The Beck Depression Inventory as a screening device for major depression in renal dialysis patients

Self-report measures of depressive symptoms have been frequently employed in medically ill samples despite the lack of information regarding their psychometric properties in these subjects. We have examined the agreement of the Beck Depression Inventory (BDI) with DSM-III diagnoses of depression in a sample of renal dialysis subjects (n = 99). A threshold of greater than or equal to 15 on the BDI produced optimal sensitivity (.92), negative predictive value (.99), and maximized Youden's index of validity (.72) for the use of the BDI as a screening device for depressive syndromes in dialysis patients. Higher BDI threshold levels decreased the sensitivity of the measure but did not produce a clinically meaningful increase in the positive predictive value.     

Reliability and validity of the Beck depression inventory in patients with Parkinson's disease.

We evaluated the validity, reliability, and potential responsiveness of the Beck Depression Inventory (BDI) in patients with Parkinson's disease (PD). In part 1 of the study, 92 patients with PD underwent a structured clinical interview for DSM major depression and based on this patients were considered depressed (PD-D) or nondepressed (PD-ND). Subsequently, patients filled in the BDI. In part 2, a postal survey consisting the BDI was performed in 185 PD patients and 112 controls. Test-retest reliability was assessed in 60 PD patients. The factor analysis revealed a cognitive-affective and a somatic factor. Cronbachs alpha for the BDI was 0.88. Mean BDI indicated significant differences (P<0.001) between the PD and control group, between the PD-ND and PD-D group, and between PD-ND and control group. In part 1, the receiver operating characteristic curves showed that the area under the curve for the total BDI was 0.88. A cutoff was calculated for the BDI (14/15) that had the highest sum of sensitivity (0.71) and specificity (0.90). In part 2, the test-retest reliability for the BDI total score was 0.89 (intraclass correlation coefficient). The smallest real difference was 3.3 for the total BDI. The BDI is a valid, reliable, and potential responsive instrument to assess the severity of depression in PD. However, an adjusted cutoff is recommended.     

抑郁症诊断筛查量表的编制及其效度检验

目的为了提高国内躯体疾病病人抑郁症的识别率,制定一个适合在中国使用的抑郁症诊断筛查量表并评估其效度。方法在《DSM-IV轴I障碍用临床定式检查病人版》(SCID)的“重性抑郁发作”基础上多次修订编制“抑郁症诊断筛查量表”。预试验由受过培训的精神科护士对二级综合医院的99例住院病人进行了评估。结果显示,评定员间针对有无重性抑郁发作的一致性极好(ICC=1.00);其中85例完成了盲法重测,重测一致性良好(ICC=0.91)。由受过培训的精神科护士采用筛查量表对分层、随机整群抽样的北京35家一级、8家二级和7家三级综合医院年龄≥15岁、病情允许且交流无明显困难的2877例顺序就诊的门诊病人和调查期间在院的2925例住院病人进行调查,每个病例的筛查时间为15～20min。对所有筛选阳性和随机选择的10%筛选阴性的病人共565例由不知道筛选结果的精神科医师进行SCID检查。结果护士使用的抑郁症筛查量表诊断为重性抑郁发作与精神科医师使用的金标准SCID诊断为重性抑郁障碍的准确度为96.8%,Kappa值0.87,敏感度98.6%,特异度96.6%,假阳性率3.4%,假阴性率1.4%。结论抑郁症筛查量表的敏感性和特异性高,信效度好,适合非精神科医师使用,可以在抑郁症流调和临床中使用以代替复杂的SCID检查。     

The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson's disease

The concurrent validity of the Hamilton Rating Scale for Depression (HAMD-17) and the Montgomery-Asberg Depression Rating Scale (MADRS) against the DSM-IV diagnosis 'depressive disorder' was assessed in patients with Parkinson's disease (PD). Sixty-three non-demented Parkinson's Disease (PD) patients who attended the outpatient department of an academic hospital were diagnosed according to a standardised research protocol. This protocol consisted of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to establish the presence or absence of 'depressive disorder' according to the DSM-IV criteria, as well as the HAMD-17 and the MADRS. Receiver Operating Characteristics curves (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 patients was reached at a cut-off score of 13/14 for the HAMD-17, and at 14/15 for the MADRS. At lower cut-offs, like 11/12 for the HAMD-17 and 14/15 for the MADRS, the high sensitivity and NPV make these scales good screening instruments. At higher cut-offs, such as 16/17 for the HAMD-17 and 17/18 for the MADRS, the high specificity and PPV make these instruments good diagnostic instruments. The diagnostics performance of the HAMD-17 is slightly better than that of the MADRS. This study shows that it is justified to use the HAMD-17 and the MADRS to measure depressive symptoms in both non-depressed and depressed PD patients, to diagnose depressive disorder in PD, and to dichotomize patient samples into depressed and non-depressed groups.     

Beck's Depression Inventory as a screening instrument for adolescent depression in Sweden: gender differences

Beck's Depression Inventory was administered in a study of all students aged 16–17 years in the first year of high school in a Swedish town, and was completed by 93% of them (n=2270). Cronbach's reliability coefficient alpha was 0.89, and there were strong correlations between item scores and total scores. A diagnostic interview focused on depressive diagnosis during the last year was conducted with 88% (n=199) of all students with high scores (≥16), and with the same number of controls with low scores. A depressive diagnosis was confirmed in 73% of high scorers and 13% of low scorers. The questionnaire performed better with girls than with boys. The mean score was significantly higher for girls, and the proposed limit for moderate depression (a score of 16) was reached by 14.2% of girls and 4.8% of boys. All symptoms were significantly more frequent and more severe in girls. It was found that 20% of girls and 6% of boys reported suicidal ideation. In a factor analysis the strongest factor that emerged differed between the sexes. For boys it included sadness, crying and suicidal ideation, and for girls it included failure, guilt, self-dislike and feeling unattractive, combined with suicidal ideation. The gender differences are discussed.     

Parkinson''s disease and depression: psychometric properties of the Beck Depression Inventory.

Although the Beck Depression Inventory (BDI) is one of the most frequently employed measures of depression in Parkinson's disease, the somatic items included in the scale raise questions about its ability to differentiate depression from manifestations of the disease. The internal consistency and validity of the BDI as a measure of depression in a sample of 119 Parkinson's disease patients and 76 controls were studied. Results from an item analysis suggested that depression in Parkinson's disease patients is not a somatic artifact. Internal consistency reliability within the Parkinson's disease group was high. The factorial validity of the BDI was confirmed in both Parkinson's disease and control subjects. The results also indicated that Parkinsonian symptoms of depression can be measured separately from symptoms of the disease. These data suggest that the BDI including the somatic items is a reliable and valid measure of depression in Parkinson's disease and control subjects.     

Use of the Chinese version of the Beck Depression Inventory for screening depression in primary care

Many Asian-Americans are unfamiliar with depression and its treatment. When depressed, they generally seek treatment from their primary care physicians and complain about their physical symptoms, resulting in under-recognition and under-treatment of depression. This study evaluates the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) for screening depression among Chinese-Americans in primary care. A total of 503 Chinese-Americans in the primary care clinic of a community health center were administered the CBDI for depression screening. Patients who screened positive (CBDI > or = 16) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-III-R, patient version (SCID-I/P) for confirmation of the diagnosis. Patients who screened negative (CBDI < 16) were randomly selected to be interviewed using the depression module of the SCID-I/P. The results of the SCID-I/P interview were used as the standard for evaluating the sensitivity and specificity of the CBDI. A total of 815 Chinese-Americans in a primary care clinic were approached, and 503 completed the CBDI. Seventy-six (15%) screened positive (CBDI > or = 16), and the prevalence of major depression was 19.6% by using extrapolated results from SCID-I/P interviews. When administered by a native-speaking research assistant, the CBDI has good sensitivity (.79), specificity (.91), positive predictive value (.79), and negative predictive value (.91). Despite the commonly believed tendency to focus on physical symptoms rather than depressed mood, Chinese-Americans are able to report symptoms of depression in response to a questionnaire. The CBDI, when administered by research assistants, has good sensitivity and specificity in recognizing major depression in this population. Lack of interest among Chinese-American patients in using the CBDI as a self-rating instrument has limited its use for depression screening in primary care settings.     

Short questionnaire for Parkinson's disease as a screening instrument

Objective

To validate and simplify a screening questionnaire for the determination of PD.

Methods

The screening questionnaire for PD was developed with the permission of the author. Reliability of the questionnaire was tested. To validate the questionnaire, 40 patients with PD and 93 controls completed the questionnaire. Multiple logistic regression analysis was used to determine the questions independently associated with PD and a risk score was calculated. The predictive performance of the risk score was evaluated via the area under the curve (AUC) of a receiver operating characteristics (ROC) curve.

Results

The questionnaire showed a Cronbach's alpha coefficient of 0.73 with no difference between the initial and follow up scores. The mean content validity was 0.86. Of the 11 questions, 4 were independently associated with PD and were used to calculate the risk score. The scores of these questions were 2 (clumsiness) + 4 (tremor) + 2 (masked face) + 2 (loss of balance while turning). The AUC of a ROC curve for the sum of risk score was 0.95. With a cutoff score of 5 or higher, the sensitivity and specificity were 0.88 and 0.95, respectively.

Conclusions

The screening questionnaire for PD is a reliable and valid instrument. The predictive performance of the simplified questionnaire is as good as the original.     

Validation of the Unified Parkinson's Disease Rating Scale (UPDRS) section I as a screening and diagnostic instrument for apathy in patients with Parkinson's disease

We examined the validity of the motivation/initiative item of the Unified Parkinson's Disease Rating Scale (UPDRS) section I as a screening and diagnostic measure for apathy in Parkinson's disease (PD). Fifty-eight patients with PD were evaluated with the UPDRS, the 14-item Apathy Scale (AS), and standardized rating scales of depression and cognitive impairment. Apathy was diagnosed using specific items of the AS together with proposed criteria for apathy. A score of 2 or more on the motivation/initiative item was adequate to screen for apathy, whereas a score of 4 had high diagnostic accuracy at the cost of unacceptable low sensitivity.     

抑郁自评量表和贝克抑郁量表区分抑郁症严重程度的准确度

目的 对抑郁自评量表和贝克抑郁量表诊断抑郁症和区分抑郁症严重程度的准确性进行 评价。方法 选取 2018 年 8 月至 2020 年 8 月在重庆市精神卫生中心就诊的门诊和自愿住院 200 例以情 绪和睡眠问题为主诉的患者,以 ICD-10 的条目标准进行抑郁症的诊断和抑郁症严重程度的评估,同时 完成抑郁自评量表和贝克抑郁量表的评定,采用受试者工作特征（ROC）曲线下面积评价两个抑郁量表 的准确性。结果 抑郁自评量表和贝克抑郁量表具有明显的相关性（r=0.848,P＜ 0.001）,两个量表诊断 抑郁症和区分抑郁症严重程度的 ROC 曲线下面积差异无统计学意义（P＞ 0.1）。随着抑郁程度的加重, ROC 曲线下面积逐渐增大（0.754/0.761～0.904/0.911）,Youden 指数逐渐增加（0.498/0.403～0.768/0.751）, 阳性似然比逐渐增加（2.71/2.14～9.63/10.1）,阳性预测值逐渐增加但不理想（17.2%/17.8%）。结论 抑郁 自评量表和贝克抑郁量表诊断抑郁症和区分抑郁症严重程度的准确性相当,且抑郁程度越重,两种量 表的评定就会越准确,两种量表有特定的使用目的和特定的人群,不能随意推荐使用。     

Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis

OBJECTIVES: To examine if depression in multiple sclerosis (MS) can be accurately recognized using the Yale Single Question (YSQ) screen as compared with the Beck Depression Inventory (BDI), a 21-item self-report rating scale for depression. In addition, we sought to assess the sensitivity, specificity the positive predictive value (PPV) and the negative predictive value (NPV) of the YSQ. BACKGROUND: Depression associated with MS is a major contributor to morbidity. Screening for depression in patients with MS currently includes the BDI, which measures characteristic attitudes and symptoms of depression. However, in a busy outpatient clinic, the BDI might not be the most appropriate instrument, particularly if depression screening can be assessed accurately using simpler techniques that are easy to administer and consume less time. We compared the accuracy of the YSQ screen response against the BDI to screen for depression in MS patients, in an outpatient setting. METHODS: This is a comparative outcome study of two 'instruments' used for screening depression in MS patients in an academic outpatient setting. All patients were initially screened for depression by asking patients the YSQ--'Do you frequently feel sad or depressed?', followed by BDI administration. Depression was defined as a score of > or = 13 on the BDI. One hundred and twenty successive patients who presented to the MS clinic at Washington University School of Medicine and met the criteria for diagnosis of MS were screened for depression. All patients diagnosed as having MS, regardless of type, were included in the study. RESULTS: Of the 120 patients studied, a total of 49 of 120 were clinically depressed as defined by a BDI cut-off of > or = 13; 71 of 120 were not. The sensitivity of the YSQ was 32 of 49 = 65.3% with a 95% confidence interval (0.50, 0.78), specificity was 62 of 71 = 87.3% (0.77, 0.94), PPV was 32 of 41 = 78.0% (0.62, 0.89) and NPV was 62 of 79 = 78.5% (0.68, 0.87). Of the 49 patients depressed by BDI criteria, 17 responded 'no' to the YSQ, yielding a false-negative rate of 34.7% (0.22, 0.50). The Wilcoxon-Mann-Whitney test for difference in age among those on antidepressants compared with those who were not showed no statistical difference (P = 0.35). For patients on antidepressants, the mean BDI score was 16.0+/-8.9 (mean+/-SD) and 9.5+/-8.7 for those not on antidepressants. Differences in BDI scores among patients on antidepressants versus those who were not were statistically significant (P < 0.0001). Patients on antidepressants had significantly higher BDI scores. CONCLUSIONS: Our results show that the YSQ cannot replace the BDI as a screening instrument for depression in MS. The YSQ could not identify 34.7% of patients who were depressed by BDI criteria. However, as reported in a published study, BDI missed 30% of cases with early depression in MS when a cut-off of > or = 13 was used. The YSQ appears to be specific in ruling out depression when a patient is not depressed. MS is a chronic disease and since prevalence of depression varies, it is important to screen patients repeatedly over time so as not to miss the diagnosis. That BDI scores were higher among those taking antidepressants underscores the fact that this subset of patients need to be on medication, but the higher scores could also represent a sampling error since the duration of antidepressant use was not studied.     

Reliability and validity of the Geriatric Depression Scale in depression in Parkinson's disease

The objective of this study was to investigate reliability and validity of the self rated 30 item Geriatric Depression Scale (GDS) in screening and diagnosis of depression in Parkinson's disease (PD). The study sample comprised 109 non-demented patients with PD admitted to the movement disorders outpatient unit. The reference diagnosis of depression was made according to DSM-IV criteria. Discriminant validity and internal consistency of the total scale were studied. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for different cutoff scores. Receiver operating characteristics (ROC) analysis was also carried out. The sample comprised 56 patients with and 53 without depression. In the discriminant validity analysis, the mean total GDS score of subjects with depression was significantly higher compared with those without depression. The Cronbach's alpha score was 0.92 and the split half correlation coefficient 0.91. The cutoff score of 13/14 provided the highest sum of sensitivity and specificity level. The sensitivity of this cutoff score was 0.78 and specificity 0.85, while PPV was 0.84 and NPV 0.79. The area under the curve value in the ROC analysis was 0.891. Sensitivity and specificity analysis showed that cutoff scores of 8/9 or 9/10 could be useful for screening and 14/15 or 15/16 for diagnostic purposes. This study showed that the 30 item GDS, with its high discriminant validity, internal consistency, and reasonably clear cutoff scores, could be a useful screening or diagnostic self rated depression scale in patients with PD.     

Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents

The concurrent validity of the Beck Depression Inventory (BDI) was evaluated in 122 outpatient adolescents referred to a clinic for depression. Criterion validators were Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) generated diagnoses and a 17-item clinician-rated depression scale extracted from the K-SADS. Initial BDI scores of greater than 13 yielded sensitivity, specificity, and positive predictive powers of 86%, 82%, and 83%, respectively, in differentiating syndromal major depressive disorder (MDD) from nonaffective disordered patients. In repeated interviews in 2 weeks with a BDI score of greater than 13, these parameters were 89%, 88%, and 93%, respectively, in those meeting MDD criteria. The BDI correlated significantly with the 17-item depression score in depressed females but not depressed males because BDI scores were more than 30% higher in females. BDI internal consistency among all cases was 0.91 and was higher in depressed than nondepressed patients.     

The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India

Background  

There is increasing interest in identifying adolescents with depression in primary care settings by paediatricians in India. This article studied the diagnostic accuracy, reliability and validity of Beck Depression Inventory (BDI) while used by paediatricians in a primary care setting in India.     

Screening for major depression in Asian-Americans: a comparison of the Beck and the Chinese Depression Inventory

OBJECTIVE: This study compares the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) and the Chinese Depression Inventory (CDI) in screening for depression among Chinese Americans. METHOD: Five hundred and three Chinese-Americans in primary care were administered the CBDI and the CDI for depression screening. The results were compared with standard semistructured interview. RESULTS: With empirically determined cutoff scores of the CBDI (> or =13) and the CDI (>/=16), both instruments have good sensitivity (0.78) and excellent specificity (0.91 and 0.93, respectively). The correlation between the total scores of the two instruments was high (0.785, P < 0.01). The areas under the Receiver Operating Characteristic (ROC) curve of the CBDI and the CDI were 0.94 and 0.95, respectively, and were not significantly different. CONCLUSION: When administered by interviewers, the CBDI and the CDI have comparable effectiveness. Low participation among Chinese-Americans with self-report measures limits both scales as efficient depression screening instruments.     

Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory

ObjectiveAlthough anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients.MethodsA total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed.ResultsDepressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥7 for the HADS depression subscale (HADS-D), ≥14 for the HADS-total, ≥11 for the CDI and ≥17 for the BDI. The optimal screening cut-off for anxiety was ≥6 for the HADS anxiety subscale (HADS-A) and ≥14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D.ConclusionThe BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥17 for BDI, ≥11 for CDI, ≥7 for HADS depression subscale, ≥6 for HADS anxiety subscale and ≥14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients.     

Validity of Hamilton Depression Inventory in Parkinson's disease.

Studies investigating the assessment of depression in Parkinson's disease (PD) are limited. We examined the concurrent validity and the internal consistency of the Hamilton Depression Inventory (HDI) and compared it to the Hamilton and Geriatric Depression Scales. PD patients (n = 79) were recruited from neurology clinics. Diagnosis of depressive disorder was made according to DSM-IV criteria. Receiver operating characteristic curves were used to calculate sensitivity, specificity, and positive and negative predictive values. The HDI exhibited an optimal cutoff for discriminating between depressed and nondepressed PD patients of 13.5/14.0 and is a valid instrument to use in the setting of PD.