Factor structure of the Brief Psychiatric Rating Scale for Children (BPRS-C) among Hospital Patients and Community Clients

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Abstract

The factor structure, reliability and concurrent validity of the Brief Psychiatric Rating Scale for Children (BPRS-C) was examined. The BPRS-C was designed to measure child psychopathology with seven scales consisting of three items each. Two large samples of intake assessments at admission to the public mental health system of state psychiatric hospitals (n = 6712) and community mental health centers (n = 21,459) for children aged 3–17 were examined. In both samples exploratory and confirmatory factor analysis found seven factors that generally supported the BPRS-C seven scale structure. Reliability as measured by internal consistency was acceptable with an average alpha of .72 (SD = .09). Mean scale scores across diagnoses and concurrent correlations with the Child Behavior Checklist (CBCL) were consistent with expectations.

Highlights

► Factor analysis found seven factors that generally supported the BPRS-C scale structure. ► Clinical samples were from hospitals (n = 6712) and the community (n = 21,459). ► Internal consistency was acceptable with an average alpha of .72 (SD = .09). ► Mean scale scores differences across diagnoses were consistent with expectations. ► Concurrent correlations with the CBCL were consistent with expectations.

Introduction

While comprehensive tests of child psychopathology are available, many are relatively long and proprietary. Freely available short broad rating scales are useful in situations where time or resources are limited. For example, when a brief measure of symptoms is needed across a large number of clients, where ongoing multiple assessments of symptoms across an episode of care are needed or when a convergent source of information is needed. This is especially important in publicly funded clinics which must treat a wide range of clients within limited budgetary and time constraints.

The Brief Psychiatric Rating Scale for Children (BPRS-C, Overall & Pfefferbaum, 1982) is a short rating scale designed to provide a brief structured measure of the major dimensions of psychopathology that should separate and distinguish diagnostic groups in order to assist screening and assessment. The BPRS-C is not a children’s version of the BPRS it is a distinct and separate test. The BPRS-C is designed to cover common major symptoms rather than narrowly cover symptoms for a specific diagnosis in depth. The BPRS-C consists of 21-items that form seven scales (Gale et al., 1986, Overall and Pfefferbaum, 1982). These scales were designed through factor analyses of symptoms to broadly represent conceptually distinct symptom constructs (Pfefferbaum & Overall, 1983). Although initial scales sometimes included four items, the final version consisted of seven scales with three items each. These short scales of specific symptom content are designed to document problems and response to treatment.

Lachar et al. (2001) conducted a factor analysis of the BPRS-C on 547 children seen in inpatient and outpatient service settings. A modified version of the BPRS-C was used that had behavioral examples as rating scale anchors to facilitate the selection of severity ratings. An orthogonal six factor solution to the BPRS-C was obtained with strong support for four (depression, behavior problems, psychomotor excitation, thinking disturbance) of the seven BPRS-C scales and more limited support for the other scales. The average item inter-rater reliability was .73 and the average coefficient alpha was .74. Examination of scale scores across diagnostic groups revealed significant appropriate scale score differences among the groups examined.

Hughes, Rintelmann, Emslie, Lopez, and MacCabe (2001) conducted a factor analysis of the BPRS-C on 4733 children seen in outpatient settings. This study also used a modified version of the BPRS-C with behavioral examples as rating scale anchors to facilitate the selection of severity ratings. An oblique five factor solution to the BPRS-C was obtained with strong support for three (psychomotor excitation, behavior problems, thinking disturbance) of the seven BPRS-C scales and more limited support for the other scales. The average item inter-rater reliability was .67 and the average coefficient alpha was .69. Examination of scale scores across diagnostic groups also revealed significant appropriate scale score differences among the groups.

Both of these previous exploratory factor analyses have found support for only five or six of the seven BPRS-C scales which calls into question the validity of the proposed factor structure of the BPRS-C. This paper extends previous research by presenting new analyses and data for the BPRS-C. Rather than use only exploratory factor analysis, the first known confirmatory factor analysis was also used to directly assess the fit of the BPRS-C’s hypothesized latent structure. Second, the first known convergent validity correlations of the BPRS-C scales with the scales of an established longer measure of child psychopathology (the Child Behavior Checklist, Achenbach, 1991) are presented. Finally, scale scores and differences by diagnoses are presented for two large clinical samples, one inpatient and one outpatient, no large scale norms have previously been available for child and adolescent inpatients.

Section snippets

Participants

BPRS-C hospital admission scores for 6712 patients (approximately 50% of all admissions) were included in the analysis. There were 2937 (44%) females and 3775 (56%) males. There were 3686 (55%) Whites, 2067 Hispanics (31%), 849 (13%) Blacks and 110 (2%) some other race/ethnicity. The average age of patients at admission was 14.3 (SD = 2.5). There were 35 patients aged 3–5 (0.5%), 1082 patients aged 6–12 (16%) and 5595 patients age 13–17 (83%).

Patients had an average of 1.81 (SD = 0.92) DSM-IV

Participants

BPRS-C and CBCL community mental health centers intake scores for 21,459 clients (approximately 30% of all admissions) were included in the analysis. There were 7108 (33%) females and 14,351 (67%) males. There were 8853 (41%) Whites, 7515 Hispanics (35%), 4669 (22%) Blacks and 422 (2%) some other race/ethnicity. The average age of clients at admission was 11.1 (SD = 3.8). There were 1741 clients aged 3–5 (8%), 10,382 clients aged 6–12 (48%) and 9336 clients aged 13–17 (44%).

Clients had an average

Discussion

Across both the hospital and community samples the factor structure of the BPRS-C was relatively close to the proposed seven factor structure. The scales for behavior problems, depression, thinking disturbance, and withdrawal were strongly supported in both studies. Scales for organicity and psychomotor excitation were strongly supported in one study but had slightly less support in the other. The anxiety scale had the least support. Reliability as measured by internal consistency was generally

Author note

The views expressed in this article are the authors and do not represent any official policy or position of the Texas Department of State Health Services.

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