMed, a free database that covers medicine (so some articles published in psychology journals might be missing). The entries will usually include abstracts, and sometimes will include a version of full text (especially if the project was grant funded). The search is designed to be highly specific (i.e., not including lots of irrelevant articles), but it might miss some articles.
Scoring syntax to make all of the above scales is available in SPSS in the OTOPS project. We are working on making a version available in R as well.
The code will work with any informant or language, provided that the variable names are the same. Because there are different versions of the GBI available on the Internet, please be careful to check that the content and order of the items is the same in the version you are using as in the 73 (+6 validity items) version that we used as the basis for the code. A second caveat is to check whether item level scores are typed in as 0 to 3 (the newer format) versus 1 to 4 (the original format).
If your institution has a Qualtrics license, you can import these .QSF files and have the survey read to launch out of the box, or you can customize it for your project.
Set of QSF files here. (*** upload to OSF and drop link to here).
Two papers that tested several short forms when used as parent report and as adolescent self report included supplemental materials that provided more detail about methods and results. These supplemental materials are published here so that they are freely accessible and archived (rather than having them only behind a publisher's paywall).
Factor Structure of the Short FormsEdit
Rationale for the Ranking of Expected Criterion CorrelationsEdit
Both papers had two samples, an academic clinic and a community mental health center, along with a large set of variables that could be used to examine the criterion validity of the short forms compared to the full length GBI scales.
Here is the detailed description of how the authors ranked the criterion correlations from what they expected to be largest to smallest:
The GBI scales were expected to show the highest correlation with the cognate rating scale on the Youth Self Report (YSR) because they were converging measures of the same trait, they were completed by the same informant (i.e., they shared method variance)(Podsakoff, MacKenzie, & Podsakoff, 2012), and they were continuous scales (not categorical variables, which would shrink the size of the observed correlation even when measuring the same construct) (Cohen, 1988).
The YSR Internalizing score was expected to show the highest correlation because of the shared method variance: both it and the GBI were completed by the same person. They would be expected to correlate r ~.3 to .4 even if they measured different constructs, due to response set, mood congruent biases, and other factors unrelated to the trait (Podsakoff et al., 2012). Further, Internalizing and Externalizing correlate r ~.6 in the standardization sample (Achenbach & Rescorla, 2001) and also in our samples. Finally, the 28-item and 10-item GBI versions included some “mixed” items, and so they had depression content embedded in them. The 7 Up, in contrast, was “purer” and showed lower correlations with Internalizing in both samples (though still > .4).
The YSR Externalizing score was the best available converging measure for the mania scales in the two samples, but it was not expected to show quite as high criterion correlations as the depression-Internalizing coefficients. A meta-analysis (Youngstrom, Genzlinger, Egerton, & Van Meter, 2015) of diagnostic accuracy shows that Externalizing is not as strongly associated with bipolar disorder as the GBI is: The effect size was r ~.45 for parent ratings on measures like the GBI, versus r ~.34 for measures such as the CBCL Externalizing; r ~.26 for GBI versus r ~ .13 for YSR correlations with diagnoses. The Externalizing score does not include items asking about grandiosity, inflated self-esteem, elevated or expansive mood, or decreased need for sleep without fatigue – the “handle” symptoms that are more specific to hypomania and mania (Craney & Geller, 2003; Youngstrom, Birmaher, & Findling, 2008). Put simply, Externalizing is not as good a measure of the mania construct as the GBI scales are, so the criterion correlation with it is not going to be stellar.
Next, the youth and parent correlations use different sources, eliminating the shared method variance component. Meta-analyses find that parent-youth agreement about the same trait in the youth hovers in the r ~.2 to .3 range (Achenbach, McConaughy, & Howell, 1987; De Los Reyes et al., 2015), exactly what we see in the Academic sample and similar to the estimates in the Community sample.
For the correlations with the diagnoses and interview-based severity ratings: Meta-analyses have established that parent report is significantly more strongly related to youth diagnoses than youth self-report is (Stockings et al., 2015; Youngstrom et al., 2015). Converting the effect sizes from Youngstrom et al. 2015 into correlations yields an estimate of r ~ .45 for parent ratings and corresponding youth diagnoses, versus .26 for youth ratings and their own diagnoses. The same pattern will hold for the YMRS and CDRS-R as the diagnoses – they were based on the same interview as the KSADS diagnoses, and so they correlate with the diagnosis r > .9. Because of attenuation artifacts when using a categorical variable (i.e., diagnosis) instead of a continuous one (i.e., severity on the YMRS or CDRS-R), we would expect the correlations with diagnosis to be about 80% of the size of the correlation with the severity rating (Cohen, 1988).
Depression scores were expected to show a small to moderate correlation with age as well as with female sex based on normative data (e.g., patterns in Internalizing scores in the standardization sample for the ASEBA; Achenbach & Rescorla, 2001). Anxiety diagnoses were expected to show a small to moderate correlation with depression scales due to overlapping symptoms (e.g., the tripartite model of depression and anxiety) (Chorpita & Daleiden, 2002; Watson, Clark, et al., 1995; Watson, Weber, et al., 1995).
Last in the rankings were some demographic variables (e.g., race) and unrelated diagnoses that were expected to have near-zero correlation coefficients.
- The Open Translations Project (TOpTraP) -- an effort to gather the translated versions of the best free measures in one place. The GBI 10 item mania and depression scales are available in more than two dozen languages; the full length version is available in several.
- EffectiveChildTherapy.Org information on Bipolar Disorder -- a website built for families to learn more about ways to improve social, emotional, and academic life for youths
- Society of Clinical Child and Adolescent Psychology -- the professional society for psychologists focusing on helping youths and families dealing with emotional and behavioral challenges
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- ↑ 1.0 1.1 1.2 Depue, Richard A.; Slater, J. F.; Wolfstetter-Kausch, H.; Klein, Daniel N.; Goplerud, E.; Farr, D. A. (1981). "A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies". Journal of Abnormal Psychology 90 (5): 381–437. doi:10/dcr7nc. ISSN KSL.
- ↑ Youngstrom, Eric A.; Joseph, Megan F.; Greene, Jamelle (2008). "Comparing the psychometric properties of multiple teacher report instruments as predictors of bipolar disorder in children and adolescents". Journal of Clinical Psychology 64 (4): 382–401. doi:10/cjbtds. ISSN 1097-4679.
- ↑ Depue, Richard A.; Slater, Judith F.; Wolfstetter-Kausch, Heidi; Klein, Daniel; Goplerud, Eric; Farr, David (1981). "A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies.". Journal of Abnormal Psychology 90 (5): 381–437. doi:10.1037/0021-843X.90.5.381. ISSN 1939-1846. http://doi.apa.org/getdoi.cfm?doi=10.1037/0021-843X.90.5.381.
- ↑ Youngstrom, Eric A.; Joseph, Megan F.; Greene, Jamelle (2008-04). "Comparing the psychometric properties of multiple teacher report instruments as predictors of bipolar disorder in children and adolescents". Journal of Clinical Psychology 64 (4): 382–401. doi:10.1002/jclp.20462. http://doi.wiley.com/10.1002/jclp.20462.
- ↑ Youngstrom, Eric A.; Van Meter, Anna; Frazier, Thomas W.; Youngstrom, Jennifer Kogos; Findling, Robert L. (2020-03-03). "Developing and Validating Short Forms of the Parent General Behavior Inventory Mania and Depression Scales for Rating Youth Mood Symptoms". Journal of Clinical Child & Adolescent Psychology 49 (2): 162–177. doi:10.1080/15374416.2018.1491006. ISSN 1537-4416. https://www.tandfonline.com/doi/full/10.1080/15374416.2018.1491006.
- ↑ Youngstrom, Eric A.; Murray, Greg; Johnson, Sheri L.; Findling, Robert L. (2013). "The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory.". Psychological Assessment 25 (4): 1377–1383. doi:10.1037/a0033975. ISSN 1939-134X. PMID 23914960. PMC PMC3970320. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0033975.
- ↑ Findling, RL; Youngstrom, EA; Danielson, CK; DelPorto-Bedoya, D; Papish-David, R; Townsend, L; Calabrese, JR (February 2002). "Clinical decision-making using the General Behavior Inventory in juvenile bipolarity.". Bipolar disorders 4 (1): 34–42. PMID 12047493.
- ↑ Youngstrom, E. A.; Van Meter, A.; Frazier, T. W.; Youngstrom, J. K.; Findling, R. L. (2018-07-24). "Developing and Validating Short Forms of the Parent General Behavior Inventory Mania and Depression Scales for Rating Youth Mood Symptoms". Journal of Clinical Child & Adolescent Psychology: 1–16. doi:10/gdvntr. ISSN (Electronic) 1537-4416 (Linking) 1537-4424 (Electronic) 1537-4416 (Linking).
- ↑ Youngstrom, E. A.; Murray, G.; Johnson, S. L.; Findling, R. L. (2013-12). "The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory". Psychological Assessment 25 (4): 1377–83. doi:10/f5kp9c. ISSN (Electronic) 1040-3590 (Linking) 1939-134X (Electronic) 1040-3590 (Linking).
- ↑ Meyers, O. I.; Youngstrom, E. A. (2008-05). "A Parent General Behavior Inventory subscale to measure sleep disturbance in pediatric bipolar disorder". Journal of Clinical Psychiatry 69 (5): 840–3. doi:ej07m03594 [pii]. ISSN (Electronic) 1555-2101 (Electronic).
- ↑ 11.0 11.1 Youngstrom, Eric A.; Genzlinger, Jacquelynne E.; Egerton, Gregory A.; Van Meter, Anna R. (2015). "Multivariate meta-analysis of the discriminative validity of caregiver, youth, and teacher rating scales for pediatric bipolar disorder: Mother knows best about mania". Archives of Scientific Psychology 3 (1): 112–137. doi:10/gf6zrb. ISSN 2169-3269.
- ↑ 12.0 12.1 Youngstrom, E. A.; Egerton, G. A.; Genzlinger, J.; Freeman, L. K.; Rizvi, S. H.; Van Meter, A. (2018-02-01). "Improving the global identification of bipolar spectrum disorders: Meta-analysis of the diagnostic accuracy of checklists". Psychological Bulletin 144: 315–342. doi:10/gc9fzw. ISSN (Electronic) 0033-2909 (Linking) 1939-1455 (Electronic) 0033-2909 (Linking).
- ↑ Youngstrom, E. A.; Murray, G.; Johnson, S. L.; Findling, R. L. (2013-12). "The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory". Psychological Assessment 25 (4): 1377–83. doi:10/f5kp9c. ISSN (Electronic) 1040-3590 (Linking) 1939-134X (Electronic) 1040-3590 (Linking).
- ↑ Merikangas, Kathleen R.; Pato, Michael (2009). "Recent developments in the epidemiology of bipolar disorder in adults and children: Magnitude, correlates, and future directions". Clinical Psychology: Science and Practice 16 (2): 121–133. doi:10/bdj38s. ISSN 1468-2850.
- ↑ 15.0 15.1 Straus, Sharon E.; Glasziou, Paul; Richardson, W. Scott; Haynes, R. Brian (2011). Evidence-based medicine: How to practice and teach EBM (4th ed.). New York, NY: Churchill Livingstone.
- ↑ Webb, M.P.K.; Sidebotham, D. (2020). "Bayes' formula: a powerful but counterintuitive tool for medical decision-making". BJA Education 20 (6): 208–213. doi:10.1016/j.bjae.2020.03.002. ISSN 2058-5349. PMID 33456952. PMC 7808025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808025/.
- ↑ "Bayesian Calculator". psych.fullerton.edu. Retrieved 2021-10-14.
- ↑ Youngstrom, E. A.; Findling, R. L.; Calabrese, Joseph R.; Gracious, B. L.; Demeter, C.; DelPorto Bedoya, D.; Price, Megan (2004). "Comparing the diagnostic accuracy of six potential screening instruments for bipolar disorder in youths aged 5 to 17 years". Journal of the American Academy of Child & Adolescent Psychiatry 43: 847–858. doi:10/fqjsq6.
- ↑ 19.0 19.1 Youngstrom, Eric A.; Morton, Emma; Murray, Greg (2020). "Bipolar disorder". In Eric A. Youngstrom. Assessment of Disorders in Childhood and Adolescence (5th ed.). New York, NY: Guilford Press. ISBN 978-1-4625-3898-0.
- ↑ Youngstrom, Eric; Zhao, Joan; Mankoski, Raymond; Forbes, Robert A.; Marcus, Ronald M.; Carson, William; McQuade, Robert; Findling, Robert L. (2013-03). "Clinical Significance of Treatment Effects with Aripiprazole versus Placebo in a Study of Manic or Mixed Episodes Associated with Pediatric Bipolar I Disorder". Journal of Child and Adolescent Psychopharmacology 23 (2): 72–79. doi:10.1089/cap.2012.0024. ISSN 1044-5463. PMID 23480324. PMC PMC3696952. http://www.liebertpub.com/doi/10.1089/cap.2012.0024.
- ↑ Christopher J. Miller, Sheri L. Johnson, and Lori Eisner, "Assessment Tools for Adult Bipolar Disorder," Clinical Psychology: Science and Practice 16, no. 2 (2009): 192–193. https://doi.org/10.1111/j.1468-2850.2009.01158.x
- ↑ 22.0 22.1 Youngstrom, Eric A.; Meter, Anna Van; Frazier, Thomas W.; Youngstrom, Jennifer Kogos; Findling, Robert L. (2018-07-24). "Developing and Validating Short Forms of the Parent General Behavior Inventory Mania and Depression Scales for Rating Youth Mood Symptoms". Journal of Clinical Child & Adolescent Psychology 0 (0): 1–16. doi:10.1080/15374416.2018.1491006. ISSN 1537-4416. PMID 30040496. https://doi.org/10.1080/15374416.2018.1491006.
- ↑ 23.0 23.1 Achenbach, T.M., & Rescorla, L.A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.