Psychology RootsInternal State Scale
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About Internal State Scale
Scale Name
Internal State Scale
Author Details
Mark S. Bauer, Paul Crits-Christoph, William A. Ball, Elizabeth Dewees, Thomas McAllister, Patricia Alahi, John Cacciola, and Peter C. Whybrow
Translation Availability
English
Background/Description
The Internal State Scale (ISS), developed by Bauer et al. (1991), is a 16-item self-report scale designed to simultaneously assess the severity of manic and depressive symptoms in adults with bipolar disorder. Published in Archives of General Psychiatry, the ISS includes four subscales: Activation (5 items, e.g., feeling overactive, racing thoughts), Well-Being (3 items, e.g., positive mood), Perceived Conflict (5 items, e.g., irritability, interpersonal tension), and Depression Index (3 items, e.g., sadness, hopelessness). The scale aims to discriminate mood states (euthymia, mania, hypomania, depression, mixed states) and is particularly useful for identifying mixed episodes, where manic and depressive symptoms co-occur.
Participants rate their internal state over the past 24 hours on a visual analogue scale (0 = “Not at all/rarely” to 100 = “Very much so/much of the time”). Total subscale scores vary by item count, with a revised scoring algorithm (Bauer et al., 2000) used to classify mood states (e.g., Activation ≥ 155 and Depression Index ≥ 125 for mixed states). The ISS was validated with 105 patients (mean age ≈ 30–50 years, ~60% male, U.S.-based, including 86 from Veterans Affairs medical centers), showing that 88% of subjects were correctly assigned to diagnostic groups via discriminant analysis. It correlates with clinician-rated mania (r ≈ 0.60–0.80) and depression (r ≈ 0.50–0.70) scales. The ISS is used in clinical psychology, psychiatry, and research to monitor mood states, assess treatment response, and guide clinical management of bipolar disorder. For inquiries, contact Mark S. Bauer at [email protected].
Administration, Scoring and Interpretation
- Obtain the scale from Bauer et al. (1991, 2000) or contact Mark S. Bauer ([email protected], Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, Ph: 401-273-7100 x3863, Fax: 401-457-3311), ensuring ethical permissions.
- Explain to participants (adults with bipolar disorder) that the questionnaire assesses current mood symptoms, emphasizing confidentiality and voluntary participation.
- Administer the 16-item scale in a clinical or controlled setting, using paper or digital formats, with instructions to mark symptom intensity on a visual analogue scale for the past 24 hours.
- Estimated completion time is 5–10 minutes.
- Ensure a private, supportive environment; provide mental health resources (e.g., crisis hotlines) and adapt for accessibility (e.g., large print) if needed.
Reliability and Validity
The ISS demonstrates robust psychometric properties (Bauer et al., 1991, 2000). Internal consistency is high for subscales: Activation (Cronbach’s alpha ≈ 0.80–0.85), Well-Being (≈ 0.75–0.80), Perceived Conflict (≈ 0.70–0.80), and Depression Index (≈ 0.70–0.80). Test-retest reliability is not explicitly reported but estimated as moderate (r ≈ 0.65–0.80 over 1–2 days) based on similar mood scales. Convergent validity is supported by correlations with the Young Mania Rating Scale (r ≈ 0.60–0.80 for Activation) and Hamilton Depression Rating Scale (r ≈ 0.50–0.70 for Depression Index).
Discriminant validity is evidenced by weak correlations with unrelated constructs like general intelligence (r < 0.20). Factorial validity is confirmed by a four-factor structure, and criterion validity is shown by 88% correct mood state classification and sensitivity to mood changes (79% accuracy in longitudinal assessments). A revised scoring algorithm (Bauer et al., 2000) enhances mixed state detection. Pairing with measures like the Altman Self-Rating Mania Scale or Patient Health Questionnaire-9 (PHQ-9) enhances comprehensive assessment.
Available Versions
16-Items
Reference
Bauer, M. S., Crits-Christoph, P., Ball, W. A., Dewees, E., McAllister, T., Alahi, P., … & Whybrow, P. C. (1991). Independent assessment of manic and depressive symptoms by self-rating: Scale characteristics and implications for the study of mania. Archives of general psychiatry, 48(9), 807-812.
Important Link
Scale File:
Frequently Asked Questions
What does the Internal State Scale measure?
It measures manic and depressive symptoms in bipolar disorder, including activation, well-being, conflict, and depression.
Who is the target population?
Adults with bipolar disorder.
How long does it take to administer?
Approximately 5–10 minutes.
Can it inform interventions?
Yes, it monitors mood states to guide treatment and management of bipolar disorder.
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