Diagnostic Test Accuracy of the Beck Depression Inventory for Detecting Major Depression in Adolescents: A Systematic Review and Meta-Analysis

Major depressive disorder in adolescents is closely linked to poor social, cognitive, and academic outcomes, including suicidality. The Beck Depression Inventory (BDI), a screening tool, is one of the most widely used instruments for detecting depression; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to systematically review and perform a meta-analysis to evaluate the accuracy of the BDI for detecting depression in adolescents. In August 2020, a search was conducted in the EMBASE, MEDLINE, CINAHL, and PsycArticles databases, and following a review against predefined eligibility criteria, 22 studies were finally included. The quality of the included articles was evaluated, and a hierarchical regression model was used to calculate the pooled estimates of sensitivity and specificity; 73.0% (95% CI; 62.0%, 81.8%) and 80.3% (72.8%, 86.1%) in cutoff 16, respectively. The findings indicated the BDI is a reliable and useful tool to screen adolescents' depression.

Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders

INTRODUCTION

The raw mean difference (RMD) and standardized mean difference (SMD) are continuous effect size measures that are not readily usable in decision-analytic models of health care interventions. This study compared the predictive performance of 3 methods by which continuous outcomes data collected using psychiatric rating scales can be used to calculate a relative risk (RR) effect size.

METHODS

Three methods to calculate RR effect sizes from continuous outcomes data are described: the RMD, SMD, and Cochrane conversion methods. Each conversion method was validated using data from randomized controlled trials (RCTs) examining the efficacy of interventions for the prevention of depression in youth (aged ≤17 years) and adults (aged ≥18 years) and the prevention of eating disorders in young women (aged ≤21 years). Validation analyses compared predicted RR effect sizes to actual RR effect sizes using scatterplots, correlation coefficients ( r), and simple linear regression. An applied analysis was also conducted to examine the impact of using each conversion method in a cost-effectiveness model.

RESULTS

The predictive performances of the RMD and Cochrane conversion methods were strong relative to the SMD conversion method when analyzing RCTs involving depression in adults (RMD: r = 0.89-0.90; Cochrane: r = 0.73; SMD: r = 0.41-0.67) and eating disorders in young women (RMD: r = 0.89; Cochrane: r = 0.96). Moderate predictive performances were observed across the 3 methods when analyzing RCTs involving depression in youth (RMD: r = 0.50; Cochrane: r = 0.47; SMD: r = 0.46-0.46). Negligible differences were observed between the 3 methods when applied to a cost-effectiveness model.

CONCLUSION

The RMD and Cochrane conversion methods are both valid methods for predicting RR effect sizes from continuous outcomes data. However, further validation and refinement are required before being applied more broadly.

Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review

OBJECTIVE

Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. A requirement for effective screening is a screening tool with demonstrated high accuracy. The objective of this systematic review was to evaluate the accuracy of depression screening instruments to detect major depressive disorder (MDD) in children and adolescents.

METHOD

Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, HaPI, and LILACS databases from 2006 to September 30, 2015. Eligible studies compared a depression screening tool to a validated diagnostic interview for MDD and reported accuracy data for children and adolescents aged 6 to 18 years. Risk of bias was assessed with QUADAS-2.

RESULTS

We identified 17 studies with data on 20 depression screening tools. Few studies examined the accuracy of the same screening tools. Cut-off scores identified as optimal were inconsistent across studies. Width of 95% confidence intervals (CIs) for sensitivity ranged from 9% to 55% (median 32%), and only 1 study had a lower bound 95% CI ≥80%. For specificity, 95% CI width ranged from 2% to 27% (median 9%), and 3 studies had a lower bound ≥90%. Methodological limitations included small sample sizes, exploratory data analyses to identify optimal cut-offs, and the failure to exclude children and adolescents already diagnosed or treated for depression.

CONCLUSIONS

There is insufficient evidence that any depression screening tool and cut-off accurately screens for MDD in children and adolescents. Screening could lead to overdiagnosis and the consumption of scarce health care resources.

Attributional Style in Work Settings: Development of a Measure

We developed the Work Attributional Style Questionnaire to assess one's attributional propensities in work settings. In Study 1, a tendency to attribute positive events to internal, stable, global, and controllable causes was associated with positive work adjustment (i.e., low helplessness and depression). Study 2 revealed similar results; however, a factor structure comprised of only 2 dimensions (controllability/internality and stability/globality) was evident. Attributional style for positive events was a marginally significant predictor of work adjustment in Study 2. When fitted to Study 1 data, the revised Study 2 model fit the data well. Positive attributional style was a significant predictor of work adjustment and negative attributional style was marginally significant.

When Being Discrepant from One's Ideal or Ought Selves Hurts: The Moderating Role of Neuroticism

Self–discrepancy theory posits that people experience emotional consequences when they perceive discrepancies between their actual and possible selves. However, the extent to which people react emotionally to these self–discrepancies (i.e. ideal, ought and undesired) may be a function of individual differences in neuroticism. Across both experimental (Study 1; N = 155) and correlational designs (Study 2; N = 139) involving college students, the authors demonstrated that neuroticism moderated the discrepancy–emotion associations such that high–neuroticism individuals showed elevated depression and anxiety symptoms when their self–discrepancies were activated. The heightened symptoms were maintained over time. Negative repetitive thoughts (i.e. rumination and worry) were examined as potential mediating mechanisms between the discrepancy × neuroticism interaction and symptoms. Partial support was obtained in that rumination mediated between undesired discrepancy × neuroticism interaction and anxious/depressive symptoms. Implications and possible theoretical extensions for self–discrepancy theory are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

The Portuguese Version of the Beck Depression Inventory-II (BDI-II)

Beck Depression Inventory-II (BDI-II) is one of the most popular and widely investigated instruments for assessing the severity of depressive symptomatology. The authors developed a Portuguese version of the inventory. This paper presents two studies: one with a college student sample (n = 547) and another with a community sample (n = 200). Reliability, factor structure, and validity data were obtained. The Portuguese version presents a good internal consistency, a factor structure very similar to the one obtained by Beck, Steer, and Brown (1996 ) with the original version, and presents an adequate convergent validity with the Center for Epidemiologic Studies of Depression Scale. Confirmatory factor analysis provides support for the fit of a two-factor model.

Gender differences in emotional reactivity of depressed and at-risk preschoolers: implications for gender specific manifestations of preschool depression

We investigated whether differences in positive and negative emotional reactivity could be found in depressed preschoolers and preschoolers at risk for later internalizing symptoms relative to nondepressed/low risk comparison groups. Observational measures of emotional reactivity, used to derive a score of the balance between anger and sadness, were obtained and analyzed in independent samples. One study utilized cross-sectional data from preschoolers (M age = 4.6 years) with a current depressive syndrome and two nondepressed comparison groups. The other study utilized longitudinal data that assessed emotional reactivity at preschool age (M age = 4.5 years) and later mental health symptoms during the transition to primary school, allowing a retrospective determination of risk. Depressed and at-risk boys displayed more anger than sadness in contrast to girls in the same groups and in contrast to no disorder/low-risk controls. This finding was detected in depressed and "at risk for internalizing" boys who were not comorbid for externalizing problems.

Elaboração e validação da Escala de Depressão para Idosos

O objetivo deste estudo foi desenvolver e validar a Escala de Depressão para Idosos (EDI). Foi elaborado um modelo teórico explicativo da depressão, composto por três categorias: cognitiva, afetiva e somático-motora. Os itens elaborados foram submetidos à análise semântica e de juizes. O instrumento piloto foi aplicado a 340 sujeitos, sendo 88% do sexo feminino, com ensino fundamental completo (67,9%) e idade média de 63,74 (DP = 6,87) anos. A amostra respondeu também ao Inventário de Depressão de Beck (BDI). Para a validação da escala, foram realizadas análises fatoriais e análise da consistência interna dos itens (alfa de Cronbach). Regressões múltiplas avaliaram o poder de predição dos fatores da EDI sobre o escore final do BDI. A validação da escala demonstrou que a EDI é composta por dois fatores: cognitivo-afetivo e somático-motor, que explicam 53% do BDI (validade convergente). Pode-se afirmar, portanto, que a EDI é formada por fatores que avaliam diferentes aspectos do constructo depressão (validade fatorial), os quais apresentam índices de consistência interna dentro dos padrões psicométricos.

Cues resulting in desire for sexual activity in women

INTRODUCTION

A number of questionnaires have been created to assess levels of sexual desire in women, but to our knowledge, there are currently no validated measures for assessing cues that result in sexual desire. A questionnaire of this nature could be useful for both clinicians and researchers, because it considers the contextual nature of sexual desire and it draws attention to individual differences in factors that can contribute to sexual desire.

AIM

The aim of the present study was to create a multidimensional assessment tool of cues for sexual desire in women that is validated in women with and without hypoactive sexual desire disorder (HSDD).

METHODS

Factor analyses conducted on both an initial sample (N = 874) and a community sample (N = 138) resulted in the Cues for Sexual Desire Scale (CSDS) which included four factors: (i) Emotional Bonding Cues; (ii) Erotic/Explicit Cues; (iii) Visual/Proximity Cues; and (iv) Implicit/Romantic Cues.

MAIN OUTCOME MEASURES

Scale construction of cues associated with sexual desire and differences between women with and without sexual dysfunction.

RESULTS

The CSDS demonstrated good reliability and validity and was able to detect significant differences between women with and without HSDD. Results from regression analyses indicated that both marital status and level of sexual functioning predicted scores on the CSDS. The CSDS provided predictive validity for the Female Sexual Function Index desire and arousal domain scores, and increased cues were related to a higher reported frequency of sexual activity in women.

CONCLUSIONS

The findings from the present study provide valuable information regarding both internal and external triggers that can result in sexual desire for women. We believe that the CSDS could be beneficial in therapeutic settings to help identify cues that do and do not facilitate sexual desire in women with clinically diagnosed desire difficulties.

The effectiveness of advanced practice registered nurses as psychotherapists

This article explores the effectiveness of advanced practice registered nurses as psychotherapists. Psychiatric/mental health (PMH) clinical nurse specialists (CNSs) possess the training, skills, and abilities necessary to provide effective psychotherapy. A case study is examined involving a client with obsessive-compulsive disorder who underwent psychotherapy by a PMH CNS graduate student. Evidence is presented that CNSs follow evidence-based procedures with effective outcomes.

Application of the Double Monotonicity Model to Polytomous Items

Abstract. This paper investigates the item scalability of the Beck Depression Inventory (BDI) in 252 subjects; 126 with and 126 without eating disorders. To do so, an order was established regarding the BDI items according to the clinical characteristics of the subjects with eating disorders. The nonparametric Item Response Theory (NIRT) model was applied to evaluate Monotone Homogeneity and Double Monotonicity of items, as well as the reliability of the scale in both groups. The results show that the order of the items is satisfied in the group with eating disorders, but not in the control group. Therefore, the results obtained allow the ordering of depression scores of subjects with eating disorders according to their clinical characteristics. This order is not valid for the depression scores of subjects who did not have eating disorders. It should be noted that the application of the Double Monotonicity model to polytomous items provides new and relevant information when compared to the data provided by the Classical Test Model. In addition, it is very useful for other items and subjects having certain characteristics.

Emotion-related abilities and depressive symptoms in Latina mothers and their children

This study examined the abilities of 40 Latina mothers and their 6- to 11-year-old children (20 girls, 20 boys) to recognize and produce emotion expressions and how these abilities differed as a function of maternal depressive symptoms. The results indicated that depressively symptomatic mothers were less accurate at recognizing basic emotions (e.g., happy, sad, etc.) and some mixed emotions (e.g., scared/ok combinations) than nonsymptomatic mothers, but there were no group differences for emotion production. In contrast, children of symptomatic mothers posed fewer recognizable sad expressions than their peers. Error pattern analyses also revealed that children of symptomatic mothers were more likely to mistakenly recognize happiness and to avoid posing sadness (across all basic emotions). Children's ability to pose emotions was related to their mothers' emotion production, and this was not moderated by maternal depressive symptoms. The discussion focuses on the possible interpersonal consequences of these biases and deficits in the emotion-related abilities of symptomatic mothers and their children and on the need to conduct research on the familial and cultural processes that might underlie these findings.