What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person‐fit

Abstract

Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.

Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis

“…However, the authors did not attempt to account for the role of physical health in their results. Wardenaar et al performed a similar IRT analysis of the BDI in subjects postmyocardial infarction and found that mood items were more representative of diagnosed depression, compared to somatic items, which were reported frequently in all subjects [16]. Collectively, these analyses support the use of IRT to better understand the effect of medical comorbidity on the assessment of depression.…”

Person misfit on the Inventory of Depressive Symptomatology: Low quality self‐report or true atypical symptom profile?

“…Foremost, a baseline model was estimated including only the control variables: IDS total score (e.g. Conijn et al, ; Wanders al., ; Wardenaar et al, ) and dummy variables representing the data collection waves. Next, extended models were estimated by including either a block of atypical symptom profiles, or a block of explanatory variables related to the quality of the self‐report.…”

“…They concluded that person‐fit statistics could be used to screen for atypical suicide risk. Wardenaar et al () found that person misfit on the Beck Depression Inventory in a sample of myocardial infarct patients reflected an atypical symptom profile characterized by low somatic complaints but other depressive symptoms indicative of clinical levels of depression.…”

“…Recently, person-fit statistics have been proposed for identifying patients with self-reported symptom profiles that do not conform to unidimensional models (e.g. Wanders, Wardenaar, Penninx, Meijer, & De Jonge, 2015;Wardenaar, Wanders, Roest, Meijer, & De Jonge, 2015).…”

“…In psychopathology measurement in mental health-care patients, only recently several person-fit studies have been conducted (Conijn, Emons, De Jong, & Sijtsma, 2015;Conrad et al, 2010;Conrad, Conrad, Dennis, Riley, & Funk, 2011;Wanders et al, 2015;Wardenaar et al, 2015). With few exceptions, these studies interpreted misfitting response patterns as reflecting true (i.e.…”