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

Mona Basker,Prabhakar D Moses,Paul Swamidhas Sudhakar Russell,Sushila Russell

doi:10.1186/1753-2000-1-8

Abstract

BackgroundThere 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.Methods181 adolescents attending 3 schools were administered a back translated Tamil version of BDI by a paediatrician to evaluate its psychometric properties along with Children's Depression Rating Scale (CDRS-R) for convergent validity. Clinical diagnosis of depressive disorders, for reference standard, was based on ICD-10 interview by an independent psychiatrist who also administered the Impact of Event Scale (IES) for divergent validity. Appropriate analyses for validity and diagnostic accuracy both at the item and scale levels were conducted.ResultsA cut-off score of ≥ 5 (Sn = 90.9%, Sp = 17.6 %) for screening and cut-off score of ≥ 22 (Sn = 27.3%, Sp = 90%) for diagnostic utility is suggested. The 4 week test – retest reliability was good (r = 0.82). In addition to the adequate face and content validity, BDI has very good internal consistency (α = 0.96), high convergent validity with CDRS-R (r = 0.72; P = 0.001), and high discriminant validity with IES (r = 0.26; P = 0.23). There was a moderate concordance rate with the reference standard (54.5%) in identifying depression among the adolescents. Factor analysis replicated the 2-factor structure explaining 30.5 % of variance.ConclusionThe BDI proved to be a psychometrically sound measure for use by paediatricians in a primary care setting in India. The possibility of screening for depressive disorders through the use of BDI may be helpful in identifying probable cases of the disorder among adolescents.

Highlights

There is increasing interest in identifying adolescents with depression in primary care settings by paediatricians in India
Among the participants identified as having a depressive disorder (N = 11), the most prevalent diagnostic group had mild, moderate or severe depression depressive episode with somatic symptoms (N = 5), followed by Brief depressive reaction (N = 3), Mixed anxiety-depression (N = 2) and grief (N = 1)
A score of ≥ 5 in Beck Depression Inventory (BDI) achieved sensitivity between 80– 100% and was ideal as a screening cut-off score, where as a score of ≥ 22 had a specificity of 80–100% making it appropriate for a diagnostic use to establish ICD-10 diagnosis of Depression

Summary

Introduction

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. Depressive disorders are identified by the World Health Organization as priority mental health disorder of adolescence because of its high prevalence, recurrence, ability to cause significant complications and impairment [1]. Several depression screening instruments are available, their psychometric properties in a primary-care paediatric setting in the Indian context has note been studied. Beck Depression Inventory (BDI) has excellent psychometric properties across clinical and non-clinical populations in other countries [10]. This study was conducted to document the psychometric properties of BDI in a primary-care setting in India while being used by paediatricians

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Results

Conclusion