Common and specific dimensions of self-reported anxiety and depression: the BDI-II versus the BDI-IA

The Beck Depression Inventory-II (BDI-II) [Beck, A. T., Steer, R. A. & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.] and Anxiety Inventory (BAI) [Beck, A. T. & Steer, R. A. (1993a). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.] were administered to 840 outpatients who were diagnosed with various types of psychiatric disorders to determine whether the general symptom compositions and relative amounts of variance of the common and specific dimensions of self-reported anxiety and depression for these instruments would be comparable to those that had been found by Steer et al. [Steer, R. A., Clark, D. A., Beck, A. T. & Ranieri, W. F. (1995). Common and specific dimensions of self-reported anxiety and depression: A replication. Journal of Abnormal Psychology, 104, 542–545.] with the BAI and amended Beck Depression Inventory (BDI-IA) [Beck, A. T. & Steer, R. A. (1993b). Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation.]. A Schmid–Leiman transformation was used with the iterated-principal-factor pattern matrix of the BAI and the BDI-II loadings and indicated that the overall symptom compositions and relative amounts of variance that were explained by the one common and two specific anxiety and depression dimensions were comparable to those previously found with the BDI-IA.     

Use of the Beck Depression Inventory-II with depressed geriatric inpatients

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.     

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.

Generalized anxiety and panic disorders: Response to Cox, Cohen, Direnfeld, and Swinson (1996)

Contrary to the contention of Cox, Cohen, Direnfeld and Swinson (1996, Behaviour Research and Therapy, 34, 949–954) that the Beck Anxiety Inventory (BAI; Beck & Steer, 1993, Manual for the Beck Anxiety Inventory) measures primarily symptoms associated with panic attacks rather than anxiety in general, we propose that the higher level of anxiety found in patients with panic disorders not only is not an artifact of the BAI's symptom content, but patients with panic disorders truly have more anxiety than patients with other types of anxiety disorders. Furthermore, the BAI contains symptoms present in other anxiety disorders, besides panic disorder, and specifically includes 11 symptoms of generalized anxiety disorder (GAD). The BAI and revised Hamilton Anxiety Rating Scale (HARS-R; Riskind, Beck, Brown & Steer, 1987, Journal of Nervous and Mental Disease, 175, 474–479) scores of 274 (69%) outpatients with panic disorders and 123 (31%) outpatients with GAD were found to differentiate these two diagnostic groups equally and significantly. The panic disorder outpatients had higher scores on both the BAI and the HARS-R than did the GAD patients. Thus, Cox et al.'s (1996) speculation about the BAI's yielding spuriously high levels of anxiety in patients with panic disorders revives an important issue relevant to the relation of panic disorder to GAD.     

Types of self-reported anxiety in outpatients with DSM-III-R anxiety disorders1

To ascertain whether psychiatric outpatients can be classified into distinct types according to their self-reported symptoms of anxiety, the Beck Anxiety Inventory (BAI) was administered to 655 outpatients diagnosed with DSM-III-R anxiety disorders. Cluster analysis identified three internally consistent subscales representing subjective, somatic, and panic symptoms. Further analysis revealed six types of outpatients reflecting below average, panic-subjective, low subjective, low somatic-panic, above average, and subjective-somatic anxiety. The types were differentiated with respect to age, primary diagnosis, clinically rated anxiety, and both self-reported and clinically rated depression.     

Ruminative Thoughts and Their Relation to Depression and Anxiety1

Although past research has shown a correlation between ruminative response style and depression (Nolen-Hoeksema, 1991), the basic relationships among amount of ruminative thoughts, depression, and anxiety has not been established. Scores from the Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996), the Beck Anxiety Inventory (BAI; Beck & Steer, 1993), and the McIntosh and Martin (1992) Rumination Scale were analyzed for 199 participants. The correlation between rumination and depression was .33, between rumination and anxiety was .32, and between depression and anxiety was .56. The partial correlation between rumination and depression (controlling for anxiety level) was .20, and the partial correlation between rumination and anxiety (controlling for depression level) was .17. The finding that rumination is not unique to depression but is also associated with the specific negative affect of anxiety alone might also suggest new treatments of these two prevalent disorders.     

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.     

Beck Depression Inventory-II items associated with self-reported symptoms of ADHD in adult psychiatric outpatients

The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Conners' Adult ADHD Rating Scale-Self-Report: Screening Version (CAARS-S:SV; Conners, Erhardt, & Sparrow, 1999) were administered to 371 (64%) female and 204 (36%) male adult (> 18 years old) outpatients who were diagnosed with various psychiatric disorders to determine whether any of the 21 items or subsets of items in the BDI-II were related to symptoms of attention deficits and hyperactivity as measured by the CAARS-S:SV DSM-IV Total ADHD Symptoms scale (attention-deficit/hyperactivity disorder [ADHD] Symptoms). Stepwise multiple-regression analyses found that the BDI-II Concentration Difficulty explained 30% of the variance in these total scores. Ratings > 1 for the BDI-II Concentration Difficulty item were discussed as being useful for ruling out possible symptoms of ADHD.     

Use of the Beck Scale for suicide ideation with psychiatric inpatients diagnosed with schizophrenia,schizoaffective, or bipolar disorders

To ascertain how useful the Beck Scale for Suicide Ideation (BSI; Beck & Steer, Manual for Beck Scale for Suicide Ideation (1991)) would be for assessing the severity of suicidal ideation in patients who were diagnosed with schizophrenia, schizoaffective, or bipolar disorders, 142 inpatients were asked to complete the BSI. Eight (6%) patients refused, and four patients (3%) were unable to complete the BSI because they were unable to concentrate. Of the 130 patients who completed the BSI, 53 (41%) had schizoaffective, 37 (28%) had paranoid schizophrenia, 30 (23%) had manic bipolar, and 10 (8%) had depressed bipolar disorders. The coefficient alpha for the BSI was .96, and its one-week test-retest reliability for a subsample of 15 inpatients was 0.88, p < 0.001. The BSI total scores were positively correlated with having ever attempted suicide, r = 0.46, p < 0.001. According to the BSI, 36 (28%) patients were classified as current suicide ideators. The results were discussed as supporting the use of the BSI with inpatients who are diagnosed with schizophrenia, schizoaffective, or bipolar disorders.     

Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders

The Beck Cognitive Insight Scale (BCIS; Beck, Baruch, Balter, Steer, & Warman, 2004) was administered to 42 (28%) inpatients with psychotic disorders, 52 (35%) with a bipolar disorder, and 56 (37%) with a major depressive disorder (MDD). The hypotheses were (a) that the mean level of cognitive insight in a psychotic or a bipolar disorder is lower than that in a MDD, (b) that the mean levels of cognitive insight in psychotic and bipolar disorders were comparable, and (c) that the mean BCIS index score for a bipolar disorder in which the most recent episode had been mania is lower than the mean BCIS index score for a bipolar disorder in which the most recent episode had been mixed or depressed. All three hypotheses were supported. The results were discussed as supporting cognitive insight as a psychological construct that varies predictably according to the nature of a psychiatric disorder.     

Anxiety-Related Stroop Interference in Adolescents

A group of 16- to 18-year-old students was presented with threat-related and neutral Stroop stimuli on separate cards. Participants were assigned to anxiety groups on the basis of their scores on the Beck Anxiety Inventory (BAI; A. T. Beck & R. A. Steer, 1990). It was found, as predicted, that the high-anxiety group took significantly longer to identify the color of the threat-related word than the neutral words, whereas there was no difference for the low-anxiety group. There was a significant linear relationship between interference on the task and BAI scores, showing that as anxiety increases there is a corresponding increase in interference produced by the threat-related stimuli when compared with the neutral stimuli. This study demonstrates an anxiety-related Stroop interference effect for adolescents consistent with that reported in the adult literature.     

Anxiety-related Stroop interference in adolescents

A group of 16- to 18-year-old students was presented with threat-related and neutral Stroop stimuli on separate cards. Participants were assigned to anxiety groups on the basis of their scores on the Beck Anxiety Inventory (BAI; A. T. Beck & R. A. Steer, 1990). It was found, as predicted, that the high-anxiety group took significantly longer to identify the color of the threat-related word than the neutral words, whereas there was no difference for the low-anxiety group. There was a significant linear relationship between interference on the task and BAI scores, showing that as anxiety increases there is a corresponding increase in interference produced by the threat-related stimuli when compared with the neutral stimuli. This study demonstrates an anxiety-related Stroop interference effect for adolescents consistent with that reported in the adult literature.     

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.     

The generality of cognitive bias in acute stress disorder

Cognitive bias was investigated in acutely traumatised civilians with either acute stress disorder (ASD; n = 26) or no ASD (n = 24). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory (BAI), the Impact of Event Scale (IES), and an Event Probability Questionnaire and an Event Cost Questionnaire that comprised items pertaining to (a) external harm, (b) somatic sensations and (c) social events. ASD participants exaggerated both the probability of negative external harm, somatic and social events occurring, and the adverse cost of those events more than non-ASD participants. Elevated probability and cost estimates were predicted by BAI and IES-Avoidance scores, respectively. These findings are discussed in the context of different patterns observed in other anxiety disorders, and interpreted in terms of network theories of posttraumatic stress.     

The Beck Anxiety Inventory: Psychometric Properties with Older Adults

The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.     

Psychosocial Correlates of Suicidal Ideation in Adolescent Psychiatric Inpatients

The Beck Scale for Suicide Ideation (BSI) was administered to 121 inpatients between 12 and 17 years old who were diagnosed with mixed psychiatric disorders. Twelve background and clinical characteristics, previously found to be associated with adolescent suicidal ideation, were entered into a multiple regression to estimate the BSI scores, along with the Beck Anxiety Inventory, the revised Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Youth Self-Report. The BHS and the BDI were the only two variables that contributed unique variance to the explanation of the BSI scores.     

When does the daily hazard rate for committing suicide stabilize in psychiatric outpatients?

To ascertain whether the daily hazard risk rate for committing suicide by psychiatric outpatients stabilizes over time, a parametric survival analysis was calculated for the 6891 outpatients who were followed by Brown, Beck, Steer, and Grisham. Approximately 3 1/4 years after a patient's initial evaluation, the daily hazard rate leveled off and dropped below the hazard rate that would occur if a constant (exponential) daily hazard rate were assumed. The cost-effectiveness of conducting follow-up studies to identify suicidal risk factors in psychiatric outpatients beyond three years was questioned.     

Amount of General Factor Saturation in the Beck Anxiety Inventory Responses of Outpatients with Anxiety Disorders

To ascertain the amount of general factor saturation underlying the Beck Anxiety Inventory (BAI; Beck and Steer 1993) responses of anxious patients, the BAI was administered to 525 outpatients with DSM-IV-TR anxiety disorders. McDonald’s omega_hierarchical(ω _h) (Zinbarg et al. 2005) was calculated to estimate the amount of general factor saturation; ω _h is the amount of variance explained by a general (second-order) factor underlying a scale composed of multiple items divided by the total amount of variance explained by all of the scale’s items. An iterated principal-factor analysis was first performed and followed by a Schmid-Leiman transformation to determine the amount of variance explained by the second-order factor. ω _h was 0.70 [95% CI 0.66–0.72], and this value was discussed as supporting the current practice of summing the 21 symptom ratings of the BAI to estimate the overall severity of self-reported anxiety.

Sex Differences on the Revised Beck Depression Inventory for Outpatients With Affective Disorders

The revised Beck Depression Inventory (BDI) was administered to 174 male and 276 female psychiatric outpatients diagnosed with affective disorders. The mean BDI scores, mean number of symptoms claimed, and corrected item-total correlations were comparable for both sexes, and the coefficients alpha for each sex was .88. Principal components analyses found four dimensions of depression underlying both sexes' BDI item-intercorrelation matrices. Although men and women had comparable dimensions with respect to weight loss, self-blame, and somatic-performance symptoms, men had affective and performance symptoms loading on the same factor, whereas women had affective and cognitive symptoms loading on the same dimension.     

The Beck Anxiety Inventory-Trait (BAIT): a measure of dispositional anxiety not contaminated by dispositional depression

We describe development of the Beck Anxiety Inventory-Trait (BAIT), a measure of trait anxiety. In Study 1 with 191 undergraduates, the BAIT correlated higher with another trait-anxiety measure than with state anxiety and trait depressiveness and lower with depressiveness than the other trait-anxiety measure did. In Study 2 (Ns of 149 undergraduates initially and 107 at 3 weeks later), the BAIT demonstrated convergent validity against the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) and self-rated trait anxiety plus discriminant validity against abstract curiosity. In Study 3 (Ns of 161 undergraduates initially and 121 at 3 weeks later), the BAIT correlated more highly with another anxiety measure than with depression, stress, positive affect, and negative affect. It also showed good internal consistency across studies and high stability in Studies 2 and 3, higher than the BAI's in Study 2. Factor analyses across studies all supported 2 factors, 1 Somatic and 1 Subjective.