Sensitivity and Specificity of the Beck Depression Inventory-II in Persons With Traumatic Brain Injury

Abstract

Objectives Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives. Design This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI. Setting This study was completed at a Veterans Affairs (VA) Medical Center. Participants Participants were veterans eligible to receive VA health care services. Interventions Not applicable. Main Outcome Measures Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). Results We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%). Conclusions Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment.

Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan

“…17 Symptoms of PTSD and depression were assessed using the PostTraumatic Stress Disorder Checklist Military (PCLM) 18 and Beck Depression Inventory (BDI). 19,20 The neurologic examination was conducted by research staff (J.D., D.R., T.M., O.A.). Severity of balance impairment was tested using the Balance Error Scoring System (BESS).…”

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

“…Finally, one may argue that reading self-report scales to patients or applying them in the same occasion of SCID-I administration may have overestimated reporting of depressive symptoms. Again, this cannot be completely ruled out, but it seems unlikely, as discussed by other authors, 10 because determining the diagnostic properties of the scales was not an objective at the time of the interviews. Moreover, in a previously mentioned study, 12 the interviewers read the HADS to all subjects and the scale performed poorly.…”

“…28 One previous study 8 Questionnaire-9. Another study 10 reported an AUC of 0.88 for the Beck Depression Inventory-II in a sample consisting of military veterans with mainly mild and moderate TBI; this sample also had other distinctive characteristics, such as a high incidence of posttraumatic stress disorder and older age. In a community sample 9 of patients with mild to severe TBI (45% of severe cases), an AUC of 0.82 was found for the HADS depression subscale; in this study, the definition of depression was broader, with the inclusion of dysthymia.…”

“…Thus far, few studies have performed ROC analysis in the context of screening for depression following TBI. Most authors found that depression rating scales are highly valid, as indicated by high area under the curve (AUC) values, [8][9][10][11] but others reported poor discriminative capacity. 12 These studies assessed patients with heterogeneous severity of injury, most commonly recruited from rehabilitation centers.…”

Alcohol use and craving among Veterans with mental health disorders and mild traumatic brain injury

“…For the purposes of this study, a MHD includes depression, anxiety, and/or PTSD symptoms that meet the following study criteria. A Beck Depression Inventory-II (BDI-II) [26][27] score of 17 or higher, a Beck Anxiety Inventory (BAI) [28][29] score of 8 or higher, and/or meeting the lenient criteria [30] on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS) classified Veterans in the MHD group. Criteria to be classified as having mTBI included reports indicating currently active symptoms (e.g., headache, sensitivity to light, and lack of concentration) where symptoms were corroborated by performance on neuropsychological tests.…”