Brief reportThe validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients
Introduction
Depression in medical inpatients is an underrecognized and undertreated condition (Koenig et al., 1997). It has been shown that depression in this population is associated with increased morbidity, mortality and health care costs (Frasure-Smith et al., 2000).
The Beck Depression Inventory (BDI) (Beck et al., 1961) is one of the most widely used self-rating scales for measuring depression (Richter et al., 1998). Beck and Steer proposed that this scale could be divided in two subscales: the cognitive-affective (items 1 to 13) and the somatic-performance (items 14 to 21) (Beck and Steer, 1993). They recommended the use of the cognitive-affective subscale alone [the so-called BDI short-form (BDI-SF)] to assess depression in the medically ill and suggested that scores higher than 10 are associated with moderate and severe depressive syndromes.
The soundness of the psychometric properties of the BDI has already been fully demonstrated in community and clinical samples (Foelker et al., 1987, Scogin et al., 1988, Leahy, 1992, Bennett et al., 1997, Richter et al., 1998, Gesztelyi et al., 1999, Green et al., 2001, Strik et al., 2001). However, there is some concern regarding the use of the complete scale in patients with specific medical conditions since symptoms caused by the physical illness may affect the BDI somatic items (Lustman et al., 1997, Lykouras et al., 1998, Sliwinski et al., 1998, Leentjens et al., 2000). These studies demonstrated that the optimal cut-off scores may be different for these populations and that they depend on the research purposes (screening or diagnosis). We found only one study reporting the validity measures for different cut-off scores of the BDI-SF in medical inpatients (Cathebras et al., 1994). In a sample of French medical inpatients whose depression was diagnosed according to the DSM-III criteria, Cathebras et al. demonstrated that a cut-off point of 7/8 yielded a high sensitivity (95.5%) at the cost of a high rate of false-positives (43%). In contrast, the cut-off of 12/13 showed a high specificity (90.1%) at the cost of a low sensitivity (63.5%). They found that the best trade-off between sensitivity and specificity (86.4%; 81.8%) was the cut-off of 9/10. Using this cut-off point, the BDI showed a high negative predictive value (93.8%) and a positive predictive value of 65.5%.
The purpose of this study was to examine the concurrent validity of the Beck Depression Inventory-Short Form (BDI-SF) to detect moderate and severe depressive episodes according to the International Classification of Diseases, 10th edition (ICD-10) criteria in inpatients with heterogeneous medical conditions and to set cut-off scores for its use in medical wards.
Section snippets
Methods
One hundred and ninety patients consecutively admitted to the adult medical wards of the University Hospital of the Federal University of Rio de Janeiro (Brazil) were recruited for the study. Thirty-five patients were excluded because they were referred from the surgical wards, were discharged before completing 72 h in the ward or had a medical illness or cognitive impairment severe enough to preclude psychiatric interview and psychological testing. After signing an informed consent, the
Results
Fig. 1 displays the results in the form of a ROC curve. The area under the ROC curve was 98.4% (95% Confidence Interval=0.97–1.00).
When a cut-off point of 9/10 was used, all depressed patients were detected, but there was a high rate of false positives, 40.4% (21 patients without depression were “cases”, according to the BDI). When a cut-off point of 13/14 was used, there was a low rate of false positives (14.7%), but 2 depressed patients were not detected. The sensitivity, specificity, PPV and
Discussion
To our knowledge, this was the first study to evaluate the concurrent validity of the BDI-SF with the ICD-10 criteria for moderate and severe depressive episodes in medical inpatients. We found that the cut-off score of 10/11 recommended by Beck and Steer (1993), for the BDI-SF discriminated depressed medical inpatients with a relatively small rate of overall misclassification (19 patients). However, this cut-off yielded a sensitivity of 96.8%, meaning that 3 patients out of 100 would not be
Acknowledgments
This work was supported by CAPES, CNPq, and FAPERJ/Brazil.
References (24)
- et al.
Beck depression inventory manual
(1993) - et al.
An inventory for measuring depression
Arch. Gen. Psychiatry
(1961) - et al.
Relationship of Beck depression inventory factors to depression among adolescents
J. Affect. Disord.
(1997) - et al.
The use of the clinical interview schedule for the evaluation of mental health in the aged community
Psychol. Med.
(1991) - et al.
Screening for depression in patients with medical hospitalization. Comparison of two self-evaluation scales and clinical assessment with a structured questionnaire
Encephale
(1994) - et al.
Confirmatory factor analysis of the short form Beck Depression Inventory in elderly community samples
J. Clin. Psychol.
(1987) - et al.
Depression and health-care costs during the first year following myocardial infarction
J. Psychosom. Res.
(2000) - et al.
Characteristics and outcome of patients with depressive disorders during hospitalization in general medical wards
J. Bras. Psiquiatr.
(1998) - et al.
Screening for depressive symptoms among post-stroke outpatients in Eastern Hungary
J. Geriatr. Psychiatry Neurol.
(1999) - et al.
A standardized psychiatric interview for use in community surveys
Br. J. Prev. Soc. Med.
(1970)
Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects
Braz. J. Med. Biol. Res.
The clinical utility of the Beck Depression Inventory after traumatic brain injury
Brain Inj.
Cited by (233)
Avoidance biases for vaping stimuli among college students with electronic-cigarette use
2024, Addictive BehaviorsEffects of square attractiveness on emotional perception, cognitive performance, and neurophysiology
2023, Frontiers of Architectural ResearchDevelopment and validation of heart failure-specific quality-of-life measurement tool in India
2023, American Heart Journal Plus: Cardiology Research and PracticeTrajectory of chronic and neuropathic pain, anxiety and depressive symptoms and pain catastrophizing after total knee replacement. Results of a prospective, single-center study at a mean follow-up of 7.5 years
2023, Revue de Chirurgie Orthopedique et TraumatologiqueTrajectory of chronic and neuropathic pain, anxiety and depressive symptoms and pain catastrophizing after total knee replacement. Results of a prospective, single-center study at a mean follow-up of 7.5 years
2023, Orthopaedics and Traumatology: Surgery and Research