Discriminability of the Beck Depression Inventory and its Abbreviations in an Adolescent Psychiatric Sample

FIGURE 1.

FIGURE 2a.

FIGURE 2b.

Figure 3.

BDI sum score distributions by version and diagnostic category_

Condition*	Version	Diagnosis +			Diagnosis −			Brunner–Munzel test		Stochastic Superiority
		n	M	SD	n	M	SD	Statistic	p	Estimate	CI
MDD vs. no depr.	BDI-1A	351	30.22	9.64	239	12.13	9.49	31.7	< 0.001	0.902	[0.88, 0.93]
MDD vs. no depr.	BDI-SF	359	20.24	6.60	243	7.75	6.56	32.3	< 0.001	0.902	[0.88, 0.93]
MDD vs. no depr.	BDI-PC	361	11.58	3.91	245	4.54	3.91	29.5	< 0.001	0.892	[0.87, 0.92]
MDD vs. no depr.	BDI-6	368	10.02	3.04	246	4.00	3.29	32.7	< 0.001	0.899	[0.88, 0.92]
Depr. vs. none	BDI-1A	389	29.13	10.04	239	12.13	9.49	28.3	< 0.001	0.884	[0.86, 0.91]
Depr. vs. none	BDI-SF	397	19.53	6.87	243	7.75	6.56	28.7	< 0.001	0.885	[0.86, 0.91]
Depr. vs. none	BDI-PC	399	11.20	4.03	245	4.54	3.91	26.8	< 0.001	0.876	[0.85, 0.90]
Depr. vs. none	BDI-6	406	9.74	3.12	246	4.00	3.29	29.8	< 0.001	0.886	[0.86, 0.91]
MDD vs. no MDD	BDI-1A	351	30.22	9.64	275	13.04	9.55	30.7	< 0.001	0.892	[0.87, 0.92]
MDD vs. no MDD	BDI-SF	359	20.24	6.60	279	8.42	6.63	30.9	< 0.001	0.891	[0.87, 0.92]
MDD vs. no MDD	BDI-PC	361	11.58	3.91	281	4.95	3.96	28.1	< 0.001	0.880	[0.85, 0.91]
MDD vs. no MDD	BDI-6	368	10.02	3.04	282	4.40	3.35	30.2	< 0.001	0.883	[0.86, 0.91]

Diagnostic test results, MDD vs_ no depressive disorder, factor score cut-off equivalent to BDI-1A sum ≥ 16_

Version	Items	Factor score cut-off	AP	Confusion matrix					Basic ratios			κ	Diagnostic odds ratio		Number needed to diagnose		Global test		Individual test adjusted p-values
				TP	FP	FN	TN	Sens.	Spec.	PPV	NPV		DOR	95% Cl	NND	95% Cl	Stat.	Adj. p	Sens.	Spec.
BDI-1A	21	−0.35	70%	350	85	23	164	0.938	0.659	0.805	0.877	0.623	29.36	[17.87, 48.24]	1.68	[1.48, 1.98]	2.70	0.250	–	–
BDI-SF	13	−0.33	70%	350	85	23	164	0.938	0.659	0.805	0.877	0.623	29.36	[17.87, 48.24]	1.68	[1.48, 1.98]	1.34	0.512	–	–
BDI-PC	7	−0.32	71%	350	90	23	159	0.938	0.639	0.795	0.874	0.604	26.88	[16.39, 44.09]	1.73	[1.52, 2.06]	0.04	0.980	–	–
BDI-6	6	−0.35	70%	350	86	23	163	0.938	0.655	0.803	0.876	0.619	28.84	[17.56, 47.37]	1.69	[1.48, 2.00]	0.36	0.835	–	–

Version membership and standardized one-factor model parameters of BDI-IA items

Item	Content	Item included in version			Factor loading	Item thresholds
		BDI-SF	BDI-PC	BDI-6		1	2	3
1	Mood	✓	✓	✓	0.80	−0.51	0.64	1.52
2	Pessimism	✓	✓	–	0.75	−0.83	0.25	1.12
3	Sense of failure	✓	✓	–	0.84	−0.74	0.45	1.11
4	Lack of satisfaction	✓	✓	–	0.83	−0.55	0.44	1.46
5	Guilty feeling	✓	–	✓	0.88	−0.46	0.28	1.00
6	Sense of punishment	–	–	–	0.65	0.07	0.74	1.27
7	Negative self-view	✓	✓	–	0.84	−0.69	0.32	0.96
8	Self-accusations	–	✓	–	0.81	−0.90	−0.21	0.31
9	Self-destructiveness	✓	✓	–	0.70	−0.68	1.12	2.11
10	Crying	–	–	–	0.71	−0.48	0.26	0.69
11	Irritability	–	–	✓	0.66	−0.92	0.32	1.31
12	Social withdrawal	✓	–	–	0.74	−0.36	0.64	1.82
13	Indecisiveness	✓	–	✓	0.75	−0.68	0.05	1.60
14	Negative body image	✓	–	–	0.73	−0.13	0.36	0.63
15	Work inhibition	✓	–	✓	0.71	−0.91	−0.03	1.49
16	Sleep disturbance	–	–	–	0.56	−0.67	0.81	1.34
17	Fatigability	✓	–	✓	0.78	−0.78	0.08	1.26
18	Loss of appetite	✓	–	–	0.58	−0.05	0.73	1.54
19	Weight loss	–	–	–	0.24	0.68	1.19	1.73
20	Somatic preoccupation	–	–	–	0.42	0.25	1.48	1.93
21	Loss of libido	–	–	–	0.58	0.20	0.93	1.62

Characteristics and presence of SCID-based diagnoses by gender_

Variable	Males	Females	Total
Participants	202	550	752
Age, mean	16.74	16.47	16.55
Age, SD	1.67	1.62	1.64
Major depressive disorder	84 (42%)	294 (53%)	378 (50%)
Dysthymia	24 (12%)	87 (16%)	111(15%)
Other depressive disorder	7 (3.5%)	29 (5%)	36 (5%)
Exclusion diagnosis	6 (3%)	61 (11%)	67 (9%)

Diagnostic test results, MDD vs_ no depressive disorder, mean score cut-off equivalent to BDI-1A sum ≥ 16_

Version	Items	Mean cut-off	AP	Confusion matrix					Basic ratios			κ	Diagnostic odds ratio		Number needed to diagnose		Global test		Individual test adjusted p-values
				TP	FP	FN	TN	Sens.	Spec.	PPV	NPV		DOR	95% Cl	NND	95% Cl	Stat.	Adj. p	Sens.	Spec.
BDI-1A	21	0.76	71%	350	89	23	160	0.938	0.643	0.797	0.874	0.608	27.36	[16.67, 44.89]	1.72	[1.51, 2.05]	–	–	–	–
BDI-SF	13	0.82	69%	348	84	25	165	0.933	0.663	0.806	0.868	0.620	27.34	[16.86, 44.34]	1.68	[1.48, 1.99]	2.22	0.329	–	–
BDI-PC	7	0.86	72%	354	95	19	154	0.949	0.618	0.788	0.890	0.598	30.20	[17.82, 51.19]	1.76	[1.54, 2.10]	3.12	0.211	–	–
BDI-6	6	1.00	69%	349	81	24	168	0.936	0.675	0.812	0.875	0.634	30.16	[18.45, 49.29]	1.64	[1.45, 1.93]	2.36	0.307	–	–

Optimal cut-off results_

BDI version	Optimization criterion	Subgroup	Optimal cut-off	κ	Sensitivity	Specificity	AUC	DOR	NND
BDI-1A	Cohen's kappa	-	0.89	0.638	0.895	0.731	0.902	–	1.60
BDI-SF	Cohen's kappa	-	1.01	0.619	0.845	0.775	0.903	–	1.61
BDI-PC	Cohen's kappa	-	1.10	0.634	0.861	0.771	0.893	–	1.58
BDI-6	Cohen's kappa	-	1.04	0.615	0.866	0.743	0.900	–	1.64
BDI-1A	Cohen's kappa	Male	0.86	0.682	0.821	0.860	0.910	–	1.47
BDI-1A	Cohen's kappa	Female	0.90	0.611	0.927	0.654	0.896	–	1.72
BDI-SF	Cohen's kappa	Male	0.79	0.629	0.869	0.763	0.912	–	1.58
BDI-SF	Cohen's kappa	Female	1.07	0.597	0.886	0.699	0.896	–	1.71
BDI-PC	Cohen's kappa	Male	1.01	0.646	0.738	0.903	0.893	–	1.56
BDI-PC	Cohen's kappa	Female	1.12	0.605	0.896	0.692	0.890	–	1.70
BDI-6	Cohen's kappa	Male	0.95	0.650	0.857	0.796	0.895	–	1.53
BDI-6	Cohen's kappa	Female	1.14	0.623	0.910	0.692	0.899	–	1.66
BDI-1A	Misclassification cost 1:1	-	0.86	0.638	0.895	0.731	0.902	–	1.60
BDI-SF	Misclassification cost 1:1	-	0.89	0.606	0.893	0.699	0.903	–	1.69
BDI-PC	Misclassification cost 1:1	-	1.05	0.634	0.861	0.771	0.893	–	1.58
BDI-6	Misclassification cost 1:1	-	1.02	0.615	0.866	0.743	0.900	–	1.64
BDI-1A	Misclassification cost 1:3	-	0.62	0.599	0.962	0.602	0.902	–	1.77
BDI-SF	Misclassification cost 1:3	-	0.68	0.611	0.979	0.594	0.903	–	1.75
BDI-PC	Misclassification cost 1:3	-	0.72	0.594	0.949	0.614	0.893	–	1.77
BDI-6	Misclassification cost 1:3	-	0.74	0.565	0.957	0.574	0.900	–	1.88