Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items

Background/ObjectiveScreening for depression in patients with cancer can be difficult due to overlap between symptoms of depression and cancer. We assessed validity of the Beck Depression Inventory (BDI-II) in this population.MethodData was obtained in an outpatient neuropsychiatry unit treating patients with and without cancer. Psychometric properties of the BDI-II Portuguese version were assessed separately in 202 patients with cancer, and 376 outpatients with mental health complaints but without cancer.ResultsConfirmatory factor analysis suggested a three-factor structure model (cognitive, affective and somatic) provided best fit to data in both samples. Criterion validity was good for detecting depression in oncological patients, with an area under the ROC curve (AUC) of 0.85 (95% confidence interval [CI], 0.76–0.91). A cut-off score of 14 had sensitivity of 87% and specificity of 73%. Excluding somatic items did not significantly change the ROC curve for BDI-II (difference AUCs = 0.002, p=0.9). A good criterion validity for BDI-II was also obtained in the non-oncological population (AUC = 0.87; 95% CI 0.81–0.91), with a cut-off of 18 (sensitivity=84%; specificity=73%).ConclusionsThe BDI-II demonstrated good psychometric properties in patients with cancer, comparable to a population without cancer. Exclusion of somatic items did not affect screening accuracy.     

Psychometric Properties of the Beck Depression Inventory-II in a Clinically-Identified Sample of Mexican American Adolescents

We examined the internal consistency reliability, convergent and divergent validity, and factor structure of the Beck Depression Inventory-II (BDI-II) in a sample of 131 Mexican American youth. The BDI-II demonstrated excellent internal consistency reliability (α=.90) and solid convergent and divergent validity with various clinical scales of the Adolescent Psychopathology Scale. Two factors, Cognitive-Somatic and Affective, emerged from an exploratory factor analysis and suggested that depressive symptomology may manifest somewhat differently in Mexican American youth. In sum, results provide tentative support for the use of the BDI-II as a measure of depression for this sample.     

Self-Reported Depression in Mothers of Children Who Have Experienced Sexual Abuse

The Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) was administered to 164 biological mothers of sexually abused children to determine the psychometric characteristics of the BDI-II and to estimate the prevalence of self-reported depression in this population. The study also sought to ascertain whether the mothers’ BDI-II total scores were correlated with various psychosocial characteristics of the mothers and their children. It was found that there was only one dimension underlying the 21 BDI-II responses, and the internal consistency of the BDI-II total scores was high. Twenty-six percent of these mothers had scores indicative of clinical depression. The mothers’ BDI-II total scores were significantly correlated with their husbands’ or paramours’ having sexually abused their children and their ratings of the children’s internalizing behaviors. These results were discussed as supporting the use of the BDI-II with mothers of sexually abused children to measure self-reported depression.     

Severity of Self-Reported Depression in Patients with a Schizoaffective Disorder

  To investigate the severity of self-reported depression in patients diagnosed with a schizoaffective disorder (SZA), the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) was administered to 75 patients with a SZA. For comparative purposes, the BDI-II was also administered to 75 patients with a major depressive disorder without psychotic features (MDD) who were matched to the SZA sample with respect to sex, being Caucasian, and age. The Cronbach coefficient αs of the BDI-II total scores for the patients with a SZA or a MDD were, respectively, .94 and .92. The mean BDI-II total score (M = 23.71, SD = 15.44) of the patients with a SZA was minimally lower than the mean BDI-II score (M = 28.73, SD = 12.46) of the patients with a MDD. The BDI-II was discussed as being useful for assessing self-reported depression in patients diagnosed with a SZA.     

Factorial and Diagnostic Validity of the Beck Depression Inventory-II (BDI-II) in Croatian Primary Health Care

The aim of this study was to examine the factorial and diagnostic validity of the Beck Depression Inventory-Second Edition (BDI-II) in Croatian primary health care. Data were collected using a medical outpatient sample (N = 314). Reliability measured by internal consistency proved to be high. While the Velicer MAP Test showed that extraction of only one factor is satisfactory, confirmatory factor analysis indicated the best fit for a 3-factor structure model consisting of cognitive, affective and somatic dimensions. Receiver operating characteristics (ROC) analysis demonstrated the BDI-II to have a satisfactory diagnostic validity in differentiating between healthy and depressed individuals in this setting. The area under the curve (AUC), sensitivity and specificity were high with an optimal cut-off score of 15/16. The implications of these findings are discussed regarding the use of the BDI-II as a screening instrument in primary health care settings.     

Convergent validity of the Beck depression inventory-II with the reynolds adolescent depression scale in psychiatric inpatients

The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Reynolds Adolescent Depression Scale (RADS; Reynolds, 1987) were administered to 56 female and 44 male psychiatric inpatients whose ages ranged from 12 to 17 years old. The Cronbach coefficient alpha(s) for the BDI-II and RADS were, respectively, .92 and .91 and indicated comparably high levels of internal consistency. The correlation between the BDI-II and RADS total scores was .84,p <.001. Binormal receiver-operating-characteristic analyses indicated that both instruments were comparably effective in differentiating inpatients who were and were not diagnosed with a major depressive disorder; the areas under the ROC curves for the BDI-II and RADS were, respectively, .78 and .76. The results (a) indicate that the BDI-II and the RADS have similar psychometric characteristics and (b) support the convergent validity of the BDI-II for assessing self-reported depression in adolescent inpatients.     

Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients.

This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a primary care medical setting. A principal-components analysis with Promax rotation indicated the presence of 2 correlated factors, Somatic-Affective and Cognitive, which explained 53.5% of the variance. A hierarchical, second-order analysis indicated that all items tap into a second-order construct of depression. Evidence for convergent validity was provided by predicted relationships with subscales from the Short-Form General Health Survey (SF-20; A. L. Stewart, R. D. Hayes, & J. E. Ware, 1988). A receiver operating characteristic analysis demonstrated criterion-related validity: BDI-II scores predicted a diagnosis of major depressive disorder (MDD), as determined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ). This study demonstrated that the BDI-II yields reliable, internally consistent, and valid scores in a primary care medical setting, suggesting that use of the BDI-II in this setting may improve detection and treatment of depression in these medical patients.     

Self-Reported Symptoms of Depression by Changes in Sleeping Patterns and Appetites for Outpatients with a Major Depressive Disorder

To determine whether self-reported symptoms of depression are differentiated by changes in sleeping patterns or appetite, the Beck Depression Inventory-II (BDI-II; Beck et al. 1996) was administered to 1,250 outpatients diagnosed with a major depressive disorder. A series of focused contrasts supported the hypothesis that the mean BDI-II total scores and the majority of the symptom ratings of the outpatients who described increases or decreases in their sleeping patterns or appetites were comparable and higher than the mean BDI-II total scores and symptom ratings of the patients who reported no changes in their sleeping patterns or appetites. However, the patients who were sleeping less described themselves as being more agitated than those who were sleeping more. Decreases and increases in sleep or appetite were both discussed as indicating comparable levels of depressive symptomatology.

Common and Specific Dimensions of Self-Reported Anxiety and Depression in Adolescent Outpatients

To investigate the common and specific dimensions of anxiety and depression in adolescents, the Beck Anxiety Inventory (BAI; Beck, A. T., & Steer, R. A. Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation 1993a) and Beck Depression Inventory-II (BDI-II; Beck, A. T., Steer, R. A., & Brown, G. K. Manual for Beck Depression Inventory (2nd Ed.). San Antonio, TX: Psychological Corporation 1996) were administered to 840 adolescent (13–17 years old) outpatients who were diagnosed with various types of psychiatric disorders. A Schmid-Leiman transformation was used with the iterated-principal-factor pattern matrix of the BAI and the BDI-II loadings. The amounts of orthogonalized common variance that were explained by the one second-order (56%), one first-order depression (22%), and two first-order anxiety (22%) dimensions were comparable to those previously reported for adult psychiatric outpatients. The results were discussed as supporting the construct of negative affectivity that is proposed in L. A. Clark and Watson’s (1991) tripartite model of anxiety and depression.

Increased spreading activation in depression

The dopaminergic system is implicated in depressive disorders and research has also shown that dopamine constricts lexical/semantic networks by reducing spreading activation. Hence, depression, which is linked to reductions of dopamine, may be associated with increased spreading activation. However, research has generally found no effects of depression on spreading activation, using semantic priming paradigms. We used a different paradigm to investigate the relationship between depression and spreading activation, one based on word frequencies. Our sample included 97 undergraduates who completed the BDI-II and the Controlled Oral Word Association test as well as the Animal Naming test. The results indicated that the group scoring within the depressed ranged evidenced greater spreading activation as compared to those who scored within the normal range on the BDI-II. The implications of these results as they relate to creativity in depression is discussed.     

Infant-directed speech produced by fathers with symptoms of depression: effects on infant associative learning in a conditioned-attention paradigm

Infant-directed (ID) speech produced by fathers who varied in their number of self-reported symptoms of depressed was analyzed for differences its ability to promote infant voice-face associative learning. Infants of fathers with elevated scores on the Beck Depression Inventory-II (BDI-II) showed significantly poorer learning than did infants of fathers with non-elevated BDI-II scores when their fathers' ID speech served as a conditioned stimulus for a face reinforcer in a conditioned-attention paradigm. Fathers with elevated BDI-II scores produced ID speech with marginally significantly lower F0 variability than fathers with non-elevated BDI-II scores. However, F0-related cues were uncorrelated with infant learning. Overall, fathers' ID speech contained significantly less F0 modulation than did mothers' ID speech. These findings show that paternal depression, like maternal depression, adversely affects infant learning in a conditioned-attention paradigm.     

The validity of the hospital anxiety and depression scale and the geriatric depression scale in Parkinson's disease

We assessed the concurrent validity of the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale (GDS) against the Hamilton Rating Scale for Depression (Ham-D) in patients with Parkinson's disease (PD). Forty-six non-demented PD patients were assessed by a neurologist on the Ham-D. Patients also completed four mood rating scales: the HADS, the GDS, the VAS and the Face Scale. For the HADS and the GDS, Receiver Operating Characteristics (ROC) curves were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut-off scores. Maximum discrimination between depressed and non-depressed PD patients was reached at a cut-off score of 10/11 for both the HADS and the GDS. At the same cut-off score of 10/11 for both the HADS and the GDS, the high sensitivity and NPV make these scales appropriate screening instruments for depression in PD. A high specificity and PPV, which is necessary for a diagnostic test, was reached at a cut-off score of 12/13 for the GDS and at a cut-off score of 11/12 for the HADS. The results indicate the validity of using the HADS and the GDS to screen for depressive symptoms and to diagnose depressive illness in PD.     

Psychometric properties of the Hamilton Depression Rating Scale and other physician-rated psychiatric scales for the assessment of depression in ESRD patients undergoing hemodialysis in Turkey

This study aimed to examine the reliability and validity of clinician-rated psychiatric scales for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) treatment in Turkey. For this, the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Global Assessment of Functioning (GAF) Scale, Clinical Global Impression (CGI) Scale, and Mini Mental State Exam (MMSE) were administered to 45 ESRD outpatients undergoing HD treatment. Regarding the reliability of HDRS and HARS, internal consistency and split-half reliability analyses revealed acceptable coefficients. The test - retest reliability coefficients were also examined for all measures after a period of a month, and despite this relatively long time interval, test - retest reliability coefficients were above .60 for all measures. Concerning the validity studies, all these scales revealed suitable convergent, discriminant, and criterion validity outcomes. A cut-off point of 10 for HDRS is suggested for the identification of depression in this population. In general, the findings of this study indicate that HDRS, HARS, CGI, GAF, and MMSE are reliable and valid instruments that can be used among ESRD patients undergoing HD.     

Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal?

PurposeAlthough the negative consequences of maternal depression on infants has been documented in several Western societies, similar studies have not been conducted in Middle-Eastern countries where cultural norms and traditions may differ. The main objective of this study was to determine the risk factors for postpartum depression (PPD) and its relationship to mother −infant bonding in a Lebanese population.MethodsOne hundred and fifty participants were administered the Edinburgh Postpartum Depression Scale (EPDS), and the social support scale at 2–3 days postpartum. At 10–12 weeks mother–infant bonding using the Postpartum Bonding Questionnaire (PBQ) and depression using the Beck Inventory (BDI-II) were assessed during a telephone interview.ResultsThe prevalence of depression was 19% with an average score of 10.9 ± 6.02 on the EPDS. At 10–12 weeks 2.7% of the whole sample was depressed with an average score of 18.60 ± 16.87 on the BDI-II. Risk factors of PPD on the EPDS were; history of alcohol use, complications during pregnancy, not a good marital relationship, baby admitted to an intensive care unit, history of depression and low social support. Risk factors for impaired bonding were age, history of depression, BDI-II scores above 20 and low social support. The multiple regression analysis found that impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance, F = 7.12, p = 0.02.ConclusionThe prevalence of PPD was higher than previously reported at day 2–3 post-delivery, but lower at 10–12 weeks postpartum. Impaired mother- infant bonding was associated older mothers, history of depression, low social support and BDI-II scores above 20 which should alert practitioner to assessing these factors in post-partum mothers.     

Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in general population

This is the first study that provides normative, reliability, factor validity and discriminant validity data of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) in the Spanish general population, Sanz and Navarro's (2003) Spanish version of the BAI was administered to 249 adults. Factor analyses suggested that the BAI taps a general anxiety dimension comprising two related factors (somatic and affective-cognitive symptoms), but these factors hardly explained any additional variance and, therefore, little information is lost in considering only full-scale scores. Internal consistency estimate for the BAI was high (alpha = .93). The BAI was correlated .63 with the BDI-II and .32 with the Trait-Anger scale of the STAXI 2, but a factor analysis of their items revealed three factors, suggesting that the correlations between the instruments may be better accounted for by relationships between anxiety, depression, and anger, than by problems of discriminant validity. The mean BAI total score and the distribution of BAI scores were similar to those found in other countries. BAI norm scores for the community sample were provided from the total sample and from the male and female subsamples, as females scored higher than males. The utility of these scores for assessing clinical significance of treatment outcomes for anxiety is discussed.     

Measurement of Depressive Symptoms in Women With Breast Cancer and Women With Clinical Depression: A Differential Item Functioning Analysis

Differential item functioning (DIF) analyses of the Beck Depression Inventory-II (BDI-II) were conducted on samples of 267 women with breast cancer and 294 women with clinical depression. Patterns of items in which there was significant and nonsignificant DIF were identified using statistical tests and measures of DIF effect size. At the most general level, 15 of 21 BDI-II items were associated with nontrivial DIF suggesting that the item responses of these samples do not reflect the same underlying construct. Factor analyses of the BDI-II using a psychometrically defensible method for item level factor analysis supported the conclusions from the DIF analyses. These findings suggest that researchers and practitioners should apply caution when interpreting self-report depression symptoms in breast cancer patients.     

Self-reported inability to cry as a symptom of anhedonic depression in outpatients with a major depressive disorder

To ascertain whether self-reported inability to cry would be associated with symptoms of anhedonic depression, the 21-item Beck Depression Inventory-II was administered to 1,050 outpatients diagnosed with a DSM-IV-TR major depressive disorder. 219 (21%) patients reported on the BDI-II Crying item that they were unable to cry, and 831 (79%) patients reported they were able to cry. Only BDI-II Loss of Interest was significantly associated with the inability to cry after the other BDI-II symptoms were controlled for using a multiple logistic-regression analysis. The inability to cry was discussed as an indicator of anhedonic depression.     

The Dysfunctional Attitude Scale: How well can it measure depressive thinking?

The Dysfunctional Attitude Scale (DAS) was designed to measure patterns of maladaptive thinking held by depressed individuals. Despite its wide use as a research and clinical tool, only a few studies to date were designed to examine its psychometric properties in a clinically depressed population. Moreover, problems of low sample size and limited tests of validity call these findings into question. The present study was designed to examine psychometric properties of the DAS in clinically depressed inpatients and in nondepressed clinical controls. Intertest correlations between the DAS parallel forms and between each form with total test scores ranged from r=.84 to r=.97. Intratest stability coefficients were r=.88 to r=.97. Support for the DAS as a valid measure of dysfunctional cognitions in depressed patients was also indicated. Of those scoring high on the DAS, 73% received an independent RDC diagnosis of clinical depression, while only 36% of those receiving low DAS scores were so diagnosed.     

Sudden Gains in Depressed Cancer Patients Treated With Behavioral Activation Therapy

Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M = 11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.     

Sociodemographic,psychosocial and physical health correlates of common mental disorder symptoms among mothers in Trinidad and Tobago: Examining ethnic variations

Historical and cultural experiences have shaped the life experiences of cultural communities in Trinidad and Tobago. Using a cultural focus, the goal of this investigation was to examine ethnic variations both in the prevalence of common mental disorder (CMD) symptoms as well as in the associations between sociodemographic, psychosocial, physical health correlates and CMDs among mothers in Trinidad and Tobago. Participants included 1002 mothers (359 African‐, 353 Indo‐ and 290 Mixed‐Ethnic Trinidadian). Mean comparisons indicated similarities in the levels of depression, somatisation and anxiety across ethnic groups. The associations between physical ill health, experiences of pain and depression and between physical ill health and somatisation were stronger for Mixed‐Ethnic Trinidadian than Indo‐Trinidadian mothers. The relationship between early experiences of domestic violence and depression was stronger for Indo‐Trinidadian than Mixed‐Ethnic Trinidadian mothers. The associations between early experiences of domestic violence and depression and between experiences of pain and somatisation were stronger for African Trinidadian than Mixed‐Ethnic Trinidadian mothers. Thus beyond the direct effects, mothers belonging to specific ethnic groups indicated greater or lesser vulnerabilities to CMDs depending on their exposure to specific correlates. Results have applicability for the development of culturally sensitive interventions for mothers experiencing CMDs.