International Journal of Psychiatry in Clinical Practice, 2007; 11(1): 36
43

ORIGINAL ARTICLE

Psychometric properties of the BASIS-24# (Behaviour and Symptom

Identification Scale Revised) Mental Health Outcome Measure

I.M. CAMERON 1, L. CUNNINGHAM1, J.R. CRAWFORD2, J.M. EAGLES3, S.V. EISEN4,

K. LAWTON5, S.A. NAJI6 & R.J. HAMILTON1
1
Department of Mental Health, University of Aberdeen, Aberdeen, UK, 2School of Psychology, University of Aberdeen,
Aberdeen, UK, 3Royal Cornhill Hospital, Aberdeen, UK, 4Centre for Health Quality, Outcomes and Economic Research,
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA and Boston University School of Public Health, Boston, USA,
5
Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK, and 6School of Health Sciences,
Faculty of Health and Social Care, The Robert Gordon University, Aberdeen, UK

Abstract
Objective. Outcome measurement in mental health services is an area of considerable clinical interest and policy priority.
This study sought to assess the Behaviour and Symptom Identification Scale-24 (BASIS-24#), a brief, patient self-reported
measure of psychopathology and functioning, in a UK sample, including establishing population norms for comparative
purposes. Methods. Participants were 588 adults recruited from psychiatric inpatient, outpatient and primary care settings;
and 630 adults randomly sampled from primary care lists who completed the BASIS-24#, and the Brief Symptom
Inventory (BSI) at two time points. Results. BASIS-24# demonstrated adequate reliability (coefficient a values for
combined clinical sample across subscales ranged from 0.75 to 0.91), validity and responsiveness to change (effect size for
change of the BASIS-24# was 0.56 compared with 0.48 for BSI Global Severity Index). Population norms were established
for the general population and adult in-patients (at in-take). The scale proved straightforward to complete across clinical
settings. Variable rates of questionnaire distribution across clinical settings highlighted the ongoing challenge of
incorporating outcome measures in clinical settings. Conclusion. BASIS-24# is a brief, easily administered, self-complete
measure of mental well-being and functioning that adequately meets the requirements of reliability, validity and
responsiveness to change required of an outcome measure.

Key Words: Outcome measurement, psychiatry, mental health

Introduction investigations identified its predecessor, the BASIS-

32† [6] as a promising instrument.
In the UK, as with elsewhere, mental health policy
This study sought to address the following re-
has highlighted the need to introduce routine out-
search questions:
come measurement into mental health care settings
in order to provide useful information on patient 1) Does the BASIS-24# demonstrate psycho-
progress at individual, local and national levels [1,2]. metric robustness in a UK sample?
The Health of the Nation Outcome Scale (HoNOS) 2) Can population norms be established for BA-
[3] a clinician-rated scale, has been identified and SIS-24# which can provide useful comparison
developed as the instrument of choice for this. benchmarks for monitoring clinical progress?
Recognition has also been made for the need for
patient-rated outcome measures to accompany clin-
ician-rated measures [4]. The present authors pro-
pose the US developed BASIS-24# (Behaviour and Methods
Symptom Identification Scale-24): a simple, brief,
Samples
self-complete measure of psychopathology and func-
tioning for the routine collection of baseline and Adult patients (age 18
65 years), with a new episode
outcome data in mental health [5]. Preliminary of a mental health problem were recruited from

Correspondence: Isobel Cameron, Research Fellow, Department of Mental Health, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK.
Tel: /44 1224 557254. Fax: /44 1224 559320. E-mail: [email protected]

(Received 1 March 2006; accepted 15 June 2006)

ISSN 1365-1501 print/ISSN 1471-1788 online # 2007 Taylor & Francis
DOI: 10.1080/13651500600885531
 Psychometric properties of the BASIS-24# 37

three health care settings: psychiatric in-patient, population sample was analysed for responsiveness
Community Mental Health Teams (CMHTs) and to change, though no change was expected in this
primary care. group.
The internal consistency of the scale was exam-
ined using Cronbach’s a in order to gauge the extent
Measures
to which responses were consistent to items in the
The BASIS-24# is a self-report questionnaire de- total scale, and items purporting to measure a
signed to measure outcome of mental health treat- subscale. Values of a falling between 0.7 and 0.9
ment from the service user’s viewpoint. Responses were considered indicators of adequate internal
fall within six symptom and functioning domains: consistency [8].
Depression/functioning, Interpersonal relationships, How well the scores of the BASIS-24# can
Psychotic symptoms, Alcohol/drug use, Emotional predict external criteria was assessed by considering
lability and Self-harm. Its predecessor, the BASIS- health care setting as an indicator of severity of
32, whilst exhibiting face validity, ease of use and symptoms reported. Data were analysed to assess
sensitivity to change following treatment, also had whether responders in the in-patient setting reported
some limitations in terms of the reliability of some greater problems and symptom distress than respon-
of its subscales, its between group differentiation ders in the CMHT setting, and whether responders
and its accessibility to responders with limited in the CMHT setting reported greater distress than
literacy skills. For these reasons the present, revised responders in the primary care setting. The validity
version was developed. It can be viewed at www. of the scale was further assessed by analysing
basissurvey.org. The Brief Symptom Inventory (BSI) whether the subscales differentiated patients in
is a 53-tem measure of psychometric symptomatol- associated diagnostic groups.
ogy [7]. By asking respondents to complete both Responsiveness to clinical change over the two
measures, the responsiveness to change of the time points was measured by running paired t -tests
BASIS-24# could be considered in the context of on the BASIS-24# total score and the BSI Global
the established BSI. Severity Index (GSI); the effect size of both mea-
sures was then calculated [9].
Data collection Where data were normally distributed t -tests were
used to test for differences in group means and h2
All participants were asked to complete the BASIS- used as a measure of effect size. Where scores were
24# and the BSI on two occasions: at the outset of not normally distributed, Mann
Whitney or Wil-
the intervention and 3 months following (clinical coxon signed rank tests were carried out on these
sample), and at two time points 3 months apart data. Analyses were carried out using SPSS.
(general population sample). In-patients met with a
study researcher to receive the information before
completing the questionnaires independently. Power calculation
CMHT participants received the study information Samples of 500 in both patient and general popula-
from their treating clinician following which they tion groups at time point one are sufficient to yield
completed the questionnaire at home and returned it reliability estimates with confidence intervals of
by post. The primary care clinical sample received 0.1 at the appropriate level of significance [10] and
the study information by post from their general to generate stable percentiles for normative purposes
practitioner (primary care physician) shortly after [8]. The sample size also yields 90% power at the 5%
attending the practice. The general population significance level to assess the scale’s responsiveness
sample received their questionnaire by post. Samples to change (minimum detectable effect size of 0.12),
recruited by post were provided with contact details and a mean difference of 0.18 between the groups.
of the research team, should they wish to discuss the
study before consenting. Questionnaires for the
Ethical considerations
second time point were distributed by post to all
samples. For the clinical sample, diagnoses at time of Informed written consent was obtained before pa-
recruitment were obtained from medical notes (or tients participated. This research was conducted
the Continuous Morbidity Recording Register in the with the approval of the Grampian Research Ethics
case of primary care). Demographic information was Committee.
collected at the outset. For the 3-month follow up,
up to two reminders were sent.
Results
Analyses Recruitment
All analyses were carried out on the clinical samples A sample of 588 patients was recruited from the three
(in-patient, CMHT and primary care). The general health care settings: psychiatric in-patient (n /331;
38 I.M. Cameron et al.

63% of patients approached), CMHTs (n /165; which had more than six item responses missing
37% of patients approached) and primary care (n / were excluded. As the scores of the subscales were
92; 31% of patients approached). Figure 1 details not normally distributed, medians are represented in
how the in-patient sample was derived. In the Table II. Observational comparisons of scores can be
CMHT sample 156 (26% of newly referred patients) made between samples, as well as between time
did not receive packs where clinicians did not, or points, both of which are subjected to statistical
found it inappropriate to distribute the study infor- analyses further on in the results (see sections
mation. In the primary care sample 41% of eligible Concurrent criterion validity and Responsiveness to
patients did not receive study information where change).
doctors felt it inappropriate (37%) or for other
unspecified reasons (4%). A general population (i.e.
Reliability
internal consistency
non-clinical) sample of 630 (42% of 1513 adults
(18
65 years) randomly selected from three general Time point one a coefficients for the six subscales
practice lists) participated. and total score from the clinical samples are shown
The follow up questionnaire was completed in Table III. Coefficient a values for the total scale
by 418 (71%) of participants in the clinical arm are robust and comparable across the clinical set-
(in-patient /219 (66%), CMHT /124 (75%) and tings and time points. Values of a are also adequate
primary care /75 (82%)) and 506 (80%) of parti- for subscales across clinical groups with the excep-
cipants in the general population sample. tion of the psychosis and interpersonal relationships
subscales in the primary care setting. Overall,
reliability is higher in the in-patient and CMHT
Sample characteristics
samples.
Sample characteristics of all participants are shown
in Table I. As might be expected, differences were
Concurrent criterion validity
observed between the groups in terms of demo-
graphic characteristics (educational qualifications, Patients in the in-patient sample scored higher than
living arrangements and employment status) and patients in the CMHT sample; mean /2.04, sd /
primary diagnosis. Participants with a schizophrenic 0.69 versus 1.49, sd /0.62, p B/0.001, df /488,
illness or bipolar affective disorder are almost h2 /0.132. Patients in the CMHT sample scored
entirely represented in the in-patient setting and higher than patients in the primary care sample;
predictably, almost the entire primary care sample mean /1.49, sd /0.62 versus 1.18, sd /0.52, p B/
had been consulting their General Practitioner about 0.001, df /254, h2 /0.061. The depression/func-
a depressive or anxiety disorder. tioning subscale did not distinguish the sample with
The BASIS-24# raw item scores range from 0 (no a diagnosis of anxiety/depression from other patient
difficulty/symptoms never present) to 4 (extreme samples; median /2.6 (IQR /1.5, 3.3) versus 2.83
difficulty/symptoms always present). Six items re- (IQR /2, 3.5), p /0.09. The substance misuse scale
quire reverse scoring. Following this the scale can be successfully distinguished the substance misuse
scored by calculating a mean score for each subscale sample; median /2.5 (IQR /1.75, 3.25) versus
and for the total scale. Mean scores have been found 0.25 (IQR /0, 1), p B/0.001. The psychosis subscale
to be highly correlated with weighted mean scores successfully distinguished the psychotic sample;
developed more recently, and currently recom- median /1.5 (IQR /0.75, 2.5) versus 0.75 (IQR /
mended for the BASIS-24# instrument [11]. Cases 0, 1.5), p B/0.001.

psychiatric
admissions
n=966

Ineligible
Eligible n=158
n=808 (146 readmitted previous
recruits; 12 not in age range)

Approached Not approached

n=528 n=280

331 (63%) 115 too ill; 128 missed;

participated 10 too hostile; 16 transferred;
11 other e.g. staff,
spoke no English

Figure 1. In-patient sample recruitment.

 Psychometric properties of the BASIS-24# 39
Table I. Sample characteristics.

Characteristic N (%) In-patient CMHT Primary care General population

unless stated otherwise N/331 N/165 N/92 N/630

Sex (male) 185 (56) 66 (40) 27 (29) 300 (48)

Age (median, IQR*) 41 (30, 50) 37 (26, 48) 43 (35, 51) 45 (34, 54)
Ethnicity
White 321 (98) 163 (99) 91 (100) 610 (97)
Asian 2 (B/1) 2 (1) 0 11 (2)
Black 3 (1) 0 0 7 (1)
Other 1 (B/1) 0 0 1 (B/1)
First language English 308 (93) 158 (96) 87 (95) 593 (96)
Education
No qualification 91 (29) 25 (15) 13 (15) 111 (18)
O level/GCSE/CSE/Scottish 104 (33) 44 (27) 32 (36) 179 (29)
A level/Higher 38 (12) 38 (24) 16 (18) 55 (9)
Teaching/HND/nursing 39 (13) 27 (17) 14 (16) 74 (12)
Degree/post grad degree 41 (13) 28 (17) 14 (16) 204 (33)
Marital status
Married/living with partner 95 (30) 76 (47) 56 (61) 438 (70)
Separated 51 (16) 16 (10) 7 (8) 22 (4)
Divorced 55 (17) 13 (8) 12 (13) 39 (6)
Widowed 11 (3) 4 (2) 5 (5) 16 (3)
Never married 108 (34) 54 (33) 12 (13) 108 (17)
Employment status
Paid employment 94 (30) 79 (48) 58 (64) 484 (77)
Volunteer worker 42 (13) 16 (10) 9 (10) 70 (11)
Student 31 (9) 30 (19) 10 (11) 54 (9)
Receiving benefits
None 162 (49) 136 (82) 79 (86) 586 (94)
For medical reasons 82 (25) 21 (13) 8 (9) 36 (6)
For psychiatric reasons 99 (30) 7 (4) 4 (4) 4 (B/1)
For substance misuse reasons 11 (3) 0 0 1 (B/1)
Carstairs Deprivation Category (median, IQR*) 4 (2, 4) 3 (2, 4) 2 (1, 4) 2 (1,4)
Primary diagnosis not applicable
Schizophrenia, schizo-affective disorder and 93 (28) 5 (3) 0
other non affective psychotic disorders
Bipolar affective disorder
hypomanic phase 36 (11) 1 (B/1) 0
Depressive/anxiety disorder 149 (45) 141 (85) 90 (99)
Substance use disorder 32 (10) 3 (2) 1 (1)
Other 15 (5) 5 (3) 0
Nil psychiatric 5 (2) 10 (6) 0

* Interquartile range.

Responsiveness to change was 0.54 (0.29, 0.87) and at time point two 0.46
(0.25, 0.75), p /0.29. Similarly there was no differ-
Paired t -tests on the combined clinical samples
ence between the BSI GSI scores at the two time
indicated a significant change from time point one
to time point two in both the BASIS-24# and BSI, points. At time point one the median score was 0.21
reflecting a reduction in psychopathology. The total (0.08, 0.49) and at time point two 0.17 (0.06, 0.43),
score of the BASIS-24 was 1.68 (sd /0.71) at time p/0.34. In a non-clinical, non-intervention sample,
point one, and 1.28 (sd /0.74) at time point two no significant difference was to be expected.
(p B/0.001), df /405. The BSI Global Severity
Index (GSI) was 1.6 (sd /0.85) at time point one, Percentile tables
and 1.19 (0.9) at time point two (p B/0.001), df /
397. The effect size for change of the BASIS-24# To provide normative data for the BASIS-24#, a
was 0.56 compared with 0.48 for the BSI GSI, percentile table was constructed based on overall
indicating that the BASIS-24# is slightly more mean scores of the general population sample and
responsive to change than the 53-item BSI. the in-patient sample (Table IV). To illustrate the
Total scores in the general population sample were use of the percentile tables, suppose an individual’s
positively skewed, therefore BASIS-24# total scores score on the BASIS-24# is 2.00 on admission. By
at the two time points were subjected to Wilcoxon referring to Table IV, the percentiles derived from
signed rank test. At time point one the median score the general population sample show that the indivi-
40 I.M. Cameron et al.

Follow-up (3 months)
General Population sample Median (IQR)
dual is at the 97th percentile; that is, their score is

1..00)

1..20)
0.25)
0.25)

1.67)
0.00)
0.75)
Time/95 days
worse than 97% of the general population. Compar-

(92, 107)
N/505
ing this same raw score to the in-patient sample, it

(0.16,
(0.00,

(0.20,
(0.33,
(0.00,

(0.00,
(0.25,
can be seen that this score is at the 62nd percentile;
i.e. such a score is not unusual for inpatient

0.50

0.60
0.00
0.00

1.00
0.00
0.46
admissions but is towards the more severe end.
Suppose also that the individual’s BASIS-24# score
at follow-up was 0.67. It can be seen that, in the

1.20)
0.50)
0.25)

2.00)
0.00)
0.87)
1.17)
Time point 1

intervening period, the patient’s disturbance has

N/625

(0.20,
(0.17,
(0.00,
(0.00,

(0.67,
(0.00,
(0.29,
become much less marked; they are now broadly
scoring in the normal range although still above the
0.60
0.67
0.00
0.00

1.33
0.00
0.54
average of the general population (the score is at the
61st percentile).
Follow-up (3 months)

1.80)
1.92)
0.50)
0.50)

2.33)
0.00)
1.25)
Primary Care sample Median (IQR)

Time/97 days

Discussion
(92, 106)
N/74

(0.40,
(0.58,
(0.00,
(0.00,

(1.00,
(0.00,
(0.46,

BASIS-24# is a brief, easily administered, self-

complete measure of mental well-being and func-
1.00
1.33
0.00
0.00

1.67
0.00
0.88

tioning that adequately meets the requirements of

reliability, validity and responsiveness to change
1.80)
2.67)
0.50)
0.50)

2.00)
0.50)
1.49)

required of an outcome measure. This version of

Time point 1

the BASIS has demonstrated improved psycho-

N/92

(0.80,
(1.33,
(0.00,
(0.00,

(1.00,
(0.00,
(0.76,

metric properties in relation to its predecessor the

BASIS-32† [6] which while demonstrating strengths
1.40
2.00
0.00
0.25

1.33
0.00
1.19

also exhibited marginal internal consistency and

poor between group differentiation in some of its
Follow-up (3 months)

subscales. Additionally, the current psychometric

2.40)
2.71)
0.75)
1.00)

2.67)
1.00)
1.82)
Time/99 days

investigations are of greater relevance across the

CMHT sample Median (IQR)

(92, 106)
N/122

(0.95,
(1.00,

spectrum of mental health service provision, with

(0.00,
(0.00,

(1.33,
(0.00,
(0.77,

inclusion of patients from diverse clinical settings.

1.80
1.67
0.00
0.50

2.00
0.00
1.21

The previous UK validation of the BASIS-32 was

based on an in-patient sample only [6].
2.40)
3.00)
1.00)
1.19)

2.00)
1.00)
1.96)
Time point 1

Representativeness of sample
N/164

(1.50,

(1.20,
(0.00,
(0.00,

(1.00,
(0.00,
(1.04,

Sample characteristics identified patients with a

broad range of diagnoses in proportions which
2.33

1.80
0.25
0.50

1.33
0.00
1.45

correspond to the clinical setting of presentation.

The lack of ethnic diversity is reflective of Scotland
Follow-up (3 months)

3.00)

2.58)
1.25)
1.25)

2.33)
1.50)
1.94)

generally [12]. The range of deprivation categories is

Time/96 days
In-patient sample Median (IQR*)

representative of the Grampian area which reflects

(92,106)
N/216

(1.00,

(1.00,
(0.00,
(0.00,

(1.00,
(0.00,
(0.79,

less poverty than Scotland as a whole [13]. As noted

earlier, there were some large, expected differences
2.00

1.78
0.25
0.50

2.00
0.50
1.34

in demographic characteristics between the samples.

The sample was sought from in-patient, CMHT
and primary care in order to assess the scale’s utility
3.00 (2.33, 3.67)

2.20 (1.45, 3.00)

0.75 (0.00, 2.25)
1.25 (0.50, 2.25)

2.17 (1.33, 2.67)

2.08 (1.62, 2.51)

1.5 (0.50, 3.00)
Time point 1

across a range of clinical settings. The in-patient

N/326

setting was well represented, the CMHT adequately

Table II. Median scores of BASIS-24.

so, but less so was the primary care setting. In this

setting a high proportion of eligible patients (41%)
did not receive study information from participating
Interpersonal relationships

general practitioners. It was evident that some

Depression/functioning

general practitioners were reluctant to make requests

* Interquartile range.

of patients to participate in the research perhaps

Emotional lability
Substance misuse
BASIS-24 scale

because they perceived that such a request could

have brought additional stress to an already bur-
Total scale
Self-harm
Psychosis

dened patient group. This highlights the continuing

challenge of implementing an outcome assessment
instrument in clinical settings.
 Psychometric properties of the BASIS-24# 41
Table III. Internal consistency (a values) clinical at time point 1.

BASIS-24 Scale In-patient (min n /258) CMHT (min n /146) Primary care (min n/80) All Clinical (min n /484)
Coefficient a (95% CI*) Coefficient a (95% CI) Coefficient a (95% CI) Coefficient a (95% CI)

Depression/functioning 0.88 (0.85, 0.90) 0.90 (0.88, 0.93) 0.87 (0.83, 0.91) 0.90 (0.88. 0.91)
Substance misuse 0.85 (0.82, 0.88) 0.80 (0.75, 0.85) 0.68 (0.55, 0.78) 0.85 (0.82, 0.87)
Psychosis 0.76 (0.72, 0.80) 0.70 (0.62, 0.77) 0.57 (0.41, 0.70) 0.79 (0.76, 0.81)
Interpersonal relationships 0.78 (0.74, 0.82) 0.77 (0.71, 0.82) 0.52 (0.33, 0.66) 0.75 (0.72, 0.79)
Emotional lability 0.70 (0.64, 0.75) 0.73 (0.65, 0.79) 0.71 (0.59, 0.80) 0.71 (0.67, 0.75)
Self-harm 0.91 (0.89, 0.93) 0.83 (0.76, 0.87) 0.85 (0.77, 0.90) 0.91 (0.90, 0.93)
Total scale 0.88 (0.86, 0.90) 0.90 (0.88, 0.92) 0.84 (0.79, 0.89) 0.91 (0.89, 0.92)

*CI, confidence interval.

An important requirement of a self-complete Responsiveness to change was also demonstrated

measure is that it should be widely acceptable to a showing that the BASIS-24# could be useful as a
broad range of patients. In the most acute setting the tool for monitoring patient progress over time and
scale was found manageable by most patients with for assessing interventions in a research context.
severe and enduring mental illness. In only 12% of
admissions did clinicians feel their patients were too
Utility
ill to participate. This proportion may become less in
time as clinicians become more familiar with the Although outcome measurement in mental health
scale and its general acceptability increases. Inevi- services has emerged as an area of considerable
tably, as with all psychiatric self-complete scales, interest and priority [1,2,14,15], there has been little
there will be a proportion of patients who will be too evidence of their use [16]. This has partly been
ill to manage to complete such a task. The lower explained by concerns expressed relating to (a) the
baseline response rate in the CMHT and primary basic psychometric properties of available measures,
care settings is not thought to relate to ease of (b) questions relating to the perceived usefulness of
completion but may be explained by the method of outcome data to clinical practice and (c) concerns
distribution. In these settings potential participants relating to inadequacy of infrastructures that would
had the questionnaire to consider at home. Greater allow for systematic data collection and useful
motivation would be required to complete and employment. As the BASIS-24# has been demon-
return it than in the in-patient setting where the strated to be psychometrically robust, this first
researchers visited the wards daily to distribute and concern is adequately addressed. The second con-
collect the study packs. cern partly reflects the culture of wariness surround-
ing the use of outcome measures [17,18]. The utility
of the information collected in the BASIS-24# will
Psychometric robustness in a research, audit or clinical
best be assessed by evaluating how successfully the
setting
measure can be introduced into clinical services and
The total scale showed good internal consistency subsequently assessing whether it provides useful
across all the clinical samples. Within subscales, a feedback to clinicians and managers. The utility of
values for psychosis and interpersonal relationships feedback to clinicians and managers is an important
were less robust in the primary care setting. This is consideration. It has been noted that outcome
attributable to lesser variability in the primary care measures are of limited use to clinicians when they
sample than in the inpatient or CMHT samples. are not available to them while they are making
As high a values may suggest some redundancy clinical decisions about patients [19]. The method of
among items, reduction in the length of the total scoring BASIS-24# by calculating a mean may have
scale might be possible without compromising relia- some advantages over the endorsed weighted algo-
bility. However, it was only in the combined sample rithm method which requires computer input before
of the total scale and the Self-harm subscale that a a score is calculated. Whilst this is acceptable for
values exceeded 0.9. As the Self-harm subscale assessing aggregated clinical data, it is impractical for
consists of two items, having a minimum of two the clinician at ground level who is interested in
items per subscale was viewed as preferable to having change scores of individual patients. Internet-based,
a single item subscale, despite some redundancy. automated scoring has recently been developed to
The BASIS-24# also demonstrated good con- address this need [20]. Simple scoring methods in
current criterion validity. The finding that the outcome measurement are necessary for their use-
‘depression/functioning’ subscale did not differenti- fulness to clinicians. In the case of BASIS-24# it
ate by diagnosis is explicable in terms of symptoms also allows for the practical use of the developed
of anxiety and depression being widely experienced percentile tables which set a context for considering
across other diagnoses. individual patient’s scores.
42 I.M. Cameron et al.
Table IV. BASIS-24 mean overall score percentiles for in-patient and general population samples.

Percentile In-patient sample General population sample Percentile In-patient sample General population sample

1 0.29 0.00 51 1.75 0.54

2 0.36 0.04 52 1.78 0.58
3 0.41 0.04 53 1.79 0.58
4 0.50 0.04 54 1.82 0.58
5 0.54 0.08 55 1.83 0.63
6 0.57 0.08 56 1.88 0.63
7 0.65 0.10 57 1.91 0.63
8 0.70 0.13 58 1.92 0.63
9 0.74 0.13 59 1.96 0.67
10 0.75 0.17 60 1.96 0.67
11 0.79 0.17 61 2.00 0.67
12 0.83 0.17 62 2.00 0.71
13 0.88 0.17 63 2.04 0.71
14 0.92 0.21 64 2.04 0.71
15 0.96 0.21 65 2.08 0.74
16 0.96 0.21 66 2.08 0.74
17 1.00 0.21 67 2.13 0.75
18 1.04 0.25 68 2.14 0.75
19 1.08 0.25 69 2.17 0.78
20 1.13 0.25 70 2.17 0.78
21 1.13 0.25 71 2.21 0.79
22 1.17 0.29 72 2.21 0.83
23 1.21 0.29 73 2.22 0.83
24 1.21 0.29 74 2.25 0.87
25 1.25 0.29 75 2.27 0.87
26 1.25 0.30 76 2.29 0.88
27 1.27 0.30 77 2.30 0.91
28 1.29 0.30 78 2.33 0.92
29 1.30 0.30 79 2.38 0.96
30 1.33 0.33 80 2.39 1.00
31 1.35 0.33 81 2.43 1.00
32 1.41 0.36 82 2.46 1.04
33 1.42 0.36 83 2.48 1.04
34 1.43 0.38 84 2.50 1.08
35 1.45 0.38 85 2.54 1.09
36 1.46 0.42 86 2.60 1.13
37 1.48 0.42 87 2.63 1.17
38 1.50 0.42 88 2.68 1.21
39 1.52 0.43 89 2.74 1.25
40 1.54 0.43 90 2.75 1.29
41 1.57 0.43 91 2.82 1.33
42 1.58 0.46 92 2.86 1.33
43 1.61 0.46 93 2.89 1.46
44 1.61 0.48 94 2.92 1.54
45 1.63 0.48 95 3.00 1.63
46 1.65 0.48 96 3.09 1.75
47 1.67 0.50 97 3.17 2.00
48 1.71 0.52 98 3.25 2.17
49 1.74 0.52 99 3.30 2.50
50 1.74 0.52 /99 3.46 2.88

Note: where a raw score corresponds to more than one percentile take the higher percentile.

The third concern, that of resources, is an completing the questionnaire. Additionally, current
important consideration. The challenges inherent ethics policy dictates that individuals have up to 24 h
in introducing routine outcome measurement into to consider whether to participate or not. In the case
clinical practice were particularly highlighted in the of routine audit, written consent is not required and
data collection for the primary care sample. It may perhaps therefore participation appears less daunting
be that where outcome measures are introduced for than in the research context. Conversely, in some
routine audit purposes there will be less obstacles settings the research process may have enhanced
present than are necessary in the conduct of research participation. In the in-patient setting, a researcher
as patients will have less to complete in routine was present daily to facilitate involvement. In
practice where concurrent measures are not used. Grampian, BASIS-24# has recently been intro-
Also, in research, potential participants have to duced as part of the clinical audit of a new urgent
consider giving informed written consent before referral service. The practical application of the
 Psychometric properties of the BASIS-24# 43

measure will be observed with keen interest. If [2] Secretary of State for Health. National Service Framework

mental health services are serious about the imple- Mental Health. London: HSMO; 1999.
[3] Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns
mentation of routine outcome measures, protected A. Health of the Nation Outcome Scales (HoNOS). Br J
time to assess and use data is also required. Psychiatry 1998;172:11
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[4] Eagar K, Trauer T, Mellsop G. Performance of routine

outcome measurement in adult mental health care. Aust NZ
Key points J Psychiatry 2005;39:713
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[5] Eisen SV, Normand SLT, Belanger AJ, Gevorkian S, Irvin

. The BASIS-24# is a brief, simple to complete EA. BASIS
32† and the Revised Behavior and Symptom
self-report measure of psychopathology and Identification Scale (BASIS). In: Maruish M, editor. The use
functioning suitable for routine clinical use of psychological testing for treatment planning and outcome
. It has demonstrated reliability, validity and assessment, 3rd ed. NJ: Lawrence Erlbaum Associates; 2004.
p 79
115.
responsiveness to change in a diverse clinical
[6] Cameron IM, Eagles JM, Howie FL, Andrew JE, Crawford
sample and can be considered robust JR, Kohler C, Eisen S, et al. Preliminary validation of a UK-
. The BASIS-24# is not appropriate for use with modified version of the BASIS-32. Int J Psychiatry Clin
a minority of acutely ill patients for whom a self- Pract 2001;5:41
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complete measure is not feasible [7] Derogatis LR. The Brief Symptom Inventory: Administra-
. It provides valuable information from the pa- tion, scoring and procedures. Minneapolis, MN: National
tient perspective Computer Systems; 1993.
[8] Nunally JC, Bernstein IH. Psychometric theory, 3rd ed. New
. Clinician perspectives should also be consid- York: McGraw-Hill; 1994.
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Acknowledgements
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[10] Streiner DL, Norman GR. Health measurement scales: a

This research was funded by a grant from the Chief practical guide to their development and use. Oxford:
Oxford University Press; 1989.
Scientist’s Office of the Scottish Executive (Refer- [11] Eisen SV, personal communication, BASIS-24 Instruction
ence number CZH/4/39) and by the US Department Guide, McLean Hospital, Department of Mental Health
of Veterans Affairs, Veterans Health Administration, Services Evaluation, 2005.
Health Services Research and Development Service. [12] Office of the Chief Statistician. Analysis of Ethnicity in the
The views expressed in this article are those of the 2001 Census: Summary Report http://www.scotland.gov.uk/
authors and do not necessarily represent the views of library5/social/aescr-00.asp, 2004.
[13] Scottish Health Statistics http://www.show.scot.nhs.uk/is
the Scottish Executive or the Department of Veter-
donline/, 2000.
ans Affairs. Administrative and clinical workers at [14] Gilbody SM, House AO, Sheldon TA. Outcomes research in
Royal Cornhill Hospital and at five General Prac- mental health. Br J Psychiatry 2002;181:8
16. / /

tices in Grampian are gratefully acknowledged for [15] Holloway F. Outcome measurement in mental health

facilitating with recruitment. welcome to the revolution. Br J Psychiatry 2002;181:1
2. / /

[16] Gilbody SM, House AO, Sheldon TA. Psychiatrists in the

UK do not use outcome measures. Br J Psychiatry 2002;180: / /

Statement of interest 101
3.

[17] Ashaye OA, Livingston G, Orrell MW. Does stadardized
BASIS-24# is copyrighted and licensed for use by needs assessment improve the outcome of psychiatric day
McLean Hospital. As part of the hospital’s intellec- hospital care for older people? A randomized controlled trial.
tual property policy, the instrument developer, Aging Ment Health 2003;7:195
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Susan V Eisen, receives a percentage of licensing [18] Marshall M, Lockwood A, Green G, Zajac-Roles G, Roberts
C, Harrison G. Systematic assessments of need and care
fees received by McLean Hospital for licensing of the
planning in severe mental illness; Cluster randomised trial.
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[19] Andrews G, Page AC. Outcome measurement, outcome

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