The Beck Depression Inventory as a Measure of Subjective Well-Being: A Cross-National Study

The present study examined the question whether the Beck Depression Inventory (BDI), which is one of the most widely used instruments to assess depression, can be used to measure differences in subjective well-being at national level. In order to establish the meaning of depression scores at country level, the functional equivalence (i.e., similarity of meaning) of depression scores at individual and country level was examined. Studies using the BDI in normal populations from 28 countries were collected. Depression showed the same correlates at individual and country level, which supports the functional equivalence of the BDI at the two levels. BDI scores and subjective well-being were then correlated with a number of country characteristics in order to test three theories of cross-national differences in subjective well-being. Livability theory stresses the importance of objective living conditions, comparison theory focuses on relative living conditions, and folklore theory states that cross-national differences can be explained by some national trait (e.g., beliefs and values concerning happiness). Cross-national differences in depression and subjective well-being could be explained by livability theory and folklore theory. BDI scores were negatively correlated with subjective well-being and other happiness-related variables. These findings suggest that depression had the same meaning at individual and country level and that depression is an adequate measure of (a lack of) subjective well-being at country level.     

Facing the Music or Burying Our Heads in the Sand?: Adaptive Emotion Regulation in Midlife and Late Life

Defenses that keep threatening information out of awareness are posited to reduce anxiety at the cost of longer-term dysfunction. By contrast, socioemotional selectivity theory suggests that preference for positively-valenced information is a late-life manifestation of adaptive emotion regulation. Using longitudinal data on 61 men, we examined links between emotion regulation indices informed by these distinct conceptualizations: defenses in earlier adulthood and selective memory for positively-valenced images in late-life. Use of avoidant defenses in midlife predicted poorer memory for positive, negative, and neutral images nearly 4 decades later. Late-life satisfaction was positively linked with midlife engaging defenses but negatively linked at the trend level with concurrent positive memory bias.     

Structure and measurement of depression in youths: applying item response theory to clinical data

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.     

Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool

Methods for detecting depression in fathers after the birth of their child are scarce. The Edinburgh Postnatal Depression Scale (EPDS), used to screen mothers for postpartum depression (PPD), lacks somatization and externalizing items. This potentially decreases its sensitivity in detecting depression in fathers, as many men actually express depression with somatization or externalizing symptoms. The present study assessed depressive symptoms in fathers of children 0–18 months old, and evaluated whether addressing both typical depression and externalizing, so‐called “depressive equivalent” symptoms, might be more suitable for such assessment. The Beck Depression Inventory‐II (BDI‐II), EPDS, and Gotland Male Depression Scale (GMDS) were responded to by 447 Swedish fathers online. Among participants, 27% reported depressive symptoms above the BDI‐II cut‐off suggestive of depression. Most fathers reported both traditional and depressive equivalent symptoms and a subgroup expressed exclusively depressive equivalent symptoms. Consistently, a scale combining items from the EPDS and GMDS showed higher sensitivity than the EPDS alone in identifying fathers with elevated depressive symptoms, at equal levels of specificity. Our findings suggest that a combination of EPDS and depressive equivalent symptom items results in a more suitable instrument for screening for depression in fathers during the postnatal period.     

Scoring Depression on a Common Metric: A Comparison of EAP Estimation,Plausible Value Imputation,and Full Bayesian IRT Modeling

There are a growing number of item response theory (IRT) studies that calibrate different patient-reported outcome (PRO) measures, such as anxiety, depression, physical function, and pain, on common, instrument-independent metrics. In the case of depression, it has been reported that there are considerable mean score differences when scoring on a common metric from different, previously linked instruments. Ideally, those estimates should be the same. We investigated to what extent those differences are influenced by different scoring methods that take into account several levels of uncertainty, such as measurement error (through plausible value imputation) and item parameter uncertainty (through full Bayesian IRT modeling). Depression estimates from different instruments were more similar, and their corresponding confidence/credible intervals were larger when plausible value imputation or Bayesian modeling was used, compared to the direct use of expected a posteriori (EAP) estimates. Furthermore, we explored the use of Bayesian IRT models to update item parameters based on newly collected data.     

Comparisons Across Depression Assessment Instruments in Adolescence and Young Adulthood: An Item Response Theory Study Using Two Linking Methods

Item response theory (IRT) methods allow for comparing the utility of instruments based on the range and precision of severity assessed by each instrument. As adolescents and young adults can display rapid increases in depressive symptoms, there is a crucial need to sensitively assess mild elevations of symptoms (as an index of initial risk) and moderate-severe symptoms (as an indicator of treatment disposition). We compare the information assessed by the Beck Depression Inventory (BDI) to the newly developed Patient Reported Outcome Measurement Information System – Depression measure (PROMIS-Depression), and the Center for Epidemiologic Studies – Depression (CES-D) scale. The present work is based on data from two fully independent samples of community adolescents and young adults. One sample completed the BDI and CES-D (n?=?1,482) and the second sample (n?=?673) completed the PROMIS-Depression measure and the CES-D. Using two different IRT-based linking methods, (1) equating based on common items and (2) concurrent calibration methods, analyses revealed that the PROMIS-Depression measure assessed information over the widest range of depressive severity with greatest measurement precision relative to the other instruments. This was true for both the 28-item and 8-item versions of the PROMIS-Depression measure. Findings suggest that the PROMIS-Depression measure assessed depression severity with greatest precision and over the widest severity range of the assessed instruments. However, future work is necessary to demonstrate that the PROMIS-Depression measure has reliable associations with external criteria and is sensitive to treatment response.     

Relationships between the Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression in depressed outpatients

The Beck Depression Inventory (BDI) and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were used with 300 outpatients diagnosed with DSM-III major depression disorders. A principal-components analysis was performed on the intercorrelations among the 21 BDI and 24 HRSD symptoms. Three orthogonal components were found and interpreted as reflecting differences in self-report and clinical rating methods for measuring the severity of depression. The importance of using both self-reports and clinical ratings for evaluating depression in psychiatric outpatients was discussed.     

Mean Level Differences in the Vividness,Meaning, and Coherence of Life Story High and Low Points: How Valenced Life Stories Do and Do Not Differ

The current paper examines systematic differences in life story high and low points. Narratives from a young adult sample (n = 145) and a late midlife adult sample (n = 154) were coded for vividness, meaning, and coherence. An automated linguistic coding technique was also used. Mean level comparisons found high and low points had similar levels of vividness and coherence. Among the young adults, but not the late midlife adults, there was greater total meaning making (positive and negative combined) in low points than in high points. Across high and low points, levels of positive meaning were greater than negative meaning, in both samples, suggesting a positivity bias in meaning making in valenced life stories. Moreover, the bias was large in both samples (68% in young adults, 450% in late midlife adults). Preliminary analyses suggested midlife adults, when compared to young adults, had a greater bias towards producing more positive than negative meaning. In both samples, automated linguistic analyses indicated that low points displayed greater word counts and usage of cognitive mechanism words, suggesting greater cognitive processing in low points at the level of word usage. Findings are framed within autobiographical memory and narrative research and socioemotional selectivity theory.     

Depression in a Cancer Patient Population

The main goal of this study was to examine depression and its components in cancer patients as compared with healthy control subjects and psychiatric inpatients. The participants were 54 cancer patients (28 females with breast cancer, 26 males with prostate cancer), 59 healthy controls (33 females, 26 males), and 75 psychiatric patients (27 females, 48 males). Participants were administered the Beck Depression Inventory (BDI) and the State Trait Personality Inventory (STPI) Depression scales. Cancer patients had higher overall depression scores than did healthy controls as measured by BDI, but the difference was due primarily to the significantly higher scores of the cancer patients on the BDI Somatic–Performance subscale. No differences were found on the BDI Cognitive–Affective subscale. Cancer patients also scored significantly higher than healthy controls on the State-Trait Personality Inventory (STPI) State Depression (S-Dep) scale because of higher Euthymia subscale scores. The psychiatric inpatients scored significantly higher than the other groups on all measures of depression. The findings of this study suggest that cancer patients may be erroneously labeled as depressed because of somatic–performance difficulties they may experience, which are similar to symptoms of depressed individuals. In addition, it is essential to delineate the various components of depression in evaluating cancer patients.     

Time trends in the effects of mindfulness-based cognitive therapy for depression: A meta-analysis

Recent studies suggest that the effects of cognitive therapies for depression show systematic changes over time. A meta-analysis was conducted to explore the temporal development of the effect of mindfulness-based cognitive therapy (MBCT) for current depression in studies that used the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HDRS) as outcome measures. A systematic search of research databases yielded 20 studies that were included in the analyses. The results showed that MBCT is effective in reducing depressive symptoms. The effect sizes of studies using the BDI or the HDRS as an outcome measure were not moderated by the time of publication. Funnel plots and the trim and fill method suggested that publication bias was low. However, the number of available studies was small, and the time period investigated relatively short. The results should therefore be considered preliminary.     

Subclinical and clinical depression: Are analogue studies justifiable?

A group of subclinically depressed students SS (N = 36) was compared with a group of mildly depressed patients MP (N = 48) and a group of severely depressed patients SP (N = 33) on 21 raw symptom severity scores in the Beck Depression Inventory (BDI). Stepwise discriminant function analysis yielded two significant functions, the first representing severity in core symptoms of depression. Symptom severity scores were then adjusted to allow for differences in total BDI scores among the groups and the adjusted scores were reanalysed. Two significant functions were again found, the first representing severity in only three of the core symptoms defining depression according to DSM III. The adjusted scores were further adjusted to equate the groups for differences in score variance and the discriminant analysis was repeated. Again two significant functions were found. The first, clearly representing a dimension of subclinical-clinical depression, was defined by a set of core symptoms smaller than that specified in the DSM III definition of major depression. It is argued that clinical and subclinical depression differ mainly in the absolute severity of the core symptoms defining depression but that subclinical shows a relative emphasis of some, and a relative de-emphasis of other core symptoms. It is concluded that subclinical depression in students offers a fairly accurate ‘model’ of clinical depression and that analogue studies are, to a reasonable extent, justifiable.     

Depression and bulimia: the link between depression and bulimic cognitions

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.     

Naturalistic evaluation of suicidal ideation: variability and relation to attempt status

Suicidal ideation has been thought to have a relatively stable course across weeks and months. However, daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinically and conceptually. For example, it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms (e.g., depression, hopelessness) among individuals with multiple suicide attempts. The present report had two related goals: (1) to prospectively evaluate suicidal ideation and related mood symptoms, and (2) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms. Non-clinical participants (N=108) with varying levels of suicidal ideation and number of previous suicide attempts completed the beck hopelessness scale (BHS), beck depression inventory (BDI), and suicide probability scale (SPS) every day for 4 weeks. Findings suggested considerable variability in suicidal ideation, especially for multiple attempters. Multiple attempt status predicted a decreased association between suicidal ideation and depression, although the results were only marginally significant. These findings have implications for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals.     

The absence of a future: the effect of past experience and current developmental conflicts on a midlife analysis

The four-year analysis of Mr. T, a highly intelligent, successful professional who entered analysis primarily because of a depression is presented; he had had no previous therapeutic experience but was very curious about analysis. The analytic work led to the discovery of a deeply held unconscious conviction of premature death that was related to interaction among the effects of a traumatic parental divorce during childhood, estrangement from both parents prior to their deaths, and signs of aging and illness in midlife. Before this analytic work the patient was unable to conceptualize, let alone plan for, late-life developmental experiences such as retirement and grandparenthood. Transference-countertransference themes are discussed, as is the importance of an understanding of midlife developmental concepts to successful analytic work with patients in this age group.     

Oral Pessimism and Depressive Symptoms

I examined the relation of oral optimistic and oral pessimistic personality traits to depressive symptoms to assess the psychoanalytic claim that fixation at the early phase of the oral stage of psychosexual development is related to depression. College students (N = 140) were administered the Oral Optimism Questionnaire (OOQ; Kline, 1978) and Oral Pessimism Questionnaire (OPQ; Kline, 1978) and the Beck Depression Inventory (BDI; Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961). Oral pessimism and levels of depressive symptoms were positively correlated, and a subsample of subjects with clinical levels of depressive symptoms also scored significantly higher on the Oral Pessimism Questionnaire than the rest of the sample. For the whole sample, 10 BDI items correlated significantly with the OPQ scores, and 5 OPQ items correlated significantly with the total BDI scores. The psychoanalytic claim relating fixation at the oral pessimism stage to depressive symptoms was supported.     

Using IRT to separate measurement bias from true group differences on homogeneous and heterogeneous scales: an illustration with the MMPI

The authors present a didactic illustration of how item response theory (IRT) can be used to separate measurement bias from true group differences on homogeneous and heterogeneous scales. Several bias detection methods are illustrated with 12 unidimensional Minnesota Multiphasic Personality Inventory (MMPI) factor scales (Waller, 1999) and the 13 multidimensional MMPI validity and clinical scales. The article begins with a brief review of MMPI bias research and nontechnical reviews of the 2-parameter logistic model (2-PLM) and several IRT-based methods for bias detection. A goal of this article is to demonstrate that homogeneous and heterogeneous scales that are composed of biased items do not necessarily yield biased test scores. To that end, the authors perform differential item- and test-functioning analyses on the MMPI factor, validity, and clinical scales using data from 511 Blacks and 1,277 Whites from the California Youth Authority.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Evaluating depression severity and remission with a modified Beck Depression Inventory

In an attempt to improve assessment of recovery from depression, a modified Beck Depression Inventory (mBDI) was created that permits endorsement of positive feelings in addition to depressive symptoms. In both normal and clinical samples, the mBDI showed evidence of reliability for measuring varying degrees of depression. In comparison to the original BDI, the mBDI did not significantly improve differentiation in depression severity among depressed individuals and assessment of remission of depressive symptoms. However, the mBDI was significantly better than the original BDI in detecting differences in depression level when overall depression severity was low. Clinical implications for evaluating remission of depression are discussed.     

The Psychometric Properties of an Internet-Administered Version of the Depression Anxiety and Stress Scales (DASS) in a Sample of Dutch Adults

Psychometric work on the widely used Depression Anxiety and Stress Scales (DASS) has mostly used classical psychometrics and ignored common internet-administered versions. Therefore, the present study used not only classical, but also modern psychometrics based on item response theory (IRT) to evaluate an internet-administered version of the DASS (Dutch translation). Internet-administered DASS data were collected as part of a large internet-based study in the Dutch adult population (n = 7972). Initially, external correlates (i.e. demographics other measures) and some classical psychometrics (internal consistency, convergent/divergent validity) of the DASS scales were evaluated. Next, IRT was used to investigate the scales’ dimensionality, discrimination and item-functioning. Finally, the DASS depression scale was further investigated by linking it to the more clinically-oriented Quick Inventory of Depressive Symptomatology (QIDS) using item response theory (IRT). Initial classical psychometric analyses supported the scales’ internal consistency (alpha = 0.94–0.98) and convergent/divergent validity. IRT analyses showed that each of the DASS scales was only suitable to measure variations in a very narrow and rather mild severity range. Linking the DASS depression scale with the QIDS also showed that the DASS depression scale discriminated best in the mild-moderate severity range, but not at higher severity levels that were covered by the QIDS. In conclusion, the scales of the internet-administered DASS show good internal consistency and validity. However, users should be aware that the scales discriminate best at mild-moderate severity ranges in the general population.     

Deployment of attention in clinical depression during symptom remission

The purpose of the current study was to investigate deployment of attention in clinically depressed patients during the process of symptom remission. Previous research indicates a non-depressed protective bias in attention whereas depressed individuals evidence no bias. A deployment-of-attention task based on negative, positive, and neutral adjectives was administered twice to 15 inpatients with major depression and 15 normal controls, at about 6 weeks apart. From test 1 to test 2, severity of patients' depressive symptoms improved significantly. Acutely depressed patients tended to show an attentional bias towards negative information whereas partially remitted patients manifested no attentional bias. Non-depressed individuals attended less to negative information than (acutely and partially remitted) depressed patients. Non-depressed participants but not depressed patients avoid negative information demonstrating a protective processing bias. Depressed patients are not characterized by a shift towards a pronounced protective pattern during symptom remission.