Reliability, validity, and screening performance of the Chinese version of the McLean Screening Instrument for...

Evidence regarding the psychometric properties of the Chinese version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in psychiatric clinical populations remains limited. This study evaluated the reliability, validity, and screening performance of the Chinese MSI-BPD in a psychiatric clinical sample and examined a theory-driven four-factor model.

The previously translated Chinese MSI-BPD was reviewed for comprehensibility and clinical appropriateness through expert review, cognitive debriefing, and pilot testing. In this cross-sectional study, 375 outpatients and inpatients from a tertiary psychiatric hospital in Zhuhai, China, completed the Chinese MSI-BPD, with the Revised Diagnostic Interview for Borderlines (DIB-R) used as the reference standard. Confirmatory factor analysis was conducted using the weighted least squares mean- and variance-adjusted estimator. Five CFA models were compared: a one-factor model, a classical four-factor model, a literature-derived modified four-factor model, the theory-driven four-factor model, and a higher-order model. Reliability, criterion-related validity, and screening performance were evaluated.

The theory-driven four-factor model showed the most favorable fit indices among the admissible models (χ²/df = 1.409, CFI = 0.995, TLI = 0.992, RMSEA = 0.033, SRMR = 0.043). The higher-order model also showed good fit, supporting a general BPD factor underlying the four symptom domains. In the theory-driven model, standardized factor loadings ranged from 0.622 to 0.911. The Chinese MSI-BPD total score was strongly correlated with the DIB-R total score (r = 0.829, p < 0.01). McDonald's omega, Guttman split-half reliability, and test-retest reliability for the total scale were 0.884, 0.894, and 0.851, respectively. The Youden-based optimal cutoff was 6.5, corresponding to a clinically practical threshold of ≥7 in the present sample, with an AUC of 0.884, sensitivity of 88.83%, specificity of 71.91%, and Cohen's kappa of 0.612.

The Chinese MSI-BPD total score demonstrated good reliability, criterion-related validity, and screening performance in this psychiatric clinical sample. The theory-driven four-factor model may provide a clinically useful but provisional interpretive framework; however, the total score should remain the primary screening index. The instrument may serve as a brief preliminary screening tool for BPD in tertiary psychiatric clinical settings in China, but not in general psychiatric or community populations without dedicated validation.