Journal of Clinical Child & Adolescent Psychology

ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: http://www.tandfonline.com/loi/hcap20

Developing and Validating Short Forms of the

Parent General Behavior Inventory Mania
and Depression Scales for Rating Youth Mood
Symptoms

Eric A. Youngstrom, Anna Van Meter, Thomas W. Frazier, Jennifer Kogos

Youngstrom & Robert L. Findling

To cite this article: Eric A. Youngstrom, Anna Van Meter, Thomas W. Frazier, Jennifer Kogos
Youngstrom & Robert L. Findling (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, DOI: 10.1080/15374416.2018.1491006

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Journal of Clinical Child & Adolescent Psychology, 00(00), 1–16, 2018
Copyright © Society of Clinical Child & Adolescent Psychology
ISSN: 1537-4416 print/1537-4424 online
DOI: https://doi.org/10.1080/15374416.2018.1491006

Developing and Validating Short Forms of the Parent

General Behavior Inventory Mania and Depression
Scales for Rating Youth Mood Symptoms
Eric A. Youngstrom
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill

Anna Van Meter

Department of Psychiatry Research, Zucker Hillside Hospital

Thomas W. Frazier
Science Department, Autism Speaks

Jennifer Kogos Youngstrom

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill

Robert L. Findling
Department of Psychiatry, Johns Hopkins University

To develop short forms of parent-rated mania and depression scales, evaluating their reliability,
content coverage, criterion validity, and diagnostic accuracy. Caregivers completed the Parent
General Behavior Inventory about their youth 5–18 years of age seeking outpatient mental health
services at either an academic medical clinic (n = 617) or urban community mental health center
(n = 530), along with other rating scales. Families also completed a semistructured Kiddie Schedule
for Affective Disorders and Schizophrenia interview, with the rating scales masked during diagnosis.
Ten-item short forms and projections of their psychometrics (vs. the full-length 46-item Depression
and 28-item Hypomanic/Biphasic scales) were built in the academic sample and then externally
cross-validated in the community sample. The mania and two depression short forms maintained
high reliability (αs > .87 across both samples); high correlations with the full-length scales (rs> .93);
excellent convergent and discriminant validity with mood, behavior, and demographic criteria; and
diagnostic accuracy undiminished compared to using the full-length scales. Present analyses devel-
oped and externally cross-validated 10-item short forms that maintain high reliability and content
coverage and show strong criterion validity and diagnostic accuracy—even when used in an
independent sample with markedly different demographics and referral patterns. The short forms
appear useful in clinical applications, including screening and initial evaluation, as well as in
research settings, where they offer an inexpensive quantitative score. Future work should further
evaluate sensitivity to treatment effects. The short forms are available in more than a dozen
translations.

Assessment of mood disorder remains an area of great

Correspondence should be addressed to Eric A. Youngstrom, unmet need in healthcare. Depression is a common comor-
Department of Psychology and Neuroscience, University of North
Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC 27599-
bidity and often undiagnosed in pediatric settings, and bipo-
3270. E-mail: eay@unc.edu lar disorder composes a significant portion of mood
Color versions of one or more of the figures in the article can be found disorders and a disproportionate degree of the risk for
online at www.tandfonline.com/hcap.
2 YOUNGSTROM ET AL.
substance misuse, risky behavior, and self-harm (Birmaher,
2013; Stewart et al., 2012). The General Behavior Inventory
(GBI; Depue et al., 1981) was originally developed as a
self-report measure of depressive and hypomanic symptoms
for use with young adults. It has accrued substantial evi-
dence of validity, including exceptional reliability estimates
(Depue et al., 1981), criterion validity including associations
with family history (Klein, Depue, & Slater, 1986), associa-
tions with cortisol and dopamine metabolites (Depue,
Kleiman, Davis, Hutchinson, & Krauss, 1985; Depue,
Luciana, Arbisi, Collins, & Leon, 1994), diagnostic discri-
minative validity (Depue et al., 1981; Youngstrom et al.,
2018), longitudinal prediction of progression to a mood
disorder (Alloy et al., 2011; Klein & Depue, 1984), and
sensitivity to treatment effects (Findling et al., 2003).
The Parent General Behavior Inventory (PGBI;
Youngstrom, Findling, Danielson, & Calabrese, 2001) is
an adaptation of the GBI, where the primary caregiver
completes the GBI as a description of the child’s mood
and behavior. It also has shown considerable evidence of
validity as a measure of depressive and hypomanic, bipha-
sic, or mixed-mood symptoms (Youngstrom et al., 2001).
The PGBI yields two scales: Depression (46 items, α > .95
in multiple samples) and Hypomanic/Biphasic (28 items, α
> .94 in multiple samples). When parents have used the
PGBI to describe the mood symptoms of youths 5–18 years
of age, the scales are reliable, do an excellent job of dis-
criminating cases with mood disorders from those with
other psychiatric conditions, and appear to be highly sensi-
tive to treatment effects (Findling et al., 2003; Youngstrom
et al., 2001; Youngstrom et al., 2005). In a recent meta-
analysis comparing the discriminative validity of all pub-
lished measures of manic symptoms in youth, the PGBI
performed in the top echelon of measures, significantly
outperforming several other widely used measures
(Youngstrom, Genzlinger, Egerton, & Van Meter, 2015).
However, the PGBI is long—73 core items (46 on the
Depression scale, 28 on the Hypomanic/Biphasic scale, with
one item included on both in the official scoring), with an
11th-grade reading level and complicated content, spanning
10 pages in 11-point font. This makes it cumbersome to use
as a screener or as an outcome measure. The high alphas
suggest it should be possible to develop a short form that is
still reliable, highly correlated with the full-length scale, and
preserves other desirable characteristics, such as high dis-
criminative validity.
We developed a 10-item hypomanic/biphasic scale
(PGBI-10M) that maintained high internal consistency and
actually exceeded the full length version in discriminative
validity, not just in the training sample (Youngstrom,
Frazier, Findling, & Calabrese, 2008), but also in subse-
quent independent applications (see meta-analysis;
Youngstrom, Genzlinger, Egerton, & Van Meter, 2015).
The PGBI-10M is technically not a short form of the
PGBI, because it did not include a depression scale and
thus did not preserve the original factor structure (Smith,
McCarthy, & Anderson, 2000). The items on the 10M were
selected primarily to maximize the discriminative validity,
with maximizing content coverage as a secondary goal.
Evidence-based medicine (Straus, Glasziou, Richardson,
& Haynes, 2011) and psychological evidence-based assess-
ment (Youngstrom, Van Meter, et al., 2017) both emphasize
the meaning of test results in terms of updated probabilities
(not as diagnostic). The concept is literally centuries old,
known as Bayes’ theorem. In older discussions of diagnostic
accuracy, the Bayesian posterior probabilities went by various
names; in psychology their most common aliases were the
positive and negative predictive powers, or predictive values
(Youngstrom, Van Meter, et al., 2017). They are heavily
influenced by the prior probability of the condition, often
measured as the base rate in a given setting. A high risk
score that conveys a sevenfold increase in the odds of a
diagnosis would move a 50% prior probability up to a revised
87.5% probability, whereas the same result would connote a
26.9% probability in a setting where the base rate was 5%.
Even if the test itself shows good generalizability of psycho-
metric properties across samples, the interpretation of an
individual score needs to be locally contextualized, taking
base rates and referral patterns into consideration. This has
been the stumbling block preventing effective application of
assessment results. A variety of solutions are now available,
including probability nomograms, online risk calculators, and
smartphone apps that can combine prior probabilities with
assessment findings (Youngstrom, Van Meter, et al., 2017).
The preferred effect size for the assessment results to get
incorporated easily in the Bayesian interpretation is a diag-
nostic likelihood ratio (DiLR; Straus et al., 2011). The DiLR
is the ratio of two fractions: the portion of people with the
target condition scoring in the reference range, divided by
the portion of people without the target also scoring in the
same range. In situations where an assessment gets inter-
preted in a binary way, the DiLR for a positive test would be
the sensitivity divided by the false alarm rate, and the DiLR
for a negative test would be the false negative rate divided
by the specificity. Multiplying the odds of a diagnosis by the
DiLR yields the updated odds. Clinicians can interpret
DiLRs by using a probability nomogram (Figure 1), avoid-
ing the need to do any computation, or by putting the DiLR
into probability calculators available through evidence-
based medicine websites and apps (Google “probability
calculator”). A DiLR smaller than 1 decreases the predicted
probability, 1.0 is a neutral result (not changing the prob-
ability at all), and greater than 1 increases the predicted
probability. Values greater than 2 (or < .5) can be useful in
combination with other information, greater than 5 (or < .2)
are helpful, and greater than 10 (or < .1) are often clinically
decisive.
The PGBI-10M was designed to provide maximally
informative DiLRs, and it still was able to maintain high
internal consistency and strong content coverage. These
 SHORT FORMS FOR PARENT GBI 3

The emphasis on high separation in score distribu-

.1 99 tions between groups with and without mood disorder—
the key feature for discriminative validity—also has
.2 advantages for the Jacobson benchmarks for clinically
significant change, increasing the clinical utility of the
.5 95
same short form as an outcome measure (Jacobson &
Truax, 1991). Essentially, the items were picked to max-
1 1000
90
imize the difference between sick and well states (or at
500 least, not moody). Indeed, the 10M showed similar or
2 200 80
better sensitivity to treatment effects as achieved with
100 the industry standard structured interviews (Findling et
50 70 al., 2009; Youngstrom et al., 2013). The accumulated
5
20 60 evidence of validity led to the PGBI-10M being
10 50
endorsed by the PhenX Toolkit (https://www.phenx
10
5 toolkit.org/) as the preferred measure of manic symp-
40
toms in youth, and it was the basis for enrollment in the
20 2 30 multisite Longitudinal Assessment of Manic
% 1 % Symptoms project (Horwitz et al., 2010), as well as an
30 .50 20
outcome measure in multiple clinical trials and a key
40 .20
10
predictor in brain imaging studies (Bebko et al., 2014).
50 .10
It has also been adopted as a risk assessment tool by
60 .05
5
advocacy groups (Depression and Bipolar Support
70 .02 Alliance, n.d.).
.01 What about depression? The PGBI includes even more
80 .005
2 items with depression content (46 on the scale, plus many
.002 items with “mixed” content). We performed similar ana-
90 .001 1 lyses on the depression items and found that it was
possible to develop two 10-item forms with balanced
95 .5 content and psychometrics (Youngstrom, Frazier,
Findling, & Calabrese, 2004, May). Having two forms
.2
introduces new possibilities in terms of avoiding retest
fatigue or biases. Short Form A was used in some treat-
99 .1
ment studies on the basis of unpublished analyses, and it
Pretest Probability Likelihood Ratio Posttest Probability performed well as an outcome measure (Youngstrom et
al., 2013).
FIGURE 1 Probability nomogram for combining diagnostic likelihood The goal of this article is to report the psychometrics of the
ratios with other information about cases to revise probability estimates. two depression forms, simultaneously evaluating the 10M with
Note: The nomogram combines the baseline probability of a diagnosis— each 10-item depression scale separately as short 20-item
usually based on clinical prevalence—with one or more DiLRs to arrive at a
forms that preserve the original scale structure of the GBI.
posterior probability. For a clinical example, see Van Meter et al. (2014).
We do this using two independent samples, an academic sam-
ple accrued at a university medical center (Findling et al.,
2005), and a community sample drawn from an urban commu-
nity mental health center (Youngstrom, Meyers, et al., 2005).
psychometric properties have been demonstrated in an We have used this combination of samples to evaluate the
extracted format in an independent sample, where the 10- generalizability of discriminative validity for the Achenbach
item form was used rather than embedding the items in the Child Behavior Checklist scales (Van Meter et al., 2017; Van
full-length version (Freeman et al., 2012). Internal consis- Meter et al., 2014), as well as to examine the stability of
tency and breadth of coverage are competing aims, and the different assessment algorithms (including some machine
PGBI-10M probably achieved this by dint of the complex learning models; Youngstrom, Halverson, Youngstrom,
item structure; most items include multiple symptoms, Lindhiem, & Findling, 2017). This will provide a strong test
increasing intercorrelation and coverage at the same time of the psychometrics of the short forms, as the community and
(see upcoming text for examples, or to retrieve the scales, academic samples differ substantially in terms of demographic
visit https://trello.com/b/dYUKlNRP/translated-measures- and clinical characteristics. We follow the steps outlined in
dashboard). Smith et al. (2000) for best practices in short form develop-
ment. The academic sample establishes the psychometrics of
4 YOUNGSTROM ET AL.
the original long form PGBI scales and empirical estimates of
the short form parameters in the academic (training) sample,
followed by projections for internal consistency and the
correlation between the short and full-length form in a new
sample. Then we report the empirical estimates from the
external cross-validation in the community sample. We
describe the short form factor structure in both samples,
and test the discriminative validity of the short forms,
using the depression scale to predict the presence of any
mood disorder, and the 10M scale to predict presence of any
bipolar spectrum disorder.
METHOD
Participants
The academic sample consists of families seeking services at
Case Western Reserve/University Hospitals of Cleveland; the
community sample consists of families presenting to
Applewood Centers, a large, urban community mental health
center. Participants were families seeking outpatient mental
health services for youth between 5 and 18 years of age.
Exclusion criteria were not being conversant with spoken
English and having a pervasive developmental or cognitive
disability. Inclusion criteria were deliberately broad to maximize
the generalizability of results. Families were paid for completing
the full-day interview, and the projects were supported by grants
from the Stanley Medical Research Institute (PI: RLF) and NIH
R01 MH066647 (PI: EAY). The R01 supported the interview
team that completed all of the interviews in the community
sample, as well as a large portion of the academic sample.
Table 1 presents the descriptive statistics for participants
in both samples, as well as effect sizes for differences
between the two. The academic sample was heavily
enriched for bipolar disorder both by recruitment for parti-
cipation in clinical trials and referrals of offspring with
bipolar parents from an adult mood disorders program.
The community sample had somewhat lower rates of
mood disorders and fewer bipolar spectrum disorders, and
high rates of externalizing disorders and attention deficit/
hyperactivity disorder (ADHD). The community sample
reflected an urban catchment area, with lower socioeco-
nomic status, and most families being African American.
Diagnoses
All diagnoses were determined by a semistructured interview
involving the parent and then the youth sequentially. The
Stanley-funded protocol used the Kiddie Schedule for
Affective Disorders and Schizophrenia–Present and Lifetime
version (KSADS-PL; Kaufman et al., 1997). The R01 protocol
combined the PL with the depression and mania modules from
the Washington University KSADS (Geller et al., 2001) to build
crosswalks to other protocols. KSADS raters were highly trained
(item-level κ > .85), and all KSADS findings were reviewed by a
clinician in a Longitudinal Expert evaluating All Data (Spitzer,
1983) consensus meeting that integrated family psychiatric his-
tory and prior treatment history but recused all rating scales (to
prevent criterion contamination when evaluating discriminative
validity).
Measures
Parent General Behavior Inventory
The PGBI adapted the GBI to be completed by a care-
giver to describe the mood symptoms of their youth over the
past year. The PGBI contains 73 items using a 4-point scale
from 0 (never or hardly ever) to 3 (very often; almost con-
stantly). The two main scales are the Depression, containing
46 items, and the Hypomanic/Biphasic, with 28 items
(Depue’s GBI scoring counts one item on both scales). The
Hypomanic/Biphasic scale includes a mix of “purely” hypo-
manic items along with “mixed” items that address mood
swings and rapid changes or extremes of mood. The mixed
items cross-load in factor analyses, and they induce a high
correlation between the Depression and the Hypomanic/
Biphasic scale. They also describe a hallmark feature of
bipolar disorder, and they include some of the most statisti-
cally discriminating items between diagnostic groups
(Youngstrom, Frazier, Findling, & Calabrese, 2008). Thus,
whereas the items might seem problematic according to some
conventions for factor analysis (e.g., “avoid double-barreled
items”; DeVellis, 1991), they are important from conceptual
and clinical perspectives, also showing strong validity in
other respects.
Mood Severity Ratings
The interviewers also completed two widely used mood
severity rating scales. The Young Mania Rating Scale
(YMRS; Young, Biggs, Ziegler, & Meyer, 1978) is an 11
item semistructured interview, with items rated on a 0-to-4
or 0-to-8 scale, integrating caregiver and youth descriptions
with direct observation of mental status and clinical impres-
sions. The Child Depression Rating Scale–Revised (CDRS-
R; Poznanski, Miller, Salguero, & Kelsh, 1984) is a 17-item
semistructured interview, with items rated 1 to 5 or 1 to 7,
also integrating both informants’ responses with direct
observation. Raters were trained to rate the symptom as
present only if it was attributable to a mood disorder and
not some other psychiatric condition (cf. Yee et al., 2015).
The YMRS and CDRS-R total scores provide a widely used
criterion for evaluating the convergent validity of the PGBI
short forms.
Achenbach Child Behavior Checklist (CBCL)
Caregivers completed the CBCL about their child
(Achenbach, 1991; Achenbach & Rescorla, 2001). There
 SHORT FORMS FOR PARENT GBI 5

TABLE 1
Demographics and Clinical Characteristics by Clinic Setting

Academic Clinica Community Clinicb Effect Sizec

Youth Demographics
Female 39% 41% .02
Age, M (SD) 11.5 (3.3) 10.7 (3.4) .24***
White 79% 6% −.73***
Family Incomed $36,700 $18,400 .75***
Clinical Characteristics (M & SD, or %)
YMRS 11.61 (12.06) 6.14 (8.35) .52***
CDRS-R 35.37 (16.35) 29.86 (12.98) .37***
CBCL Externalizing T Score 66.70 (11.72) 70.35 (9.60) −.34***
CBCL Internalizing T Score 64.93 (11.41) 63.10 (10.48) .17**
PGBI – Hypo/Biphasic Raw 25.11 (16.72) 19.94 (14.41) .33***
PGBI – Depression Raw 36.66 (25.51) 25.10 (22.00) .48***
10M Raw 10.28 (7.82) 7.59 (6.37) .38***
10Da Raw 9.13 (7.03) 5.71 (5.69) .53***
10Db Raw 9.08 (7.19) 5.59 (5.69) .53***
PGBI – Hypo/Biphasic POMP 30 (20) 24 (17) .33***
10M POMP 34 (26) 25 (21) .38***
PGBI – Depression POMP 27 (18) 18 (16) .48***
10Da POMP 30 (23) 19 (19) .53***
10Db POMP 30 (24) 19 (19) .53***
Number Axis I KSADS Diagnoses 2.2 (1.3) 2.7 (1.4) −.39***
Any Mood Disorder Diagnosis 68% 42% −.26***
Unipolar Depressive Disorder 24% 29% .05
Bipolar Spectrum Diagnosis 44% 13% −.34***
Any ADHD 55% 66% .11***
Any Oppositional Defiant Disorder 31% 38% .08*
Any Conduct Disorder 8% 13% .08**
Any Anxiety Disorder 14% 27% .16***
Any Posttraumatic Stress Disorder 2% 10% .17***

Note: YMRS = Young Mania Rating Scale; CDRS-R = Child Depression Rating Scale–Revised; CBCL = Child Behavior Checklist; PGBI = Parent
General Behavior Inventory; 10M = 10-item Mania short form; 10Da = 10-item Depression Short Form A; 10Db = 10-item Depression Short Form B;
POMP = Percentage of Maximum Possible; KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia; ADHD = attention deficit/hyperactivity
disorder.
a
N = 617.
b
N = 530.
c
A φ for categorical variables (sex, race, diagnostic group), Cohen’s d for continuous variables (age, number of diagnoses, rating scales). A positive
coefficient means the effect was larger in the academic sample, and a negative coefficient means that the effect was larger in the community; the academic
parameter would underestimate the corresponding value in the community.
d
Income assessed via ranked bands.
*p < .05, **p < .005, ***p < .0005, two-tailed.

are 118 items rated from 0 (not true [as far as you know]) to
2 (very true or often true). The CBCL produces several
scales, including the Externalizing and Internalizing scales,
which broadly describe the degree of symptomatology that
the youth experiences in each of these domains. The
Externalizing and Internalizing scores provided established
benchmarks for comparison with the PGBI short forms.
Statistical Analyses
Analyses used the academic sample as the “training” set to
develop estimates used to project the performance of the
short forms upon replication in the independent community
sample. The sequence emulates the typical flow of research
from a university setting to application in the community
(e.g., Youngstrom et al., 2001; Youngstrom et al., 2005).
After checking missing data patterns and setting up propen-
sity scores, we estimated descriptive statistics and effect
sizes (Cohen’s d or φ for categorical variables) to quantify
differences between samples.
We used the internal consistency estimates from the full-
length scales in the academic sample and a target length of
10 items (the most that would still fit on one single-sided
page at an 11-point font) with the formulae from Smith et al.
(2000) to project the internal consistency, coverage, criter-
ion attenuation, and time saving entailed. We used both
rational content mapping and factor analysis to investigate
the content coverage. Item response theory (IRT) analyses
used a graded response model to estimate item characteris-
tics and reliability across levels of the mood trait.
6 YOUNGSTROM ET AL.
Criterion validity looked at correlations between the
short forms and the various established severity ratings,
diagnoses, and demographic variables. We included an
array of variables expected to show convergent or discrimi-
nant validity, and we used Steiger’s test of dependent corre-
lations to see whether there was significant change in
criterion validity between the short and long forms. For
the mania scale, the interview ratings of manic severity
(YMRS score) provide a convergent validity criterion, as
would the point-biserial correlation with bipolar diagnoses.
The correlations with interview ratings of depression
(CDRS-R) and diagnoses of any mood disorder also
would be expected to be at least medium-sized, given that
depressive and mixed-mood episodes are core aspects of
bipolar disorder (although not all youth who experience
mania will have had depressed or mixed states). The corre-
lation with unipolar mood diagnoses would include an arti-
fact induced by including the bipolar cases (with high scores
on the PGBI) in the “not unipolar depression” group, mix-
ing the subset with highest scores into the comparison
group. The mania score should also show a high correlation
with Externalizing, based on the robust literature that bipo-
lar disorder is associated with elevated Externalizing scores
(Youngstrom et al., 2015), as well as the shared method
variance with the same informant completing the CBCL and
the PGBI (Podsakoff, MacKenzie, & Podsakoff, 2012). The
mania scores would be expected to show smaller but sig-
nificant elevations in the presence of ADHD or disruptive
behavior disorders, consistent with them being more chal-
lenging to distinguish clinically (Kim & Miklowitz, 2002)
and contributing to false positive results in screening. There
is an age trend for manic symptom levels to decrease some
with age, possibly due to the decreases in comorbid ADHD
or disruptive behavior (Demeter et al., 2013).
For the depression scales, convergent correlations were
expected to be highest with the CDRS-R Total and the CBCL
Internalizing Score (which also shares source/method variance
with the PGBI, as both were questionnaires completed by the
same caregiver) and diagnoses of any mood disorder (as depres-
sive symptoms are often elevated in bipolar spectrum disorders
as well as in unipolar depression). We expected moderate cor-
relations with Externalizing and YMRS scores due to comor-
bidity as well as mixed-mood presentations, with smaller
positive correlations anticipated with age and female status, as
depressive symptoms often increase around adolescence
(Cyranowski, Frank, Young, & Shear, 2000).
Finally, we used Receiver Operating Characteristic
(ROC) analyses to quantify the discriminative validity of
the mania scale for identifying bipolar spectrum disorder
versus all other diagnoses and the depression scales for
separating cases with any mood disorder from all others
presenting to the clinic. DeLong’s tests compared whether
there was significant shrinkage in the areas under the curve
(AUCs) when the scales were used in the community sam-
ple, and DeLong’s test for dependent AUCs benchmarked
the short forms against the corresponding full-length and
CBCL scales (DeLong, DeLong, & Clarke-Pearson, 1988).
Multilevel DiLRs were calculated, based on optimal cut-
points. This method provides clinically useful information
regarding the likelihood of a diagnosis across a range of
possible scores. DiLRs of less than 1.0 are associated with
lower risk, DiLRs of 1.0 are associated with average risk,
DiLRs between 2 and 5 represent a small increase in risk,
DiLRs between 5.0 and 10.0 are a moderate increase, and
DiLRs larger than 10 can be diagnostic (Straus et al., 2011)
Procedure
All procedures were reviewed and approved by the university,
hospital, and community mental health center Institutional
Review Boards. After caregiver consent and youth assent, the
same interviewer met with the caregiver and youth sequen-
tially, using clinical judgment and reinterviewing to resolve
discrepancies. The primary caregiver completed the full length
73-item PGBI while the youth completed the KSADS inter-
view. PGBI and CBCL scores were masked during the diag-
nostic consensus process, and we followed the 25 STARD
design and reporting guidelines (Bossuyt et al., 2003).
RESULTS
Missing Data Analyses
The largest source of missing data was inclusion of the CBCL
scales as a criterion measure, as these were not initially
gathered at the academic center, and needed to be copied
from the intake packet at the community mental health center.
Even listwise deleting on all variables included in the study
maintained 80% of participants, and the variable level com-
pletion rate exceeded 92%. We constructed propensity scores
(Guo & Fraser, 2010)—a probability summarizing how likely
the person was to have incomplete data—using clinical and
demographic variables; we used the propensity score in sen-
sitivity analyses (for criterion and discriminative validity).
The only variable that made a significant incremental contri-
bution to the propensity model was for non-White participants
to be slightly more likely to have missing data in the academic
sample (p = .038).
Demographics and Descriptives
Table 1 presents descriptive statistics for demographic and
clinical variables, including effect sizes for comparisons
between the academic (training) and community (external
validation) samples. The academic sample was much more
White and affluent, with youth averaging a year older in
age. The academic sample had much higher rates of bipolar
disorder (reflecting study recruitment priorities), and corre-
spondingly higher scores on the mania rating scales.
 SHORT FORMS FOR PARENT GBI 7

TABLE 2
Projected and Empirical Estimates of Internal Consistency Reliability, Correlation with Full-Length Scale, and Length Reduction for Short Forms

Hypomanic/Biphasic Depression

Full Length
Items 28 46
Alpha (Academic) .940 .962
M Interitem Correlation .359 .355
Short Form Mania (10M) Depression-A (10Da) 10Db
Items 10 10 10
Projected Alpha .848 .846 .846
Observed Alpha–Academic .914 .901 .912
Observed Alpha–Community .881 .875 .879
Projected Correlation With Full .797 .814 .814
*Observed Correlation—Academic .949 .954 .941
*Observed Correlation—Community .944 .948 .932
Savings in Length 64% 78% 78%
Projected Validity Reduction 20% 18% 18%
Standard Error of the Measure 2.24 2.11 2.06
Standard Error of Difference 3.17 2.98 2.91
90% Critical Change 5.24 4.93 4.80
95% Critical Change 6.22 5.85 5.70

Note: 10M = 10-item Mania short form; 10Da = 10-item Depression Short Form A; 10Db = 10-item Depression Short Form B.
*Observed correlations are based on embedded item administration.

Although rates of unipolar depressive disorders were more
similar, the percentage with any mood disorder was higher,
and thus the average depression scale scores also were
higher in the academic sample. Conversely, rates of
ADHD, oppositional defiant disorder, conduct disorder,
and posttraumatic stress disorder all were higher in the
community sample, with the average CBCL Externalizing
score also being higher. The effect sizes ran the gamut from
small (differences in rates of oppositional defiant disorder)
to large (socioeconomic status and race). Based on all these
demographic and clinical differences, the community sam-
ple provides a rigorous test of external validity.
Factor Structure and Content Coverage of Short Forms
The 73 items of the full length GBI and PGBI are usually
scored as two scales, Depression and Hypomanic/Biphasic
(Depue et al., 1981). Factor analyses of the GBI find two
large factors corresponding to these, although there are other
smaller factors, with the most common being a “mixed”
factor (which Depue called “biphasic”).
Prior work (Danielson, Youngstrom, Findling, &
Calabrese, 2003; Youngstrom et al., 2001) grouped the 73
items into 20 parcels of three or four items each based on
content coverage, and our prior investigations of factor
structure used the parcels instead of directly analyzing
items. Eight of the parcels contain items from the
Hypomanic/Biphasic scale on the original PGBI, and the
other 12 consist of items from the Depression scale. The
parcels are all statistically homogeneous. To prioritize con-
tent coverage, we considered the parcels when selecting the
items. The 10 items evaluated for the mania short form drew
from six of eight parcels with hypomanic/biphasic content.
The content from “extreme mood and energy” (Parcel 1)
was adequately represented by “mood never in the middle”
items (Parcel 2), and the selected items included both “pure”
hypomanic and mixed items. The 10Dep A form includes
items from nine of the 12 potential parcels (obviously it is
not possible to cover 12 parcels with 10 items), and 10Dep
B represents seven parcels, including two of those not
directly represented on 10Dep A. Because the GBI contains
only one item asking about suicidal ideation (#73), it was
omitted from both short forms, as there was no way to
maintain parallel content, and asking about suicide also
raises liability issues that could create barriers to use in
some screening contexts.
We ran exploratory factor analyses on the mania and
depression scales using the three most accurate decision
rules to determine the number of factors: the scree plot,
Velicer’s minimum average partials and Glorfeld’s extension
of parallel analysis (with 1,000 simulations, and using the
95th percentile as the threshold). Analyses examined the 10
items for the mania and 10 items for each depression form
both jointly (30 items) and again with each subset of depres-
sion items separately (to see if the factor structure of the full
PGBI was preserved with the reduced item set, recognizing
that users would typically administer only one of the two
depression forms). This resulted in six analyses (three item
sets × two samples) and 18 decision rules; 15 indicated the
hypothesized two-factor solution fit best. Including 30 items
(both depression sets, as well as the 10 mania items)
resulted in Glorfeld’s extension of parallel analysis and
8 YOUNGSTROM ET AL.
minimum average partials preferring more than two factor
solutions in the academic (but not community) sample.
When it emerged, the third factor contained “mixed”
items, as anticipated. We chose to retain the mixed items
on conceptual grounds (mood and energy shifting from high
to low being a hallmark of bipolar disorders) and statistical
grounds (these items were among the most discriminating
between cases with and without mood disorder).
We evaluated the interpretability of the two-factor solution,
allowing the factors to correlate. All of the solutions produced
excellent simple structure, with all items showing adequate to
strong loadings on the hypothesized factor and modest cross-
loadings (the largest cross-loading was .319, with a primary
loading of .464; and only four of 140 cross-loadings were
above .3). The median correlation between factors was .55.
Full details are available upon request, including syntax and
data to rerun.
Reliability and Precision of the Short Forms
Based on the average interitem correlation in the academic
sample for the full-length forms, the projected reliability (using
Formula 1 in Smith et al., 2000) of a 10-item short form
approached an alpha of .85 for both the hypomanic and depres-
sive item sets (see Table 2). Using the factor loadings and content
coverage from the parcels, we constructed 10-item forms with
alphas exceeding the projected values in the academic sample.
Impressively, the alphas remained higher than projected in the
community sample as well, with α = .88 for the 10M and both
10D forms (Table 2). Corrected item-total correlations for all
items were .47 or higher in the community sample, also demon-
strating good internal consistency. IRT analysis showed that all
of the short forms maintained good conditional reliability
through the bulk of the latent trait (see Figure 2), with all three
showing reliability above .80 between theta levels 1 SD below
average to 3 SDs above the average trait level for each mood
score. Table 2 also reports the standard error of the measure and
an estimated of the standard error of the difference score for two
administrations of the form. The standard error of the measure
values were all between 2.1 and 2.2, and the standard error of the
difference score values were 2.9 to 3.2, with 6-point changes
being large enough to be 95% confident that the patient was
showing reliable change (Jacobson & Truax, 1991).
Content Coverage of the Short Forms
There is a trade-off between high internal consistency
and breadth of coverage, and it is particularly challen-
ging to balance these with a small item set. The pro-
jected correlation between the short and full-length
scores (Formula 2 from Smith et al., 2000) was r = .80
for mania and .81 for the depression scales. The
observed correlations were all r > .93 in the community
sample. These are inflated by being based on an
embedded administration format. The 10M was adminis-
tered in an extracted format to a subset of cases, but in a
retest format with 1–2 weeks between administrations
that confounds stability with coverage (Freeman et al.,
2012). Only one of the 10 items showed statistically
significant differences in thresholds between the
embedded and extracted administration formats, and the
effect on total scores was negligible (Freeman et al.,
2012). The eight-day retest stability for the 10M was
r = .64. As just described in the item selection, all short
forms selected items to provide good content coverage,
pulling from different item parcels. The one possible
conceptual omission from content for the 10M was
grandiosity or inflated self-esteem (cf. Van Meter,
Burke, Kowatch, Findling, & Youngstrom, 2016).
Criterion Validity of the Short Forms: Convergent and
Discriminant Correlations
Validity of the 10M
Table 3 presents the criterion correlations for both the
28-item and the 10-item mania scales, sorted in descend-
ing order of expected criterion correlation. The pattern
of findings is consistent with a priori expectations for
the full-length scale, and even more so for the 10M. The
a priori ranking of expected correlation magnitude cor-
related with the observed coefficients r = .96 in the
academic and r = .93 in the community sample. Using
Steiger’s test of dependent correlations, eight of 16
correlations showed small but statistically significant
differences; strikingly, the difference always favored
the criterion validity of the short form. The Steiger test
had exceptional statistical power because of the combi-
nation of the sample size and r = .94 correlation between
the 28-item and 10-item forms, so differences in criter-
ion correlations as small as .03 achieved p < .01 sig-
nificance. As hypothesized, the 10M showed
significantly higher correlations with the YMRS than
the CDRS-R (r = .60 vs. r = .11), t(614) = 10.60,
p < .000005. Similarly, 10M scores correlated more
strongly with presence of a bipolar diagnosis versus a
unipolar depressive disorder (r = .59 vs. −.18),
t = 13.65, p < .000005. The 10M scores correlated
more highly with the Externalizing than Internalizing
scores (r = .62 vs. .42), t = 6.19, p < .000005.
The more rigorous test is the external replication in
the community sample. As expected, the convergent
criterion correlations tended to be smaller in the com-
munity sample, reflecting the milder presentation of
bipolar cases and the high rate of other disorders that
could elevate scores on manic symptom scale. Even so,
the community data strongly replicated the patterns seen
in the academic sample. The criterion correlations were
 SHORT FORMS FOR PARENT GBI 9

PGBI - Mania Short Form Validity of the Depression Forms

Information Reliability Table 4 presents the criterion correlations for the full-
length PGBI Depression scale and the two 10-item
15 1.0
forms, sorted in descending order of expected magnitude
0.8
of correlation. The expected pattern held across all three
Information

10

Reliability
0.6 scales and both sample (r = .88–.91 between expected
0.4 rank and observed correlations). Again, the test of dif-
5
0.2 ferences between the criterion correlations had very high
0 0.0 statistical power, and differences as small as .03 were
-3 -2 -1 0 1 2 3 statistically significant. Only one correlation behaved
Theta (θ)
significantly differently than expected: The short forms
PGBI - Depression Short Form A correlated less with Internalizing than did the full-length
Information Reliability
scores, largest difference = .05 (r = .69 for full length
vs. r = .64 for 10Dep form B in the academic sample).
15 1.0
However, these decrements are not substantively mean-
0.8 ingful, as the correlations between the Internalizing
Information

10

Reliability
0.6 scale and both the long and short forms would be
5
0.4 considered “large” effect sizes.
0.2 The convergent correlations with CDRS-R, Internalizing,
0 0.0 and presence of any mood diagnosis all were significantly
-3 -2 -1 0 1 2 3 larger than the corresponding discriminant validity coefficient
Theta (θ)
for YMRS, Externalizing, or bipolar spectrum diagnoses,
PGBI - Depression Form B smallest t(527) = 6.20, p < .000000005 .

Information Reliability

20 1.0
Discriminative Validity of the Short Forms
15 0.8
ROC analyses quantified the discriminative accuracy of the
Information

Reliability

0.6 full-length and short forms. We compared the 10M against

10
0.4
5 0.2
0 0.0
-3 -2 -1 0 1 2 3
Theta (θ)
FIGURE 2 Information and reliability estimates from IRT analysis of
short forms. Note: The arrow indicates the theta level where marginal
reliability is .80.
significantly different in four instances, three of them
favoring the validity of the short form; the exception
was that the 10M score showed a higher correlation with
the CDRS-R than did the 28-item scale (r = .30 vs. .27),
t(522) = 2.03, p < .05, indicating modestly lower dis-
criminant validity. The validity coefficients strongly
aligned with the a priori ranking (r = .93), and the
10M scores correlated significantly more with the
YMRS than the CDRS-R (r = .41 vs. .30), t = 2.48,
p = .013, and with bipolar diagnoses versus unipolar
depressive diagnoses (r = .32 vs. .08), t = 3.64,
p < .0005. The criterion correlations with Externalizing
and Internalizing CBCL scores were both r = .39, not
significantly different.
the full-length Hypomanic/Biphasic scale and the
Externalizing scale for discriminating cases with bipolar
disorder from all other cases, using DeLong’s tests to see
if there was significant change in performance between the
academic and community samples (independent AUCs), and
DeLong’s test for paired AUCs to compare performance of
the short forms versus the long or the CBCL AUCs. Based
on the accuracy of the criterion diagnoses, the upper bound
of the observed AUC performance would be about .925, not
the theoretical limit of 1.00 (Kraemer, 1992). The 10M
delivered an AUC of .85 in the academic and .78 in the
community sample (see Table 5). The shrinkage in moving
to the community sample was significant (p < .05) but still
left the AUC in the upper half of the performance range for
caregiver report on a mania scale in a clinically general-
izable sample based on the results of a meta-analysis, 95%
confidence interval [.70, .81] (Youngstrom et al., 2015). The
10M performed better than the full-length form in the aca-
demic sample (p < .005) and slightly, but not significantly,
better in the community sample; it far exceeded the perfor-
mance of the Externalizing score at identifying cases with
bipolar in both samples (ps < .005).
Both forms of the 10D performed quite similarly in both
samples, earning AUCs of .84 for identifying cases with any
mood disorder in the academic sample, shrinking slightly to
.79 for Form A (DeLong p = .046) and .80 for Form B
10 YOUNGSTROM ET AL.

TABLE 3
Criterion Correlations for 10-Item Mania Scale and Full-Length Hypomanic/Biphasic Scale

Academica Communityb

Expected Rank Criterion Variable Full Length 10M t Full Length 10M t

1 YMRS total (interview) .57 .60 −3.40** .40 .41 −0.96

2 Bipolar spectrum diagnosis .55 .59 −3.40** .31 .32 −1.53
3 CBCL Externalizing T score .65 .62 3.58*** .43 .39 3.41**
4 CBCL Internalizing T score .47 .42 4.71**** .41 .39 1.06
5 Any mood disorder Diagnosis .42 .42 −0.23 .28 .30 −1.50
6 CDRS-R total (interview) .14 .11 2.14* .27 .30 −2.03c,*
7 Count of comorbid Diagnoses .36 .35 1.05 .33 .33 −0.14
9 ADHD diagnosis .21 .20 1.19 .25 .22 2.33*
9 ODD diagnosis .18 .19 −0.22 .14 .14 −0.10
9 Conduct disorder diagnosis .15 .11 2.64* .18 .15 2.19*
12 PTSD diagnosis .05 .05 0.11 .06 .07 −1.13
12 Any anxiety diagnosis .00 .00 −0.15 .08 .09 −0.26
12 Female youth .00 .02 −1.07 −.02 −.01 −0.78
15 Youth age (years) −.09 −.11 1.19 −.08 −.09 0.96
15 White youth −.10 −.07 −2.22* .02 .01 0.46
15 Any unipolar depression −.18 −.22 3.05** .08 .08 −0.49

Note: Coefficients are point-biserial correlations for dummy-coded categorical variables, and Pearson correlations for continuous variables. Steiger’s test of
dependent correlations tested difference between full length and short form criterion correlations. Differences, where significant, favored short form validity
unless noted otherwise. YMRS = Young Mania Rating Scale; CDRS-R = Child Depression Rating Scale–Revised; CBCL = Child Behavior Checklist;
10M = 10-item Mania short form; ADHD = attention deficit/hyperactivity disorder; ODD = oppositional defiant disorder; PTSD = posttraumatic stress disorder.
*p < .05, **p < .005, ***p < .0005, ****p < .00005, two-tailed
a
N = 617.
b
N = 530.
c
Discriminant validity of 10M was slightly worse than full length scale in Community sample.

(p = .114) in the community sample. The short forms’
performance was quite similar to the full-length 46-item
Depression scale, which had AUC = .86 in the academic
and .79 in the community sample, not significant in three of
four tests before any post hoc correction. The short forms
substantially exceeded the discriminative validity of the
Internalizing score in both samples, least significant
p = .0013. Overall, the short forms showed negligible
change in accuracy compared to the full-length versions,
marked superiority to the corresponding CBCL scale, and
robust performance in a new, independent sample that com-
pares favorably with meta-analytic benchmarks.
Diagnostic Likelihood Ratios
Often it is possible to split assessment scores into multiple
segments, preserving more information. We estimated
DiLRs by first segmenting scores into quintiles based on
the academic sample and then adjusting boundaries to avoid
degenerate score distributions in either sample (where the
DiLRs would not progress monotonically due to sampling
error within a particular segment). Table 6 gives the DiLRs
for using the 10M to predict the probability of a bipolar
spectrum disorder (bipolar I, II, cyclothymic disorder, or
other specified bipolar and related disorder), as well as the
DiLRs for both depression scales predicting any mood dis-
order (including depression, dysthymic/persistent depressive
disorder, and other specified depressive disorder, as well as
bipolar disorders).
Sensitivity Analyses to Effects of Propensity Scores
and Outliers
Although the percentage of missing data was small and the
differences between missing and complete cases tended to
be small, we ran sensitivity analyses controlling for the
propensity score in logistic regression models. In all six
analyses, the short form continued to show highly signifi-
cant prediction of the target diagnosis, with changes in the
regression weight ranging from –.009 to .097 (Mdn
= –.0035), indicating negligible change in performance
adjusting for potential dropout bias.
In addition, regression analyses checked for multivariate
outliers, using the short form score as the dependent vari-
able and the diagnoses (including comorbidities), age and
sex as predictors. We used Mahalanobis’s distance to iden-
tify outliers with unusual constellations of scores on the
predictors, Studentized deleted residuals to flag cases with
short-form scores far from predicted values, and Cook’s
distance to identify cases with discrepant combinations of
 SHORT FORMS FOR PARENT GBI 11

TABLE 4
Criterion Correlations for 10-Item Depression Forms A and B and Full-Length Depression Scale

Academica Communityb

Expected Full Full Full Full

Rank Criterion Variable Length 10Da t Length 10Db t Length 10Da t Length 10Db t

1 CDRS-R total .58 .62 −3.83*** .58 .63 −4.30**** .54 .57 −2.79* .54 .56 −2.00*
(interview)
2 CBCL Internalizing .69 .65 4.50**** .69 .64 5.23**** .55 .51 4.23**** .55 .52 2.80*
Ta
3 Any unipolar .25 .32 −5.43**** .25 .31 −3.92*** .32 .35 −2.19* .32 .40 −5.94****
depression
4 Any mood disorder .53 .52 0.58 .53 .51 1.72 .46 .48 −1.07 .46 .50 −2.74*
5 Bipolar spectrum .27 .22 5.12**** .27 .21 4.82**** .25 .23 1.45 .25 .19 3.94****
6 CBCL .43 .36 6.65**** .43 .33 8.04**** .27 .22 3.76*** .27 .19 5.60****
Externalizing T
7 YMRS total .27 .20 5.94**** .27 .19 5.59**** .28 .27 0.85 .28 .21 5.92****
(Interview)
8 Youth age (Years) .23 .30 −6.40**** .23 .30 −5.58**** .16 .19 −2.62* .16 .25 −6.71****
9 Comorbid .22 .17 4.60**** .22 .15 5.46**** .33 .30 3.23** .33 .30 2.55*
10 Female youth .16 .19 −2.46* .16 .19 −2.09* .12 .13 −0.89 .12 .16 −2.72*
11 Any anxiety .09 .07 1.93 .09 .09 −0.19 .24 .22 1.61 .24 .23 0.24
disorder
14 White youth −.05 −.03 −1.84 −.05 −.02 −1.92 −.02 −.03 0.98 −.02 −.02 0.27
14 Any ADHD −.09 −.15 5.01**** −.09 −.17 6.31**** .00 −.05 4.18**** .00 −.07 5.37****
diagnosis
14 Any ODD −.01 −.05 3.36** −.01 −.04 2.09* .05 .04 0.89 .05 .01 2.45*
diagnosis
14 Any conduct .04 .03 0.92 .04 −.01 3.59*** .09 .07 1.17 .09 .10 −0.55
disorder
14 Any PTSD .12 .09 2.21* .12 .11 0.73 .16 .18 −1.45 .16 .16 0.56

Note: Coefficients are point-biserial correlations for dummy-coded categorical variables, and Pearson correlations for continuous variables. Steiger’s test of
dependent correlations tested difference between full-length and short form criterion correlations. Differences, where significant, favored short form validity
unless noted otherwise. YMRS = Young Mania Rating Scale; CDRS-R = Child Depression Rating Scale–Revised; CBCL = Child Behavior Checklist; 10Da
and 10Db = 10-item Depression Short Forms A and B; ADHD = attention deficit/hyperactivity disorder; ODD = oppositional defiant disorder;
PTSD = posttraumatic stress disorder. Italicized values were expected to be near zero coefficients, not significant ones.
*p < .05, **p < .005, ***p < .0005, ****p < .00005, two-tailed.
a
N = 617.
b
N = 530.
c
Convergent validity of both short forms with Internalizing was significantly lower than for full-length depression in both Academic and community
samples, largest difference r = .05.

short form score versus predictors. Outlier diagnostics iden-
tified a few marginal cases; dropping them and re-running
analyses did not change the associations between the target
diagnosis and respective short form.
DISCUSSION
The goal of this article was to develop and rigorously
evaluate 10-item short forms assessing mood symptoms,
pulling from the 73 items on the parent-rated GBI. The
GBI has an extensive program of research supporting it,
with a wealth of data about multiple facets of validity, and
the parent-rated version has shown top-tier discriminative
validity in a recent meta-analysis (Youngstrom et al., 2015),
as well as excellent sensitivity to treatment effects.
However, the GBI’s length makes it cumbersome to use in
many clinical settings. A 10-item form was carved from the
28-item Hypomanic/Biphasic scale previously (Youngstrom
et al., 2008), and it showed excellent psychometric proper-
ties, including high internal consistency, good context cov-
erage, and excellent discriminative validity. These features
led to its widespread adoption, and it has continued to show
strong reliability and validity across a range of samples and
12 YOUNGSTROM ET AL.

TABLE 5
ROC Analysis of the Discriminative Validity of the PGBI-10M, Hypomanic/Biphasic Scale (Full Length), and the CBCL Externalizing Score for
Discriminating Cases with Bipolar Spectrum Disorder from All Other Cases at Clinic

Academic Community
Predictor AUC 95% CI AUC 95% CI DeLong Test

Diagnosis ROC .925 — .925 — —

Hypo/Biphasic Full Length .83 [.80, .86] .76 [.71, .82] 1.94
10-Item Mania .84 [.81, .88] .78 [.72, .83] 2.29*
Externalizing .78 [.75, .82] .67 [.61, .74] 2.91**
Diagnosis ROC .925 — .925 — —
Depression Full Length .85 [.82, .89] .79 [.75, .82] 2.65*
10-Item Depression - Form A .84 [.81, .87] .79 [.75, .83] 2.04*
10-Item Depression - Form B .84 [.81, .88] .80 [.77, .84] 1.58
Internalizing .76 [.71, .80] .71 [.67, .76] 1.31

Note: The diagnosis receiver operating characteristic is dictated by the interrater reliability of the Longitudinal Expert evaluating All Data diagnoses (κ
= .85; Kraemer, 1992), and sets an upper border for the area under the curve (AUC) that could be empirically observed. The 10M mania short form performed
significantly better than both the full-length Hypomanic/Biphasic scale and the CBCL Externalizing score, in both the academic and the community samples
(largest p < .05). The 10Da and 10Db depression short forms performed better than the CBCL Internalizing score in both samples (largest, most conservative
p = .00005). The 10Da and 10Db performed no differently than the full-length PGBI Depression scale (smallest p > .10). ROC = receiver operating
characteristic; PGBI = Parent General Behavior Inventory; 10M = 10-item Mania short form; CBCL = Child Behavior Checklist; CI = confidence interval.
*p < .05, **p < .005, two-tailed.

TABLE 6
Multilevel DiLR for Short Forms, Using 10M to Predict Bipolar Spectrum Disorders, and 10da and 10db to Predict Any Mood Disorder

10M for Bipolar 10Da for Any Mood 10Db for Any Mood

Risk Change Label Score Range DiLR Score Range DiLR Score Range DiLR

Very Low 0–2.59 .07 0–1.99 .25 0–1.99 .22

Low 2.6–6.99 .41 2–5.99 .71 2–5.99 .71
Neutral 7–10.99 1.44 6–9.99 1.85 6–10.99 2.69
High 11–17.99 2.39 10–14.99 4.52 11–14.99 5.64
Very High 18+ 5.38 15+ 8.80 15+ 8.09

Note. Segments defined by quintiles in the academic sample and then adjusted to avoid degenerate distributions in either sample (Pepe, 2003). DiLR =
diagnostic likelihood ratios; 10M = 10-item Mania short form; 10Da and 10Db = 10-item Depression Forms A and B.

applications (e.g., Bebko et al., 2014; Findling et al., 2013;
Findling, Youngstrom, McNamara, et al., 2012; Findling,
Youngstrom, Zhao, et al., 2012; Jo et al., 2016; Portugal
et al., 2016). The major contributions of this article are to (a)
develop depression short forms, taking advantage of the
large item pool to explore the possibility of parallel forms;
(b) examine the combination of depression and mania short
forms to confirm that they preserve the content coverage
and structure of the full-length GBI; (c) compare the
observed psychometrics with projections based on recom-
mended formulae (Smith et al., 2000) and using IRT to
examine reliability across a range of trait mood levels; (d)
extend the criterion validity nomothetic network for all the
short forms, examining convergent validity with interview
ratings and CBCL scores, discriminant validity with con-
trasting constructs, and criterion validity with demographic
and clinical characteristics; and (e) test the diagnostic dis-
criminative validity of the scales, again comparing to
performance of the full-length version, the CBCL scales,
and meta-analytic benchmarks. External cross-validation in
a sample that has quite different demographics, referral
patterns, and clinical issues is a major strength (Konig
et al., 2007).
Starting with the 73-item full-length version, we con-
structed a 10-item Mania scale and two parallel 10-item
Depression scales, Forms A and B. Combining either of
the depression forms with the 10M reproduces the two-
factor structure usually used to score the full-length GBI.
The short forms include “mixed-mood” items, and factor
analyses of the 30 items produce a “mixed” or biphasic
factor, should that be desired. The conceptual content cover-
age of the short forms is good, representing the bulk of the
item parcels the full item set comprises.
We followed recommendations to project the reliability
and the coverage correlation between the short and full-
length forms (Smith et al., 2000). Ten-item formats offer a

64% savings in terms of scale length for the mania and 78%
for the depression scales. The correlation attenuation for-
mula projects that a well-designed short form should show
roughly a 20% decrement in validity coefficients (Smith
et al., 2000). The observed internal consistency estimates
in the community sample exceeded projections based on the
psychometrics in the academic sample for all short forms.
So did the coverage estimates. The coverage correlations are
inflated by the fact that only an embedded item administra-
tion format was available for primary analyses, so the results
are somewhat optimistic. However, the criterion correlations
are impressive, with almost none showing shrinkage com-
pared to the full-length form—even in the independent
community sample—and with many demonstrating stronger
criterion validity estimates than the full-length form. This
unusual combination of strengths is likely due to the con-
struction of the items: Rather than focusing on single symp-
toms, the PGBI items routinely juxtapose and combine
symptoms—irritability when sleeping less; mood shifting
from happy to sad rapidly—and emphasize the aspects of
episodicity and change that are hallmarks distinguishing
mood disorder from other more chronic conditions
(Goldstein et al., 2017; Youngstrom, 2009). These features
create some technical challenges in evaluating factor struc-
ture: For example, is “mood shifts rapidly from happy to
sad” a hypomanic item, or a depressed item? It will show
local dependence with other items asking about happiness,
or about sadness. However, it is precisely the emphasis on
change and constellations of symptoms that enables the GBI
to discriminate better between mood disorders and ADHD,
anxiety, and other common disorders with similar presenta-
tions (Youngstrom et al., 2015). IRT analyses showed that
the scales are measuring well (i.e., high information and
reliability values) across a wide swath of the depression and
mania traits. Their precision is high in score ranges likely to
be useful for screening and diagnostic purposes as well as
grading symptom level in community or population sam-
ples; they also would likely be useful for quantitative trait
studies and correlates with quantitative biological
measurements.
The comparisons between the PGBI scales and the
CBCL Externalizing and Internalizing scales are revealing
in this regard. The 10M correlated r ~ .6 with both the
YMRS and the Externalizing score in the academic sample,
and r ~ .4 with both in the community sample. The YMRS
correlations are mono-trait but hetero-method correlations,
albeit with some overlap—the interviewer made YMRS
ratings based on interview and observation of the youth as
well as interviewing the caregiver. The correlations with
Externalizing are mono-method and hetero-trait, although
again, mania and externalizing would be expected to be
correlated constructs. The ROC analyses reveal the greater
specificity of the PGBI item content, with the AUC sub-
stantially outperforming the Externalizing score, and the gap
widening in the community sample, where the bipolar
SHORT FORMS FOR PARENT GBI 13
presentations are milder and the cognate conditions that
are likely to lead to elevated Externalizing behaviors for
other reasons are more common. The Externalizing scale
combines the items in the Aggressive Behavior and the Rule
Breaking Behavior scales; the CBCL does not have mania
scale per se and omits many symptoms that are more spe-
cific to mania. The pattern of findings in the present samples
aligns with the pattern shown in the meta-analysis of all
available rating scales for identifying bipolar disorder in
youths: Instruments that contain more diagnostically speci-
fic items outperform other scales in both youths
(Youngstrom et al., 2015) and in adults (cf. performance
of Altman or Behavioral Activation Scale vs. GBI or
Hypomania Checklist; Youngstrom et al., 2018).
The performance of the Depression short forms followed
a similar pattern, with one added nuance. In both samples,
the short forms showed significantly higher correlations
than the full length did with the CDRS-R and with diag-
noses of unipolar depressive disorders. The nuance is that
the short forms showed lower correlations with Internalizing
than did the full-length scale. The difference was small but
significant, indicating the greater focus on depression built
into the short-form item selection process. The Internalizing
scale was not built to narrowly focus on depression. It
combines three subscales: Anxious/Depressed, Withdrawn,
and Somatic Complaints, and Internalizing scores are highly
elevated in anxiety disorders, not just depressive disorders
(Ferdinand, 2008; Van Meter et al., 2014). The short forms’
greater focus is shown by their better discriminative validity
versus that of the Internalizing score for identifying cases
with mood disorder. The short forms also include items
related to low positive affect, low energy, and anhedonia
—the “low positive affect” dimension that is specific to
depression in the tripartite model of depression and anxiety
(Clark & Watson, 1991; Gaylord-Harden, Elmore,
Campbell, & Wethington, 2011). This contributes to the
excellent discrimination of depressed versus nondepressed
cases, even when a large number of cases with bipolar
disorder were included in the analysis. It is likely that the
short forms would be useful for detecting and measuring
depression in bipolar cases as well.
We calculated diagnostic likelihood ratios to help inter-
pret short form scores in terms of predicting the prob-
ability of bipolar or any mood disorder (Straus et al.,
2011). Low scores on the 10M are decisive in ruling
bipolar disorder out, and very high scores are clinically
helpful. The corresponding DiLRs could move a 10%
base rate down to less than 1% with a very low score
and up to 37% with a very high score. The two depres-
sion forms are useful with low risk scores, moving a 30%
prior probability down to less than 10%, and very high
risk scores would move 30% up to about 78%. These
results can be combined with other information about the
case, such as family history of mood disorder, further
refining the probability (Algorta et al., 2013;
14 YOUNGSTROM ET AL.

Youngstrom, Van Meter, et al., 2017). Combining diag- Clinical Implications

nostic likelihood ratios makes a simplifying assumption
The new forms are short and less burdensome: They are
that the predictors have negligible correlations. In prac-
less than one third of the length of the original, can be
tice, the results still tend to be accurate and generalize
used to track change, will improve diagnostic accuracy,
well across samples (Baumer, Kaplan, & Horton, 2017;
and are free. They outperformed the well-established
Youngstrom, Halverson, et al., 2017).
CBCL scales for the specific purpose of identifying
There are important advantages to having two alternate
cases with mood disorder. Their psychometric properties
forms of a test that are highly correlated, produce the same
generalized well from an academic sample to a commu-
scores on average, have similar variances, and yet have
nity sample with large differences in terms of demogra-
different item content. The nearly identical performance of
phy and clinical referral pattern, providing a stringent
the two short forms makes it possible to use one version for
test of external validation. The diagnostic likelihood
recruitment purposes and the other to measure depression
ratios provide a case-oriented effect size that allows
levels at study baseline for eligible cases. Similarly, the
clinicians to combine the test result with the base rate
short forms could be alternated as measures of treatment
of mood disorders at their setting and other risk factors
response or outcome, reducing the repetitiveness (and cor-
to estimate the probability of mood disorder, guiding
responding burden and practice effects) for participants. In
clinical decisions about more intensive assessment and
computer adaptive testing implementations, the items could
treatment selection. The precision of the scales, with
be pooled and selected based on participant responses to
standard errors of roughly 2 points, suggests that they
construct other dynamic short forms.
may also be helpful for measuring treatment effects,
although more work can be done to enhance their utility
in a clinical significance framework. Because the PGBI
Limitations and Future Directions has already been translated into a variety of languages,
the short forms also are available in Spanish and more
It would be ideal to have more information about the
than a dozen other languages (available upon request
psychometrics of the depression scales when they are
from the authors), further enhancing utility.
used in a standalone, extracted format. Whereas technical
psychometric information has been published for the 10M
FUNDING
(Freeman et al., 2012), we did not gather the depression
short forms in an extracted format in these protocols. The
This research was supported in part by National Institute of
psychometrics are likely to prove robust based on all
Mental Health R01 MH066647 (PI: E. Youngstrom) and a
indications in the present data, plus the construction of
grant from the Stanley Medical Research Institute (PI: R.L.
the items on the depression form is similar to the mania
Findling).
items, so the features contributing to the high alpha and
coverage are likely similar. Of note, 10D Form A has
been used in an extracted format in multiple clinical trials
now, and it has shown excellent sensitivity to treatment
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