{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T06:30:21Z","timestamp":1786516221502,"version":"build-2736575974"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Brief Symptom Inventory-18 (BSI-18) is a widely used self-report measure of psychological distress assessing somatization, depression, and anxiety. Although German population norms were published in 2017 based on data from 2009, updated psychometric evidence using modern statistical methods is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The BSI-18 was administered to a random probability sample representative of the German residential population aged 16 years and older (N\u00a0=\u00a02,519; 52.5% women; age range 16\u201396 years), collected between December 2020 and March 2021. Psychometric evaluation included confirmatory factor analysis (CFA) with the weighted least squares mean and variance adjusted (WLSMV) estimator, internal consistency (McDonald\u2019s omega and Cronbach\u2019s alpha with bootstrap confidence intervals), measurement invariance across gender, age, and clinical screening status, construct validity via latent correlations with the PHQ-9, GAD-7, and CFQ-11, and age- and gender-stratified population norms. Cross-cohort comparisons were conducted with the normative sample from 2009.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The correlated three-factor model showed good fit (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (132) = 644, CFI\u00a0=\u00a00.986, RMSEA\u00a0=\u00a00.039, 90% CI [0.036, 0.042]). Internal consistency was good to very good (Global Severity Index [GSI]: \u03c9 = 0.966; subscales: \u03c9 = 0.855 to 0.893). Full measurement invariance was established across gender, age, and clinical screening status. Latent correlations confirmed the hypothesized convergent validity pattern for depression (PHQ-9:\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.912), anxiety (GAD-7:\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.889) and somatization (CFQ-11:\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.580). Women scored higher on all scales (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a0-0.11 to -0.14). Cross-cohort comparisons revealed no significant change in the GSI (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a0-0.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.105) or depression (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a00.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.200), whereas somatization (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a0-0.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) and anxiety (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a0-0.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.006) scores were significantly lower in 2020\/21.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The German BSI-18 demonstrated sound psychometric properties, including full measurement invariance. The updated population norms provide a useful reference for clinical practice. Cross-cohort comparisons revealed no general increase in distress during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1877721","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:54:33Z","timestamp":1786514073000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychometric properties and population norms of the Brief Symptom Inventory-18 (BSI-18) based on a representative German sample"],"prefix":"10.3389","volume":"17","author":[{"given":"S\u00f6ren","family":"Kliem","sequence":"first","affiliation":[{"name":"Department of Social Welfare, Ernst-Abbe University of Applied Sciences Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lohmann","sequence":"additional","affiliation":[{"name":"Department of Social Welfare, Ernst-Abbe University of Applied Sciences Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Social Welfare, Ernst-Abbe University of Applied Sciences Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Zenger","sequence":"additional","affiliation":[{"name":"Faculty of Applied Human Studies, University of Applied Sciences Magdeburg and Stendal","place":["Stendal, Germany"]},{"name":"Integrated Research and Treatment Center Adiposity Diseases - Behavioral Medicine Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center","place":["Leipzig, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Baier","sequence":"additional","affiliation":[{"name":"Institute of Delinquency and Crime Prevention, Zurich University of Applied Sciences","place":["Zurich, Switzerland"]},{"name":"Crimelab, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Br\u00e4hler","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz","place":["Mainz, Germany"]},{"name":"Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center","place":["Rostock, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg M.","family":"Fegert","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Hettich-Damm","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Sachser","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100341","article-title":"The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990\u20132019: findings from the Global Burden of Disease Study 2019","volume":"16","author":"Castelpietra","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"B2","first-page":"13","article-title":"SCL-90: an outpatient psychiatric rating scale \u2013 preliminary report","volume":"9","author":"Derogatis","year":"1973","journal-title":"Psychopharmacol Bull"},{"key":"B3","volume-title":"SCL-90: Administration, Scoring, and Procedures Manual","author":"Derogatis","year":"1977"},{"key":"B4","volume-title":"SCL-90-R: Administration, Scoring, and Procedures Manual","author":"Derogatis","year":"1994"},{"key":"B5","volume-title":"Scl-90-R \u2013 Symptom-Checkliste-90-R. 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