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Open Access Highly Accessed Research article

The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents

For-Wey Lung1234 and Ming-Been Lee56*

Author Affiliations

1 Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

2 Graduate Institute of Behavior Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

3 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan

4 Calo Psychiatric Center, Pingtung County, Taiwan

5 Departments of Psychiatry and Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

6 Director of Taiwan Suicide Prevention Center, Taipei, Taiwan

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BMC Psychiatry 2008, 8:53  doi:10.1186/1471-244X-8-53

Published: 2 July 2008



An efficient screening instrument which can be used in diverse settings to predict suicide in different populations is vital. The aim of this study was to use the five-item Brief Symptom Rating Scale (BSRS-5) as a screening instrument for the prediction of suicide ideation in psychiatric, community and general medical settings.


Five hundred and one psychiatric, 1,040 community and 969 general medical participants were recruited. The community participants completed a structured telephone interview, and the other two groups completed the self-report BSRS-5 questionnaire.


The logistic regression analysis showed that the predictors of suicide ideation for the psychiatric group were depression, hostility and inferiority (p < 0.001, p = 0.016, p = 0.011), for the community group, inferiority, hostility and insomnia (p < 0.001, p < 0.001, p = 0.003), and for the general medical group, inferiority, hostility, depression and insomnia (p < 0.001, p = 0.001, p = 0.020, p = 0.008). The structural equation model showed the same symptom domains that predicted suicide ideation for all three groups. The receiver operating characteristic curve using the significant symptom domains from logistic regression showed that for the psychiatric group, the optimal cut-off point was 4/5 for the total of the significant dimensions (positive predictive value [PPV] = 78.01%, negative predictive value [NPV] = 79.05%), for the community group, 7/8 (PPV = 68.75%, NPV = 96.09%), and for the general medical group, 12/13 (PPV = 92.86%, NPV = 88.48%).


The BSRS-5 is an efficient tool for the screening of suicide ideation-prone psychiatric inpatients, general medical patients, and community residents. Understanding the discriminative symptom domains for different groups and the relationship between them can help health care professionals in their preventative programs and clinical treatment.