Use of the beck depression inventory-II (BDI-II) with persons with traumatic brain injury: Analysis of factorial structure

Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study

INTRODUCTION

The prevalence of traumatic brain injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interact with age-related conditions such as multimorbidity. Despite this, TBI research in older adults is sparse. Minder, an in-home monitoring system developed by the UK Dementia Research Institute Centre for Care Research and Technology, uses infrared sensors and a bed mat to passively collect sleep and activity data. Similar systems have been used to monitor the health of older adults living with dementia. We will assess the feasibility of using this system to study changes in the health status of older adults in the early period post-TBI.

METHODS AND ANALYSIS

The study will recruit 15 inpatients (>60 years) with a moderate-severe TBI, who will have their daily activity and sleep patterns monitored using passive and wearable sensors over 6 months. Participants will report on their health during weekly calls, which will be used to validate sensor data. Physical, functional and cognitive assessments will be conducted across the duration of the study. Activity levels and sleep patterns derived from sensor data will be calculated and visualised using activity maps. Within-participant analysis will be performed to determine if participants are deviating from their own routines. We will apply machine learning approaches to activity and sleep data to assess whether the changes in these data can predict clinical events. Qualitative analysis of interviews conducted with participants, carers and clinical staff will assess acceptability and utility of the system.

ETHICS AND DISSEMINATION

Ethical approval for this study has been granted by the London-Camberwell St Giles Research Ethics Committee (REC) (REC number: 17/LO/2066). Results will be submitted for publication in peer-reviewed journals, presented at conferences and inform the design of a larger trial assessing recovery after TBI.

Return to work following mild traumatic brain injury: Psychological and cognitive factors in a litigating sample in the post acute stage of recovery

The purpose of this study was to investigate return to work (RTW) rates following a single uncomplicated mild Traumatic Brain Injury (mTBI) in the post-acute stage in the context of active litigation. More specifically, we sought to determine what psychological and/or cognitive factors predict a RTW after mTBI. Archival data were obtained from a random sample of litigating patients (n = 125; 54% female; mean age: 42.96 (SD = 12.74) who were referred to a private practice for a neuropsychological examination regarding their disability status following a single uncomplicated mTBI. A hierarchical regression analysis was used to assess the predictive value of emotional symptoms and cognition with respect to RTW status. Approximately 50% of the sample did not RTW. Attentional deficits (rs = -0.248) and depressive symptoms (rs = 0.248) were significantly associated with RTW. A hierarchical regression analysis found that depressive symptoms (p < .05) were associated with RTW outcomes. These findings suggest that individuals with increased depressive symptoms are more likely to demonstrate poor RTW outcomes in the post-acute stages of mTBI. These results are of interest to clinicians as they underscore the importance of screening and early intervention for depressive symptoms following a single uncomplicated mTBI in the post-acute stages in litigating samples.

Survey of depressive symptomatology in brain injury resulting from intimate partner violence

OBJECTIVE

A high prevalence of depression exists in specific sub-samples of survivors of brain injury (BI) sustained from intimate partner violence (IPV). However, the experience of depression by survivors of IPV-related BI from general civilian populations remains unclear. This study documents the symptom profile of depression reported by individuals who screened positive for sustaining an IPV-related BI.

METHODS

36 individuals who screened positive for possible IPV-related BI completed the Beck Depression Inventory-2^nd Edition (BDI-II). Subscales characterizing the nature of the symptoms were created. Frequency and descriptive statistics were calculated for item responses on the BDI-II. Participants were also assigned to high or low symptom severity groups to examine between-group differences.

RESULTS

Participants endorsed experiencing somatic symptoms more severely than self-evaluative and affective symptoms. Additionally, self-evaluative and cognitive symptoms correlated with total BDI-II scores for the high symptom severity group but not for the low symptom severity group.

CONCLUSIONS

The findings highlight somatic symptoms of depression, in particular as a common experience among survivors of IPV-related BI. Further, self-evaluative and cognitive symptoms may be more sensitive in detecting depression after IPV-related BI. These results may aid in the development of guidelines to better diagnose and treat depression in IPV-related BI.

Extracting Apathy From Depression Syndrome in Traumatic Brain Injury by Using a Clustering Method

OBJECTIVE

Depression and apathy are common after traumatic brain injury (TBI), and different intervention strategies are recommended for each. However, a differential diagnosis can be difficult in clinical settings, especially given that apathy is considered to be a symptom of depression. In this study, the investigators aimed to isolate apathy from depression among patients with TBI and to examine whether apathy is exclusively associated with the amount of daily activity, as previously reported in the literature.

METHODS

Eighty-eight patients with chronic TBI completed the Japanese versions of the 21-item Beck Depression Inventory-II (BDI-II) and the Starkstein Apathy Scale (AS). Daily activity was measured with a 24-hour life log. A hierarchical cluster analysis was applied to divide the BDI-II data into separable components, and components' correlations with results of the AS and 24-hour life log scale were evaluated.

RESULTS

The BDI-II and AS revealed that 37 patients (42.0%) had both depression and apathy. BDI-II data were classified into four separate clusters (somatic symptoms, loss of self-worth, affective symptoms, and apathy symptoms). Loss of self-worth and apathy symptoms subscores were significantly positively correlated with total AS score (r=0.32, p=0.002, and r=0.52, p<0.001, respectively). The apathy symptoms subscore was significantly correlated with the amount of daily activity (r=-0.29, p=0.009).

CONCLUSIONS

The findings suggest that the BDI-II can differentiate between apathy and depression among patients with TBI, which is essential when selecting intervention options. Moreover, apathy symptoms predicted patients' real-life daily activity.

Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes

Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.

Independent contributions of social cognition and depression to functional status after moderate or severe traumatic brain injury

Impairments in cognitive processing related to social understanding and communication (i.e., "social cognition") are well documented after moderate or severe traumatic brain injury (TBI) and can contribute to negative functional outcome. Depression is also a common feature of TBI with detrimental functional consequences. We evaluated relationships between social cognition, depression symptom severity, and functional status in individuals with chronic TBI (>1 year post injury; n = 25) and healthy controls (n = 30) using objective tests of social cognition as well as self-reported depression (Beck Depression Inventory-II) and functional status (Functional Behavior Profile). Results revealed significant relationships between depression and functional status across the sample, and relationships between social cognition and functional status specific to TBI. In the TBI group only, social cognition significantly predicted both overall and social functional status above and beyond depression. Group differences in functional status were independently mediated by social cognition and, especially, depression. Our findings suggest that social cognitive impairments and depression are distinct, functionally relevant TBI sequelae. Interventions to improve social functioning in this population may be most effective when contextualized within treatments for emotional disturbances.

Chronic Central Pain Among Community-Dwelling Survivors of Moderate-to-Severe Traumatic Brain Injury: A Quantitative Sensory Testing Study

Background:

Central pain associated with changes in sensory thresholds is one of the most enduring consequences of major trauma. Yet it remains sparsely studied among community-dwelling survivors of moderate-to-severe traumatic brain injury (TBI).

Purpose:

To describe and compare thermal and mechanical sensory thresholds in home-based patients with and without central pain after moderate-to-severe TBI with a cohort of healthy controls.

Design:

Cross-sectional.

Method:

Thresholds for cold/heat detection, thermal pain, touch, and distorted sensation were gathered using quantitative sensory testing (QST). QST was performed on the painful and contralateral pain-free body regions in TBI participants with pain (TBI-P) and on both forearms in TBI participants without pain (TBI-NP) and healthy controls (HC). Central pain was characterized using the Brief Pain Inventory–Short Form.

Results:

We tested 16 TBI-P patients, 17 TBI-NP patients, and 16 HC. Mean time since injury for TBI patients was 24 ± 15 months. TBI-P and TBI-NP patients showed significant loss in innocuous mechanical sensitivity compared to HC ( F = 18.929; Bonferroni-adjusted p ≤ .001). Right–left differences in cold pain sensations were significantly larger in TBI-P than in TBI-NP and HC participants ( F = 14.352; Bonferroni-adjusted p ≤ .001). Elevated heat sensitivity thresholds were also observed in TBI-P participants but remained within normal range.

Conclusion:

Damage to cutaneous mechanoreceptors is a necessary, but not sufficient, condition for the development of chronic central pain following TBI. Damage or incomplete recovery of cutaneous thermoreceptors may be a contributing factor to chronic pain after TBI.

Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases

BACKGROUND

Information on the psychometric properties of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases is currently unavailable, indicating a significant gap in the literature. Therefore, we investigated 1) which of the five evaluated measurement models had the best fit, 2) the scale's reliability, and 3) the scale's convergent validity.

METHODS

In 2018, a cross-sectional ex post facto study with non-probability convenience sampling was conducted in 446 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City; the family caregivers responded to the BDI-II and a battery of instruments measuring anxiety, caregiver burden, parental stress, well-being, and quality of life. A confirmatory factor analysis was conducted to determine the fit of the five models. Cronbach's alpha and composite reliability were calculated to assess the scale's reliability, and Spearman´s rank correlation was used to investigate the scale's convergent validity.

RESULTS

This study provided evidence that the two-factor somatic-affective and cognitive model had the best fit. The BDI-II demonstrated adequate reliability and evidence of convergent validity, as the BDI-II factors were positively correlated with anxiety, caregiver burden, and parental stress and negatively correlated with well-being and quality of life.

CONCLUSIONS

The findings reveal that the BDI-II is a valid, reliable, and culturally relevant instrument to measure depression in family caregivers of children with chronic diseases.

Neural correlates of reduced depressive symptoms following cognitive training for chronic traumatic brain injury

Depression is the most frequent comorbid psychiatric condition among individuals with traumatic brain injury (TBI). Yet, little is known about changes in the brain associated with reduced depressive symptoms following rehabilitation for TBI. We identified whether cognitive training alleviates comorbid depressive symptoms in chronic TBI (>6 months post-injury) as a secondary effect. Further, we elucidated neural correlates of alleviated depressive symptoms following cognitive training. A total of seventy-nine individuals with chronic TBI (53 depressed and 26 non-depressed individuals, measured using the Beck Depressive Inventory [BDI]), underwent either strategy- or information-based cognitive training in a small group for 8 weeks. We measured psychological functioning scores, cortical thickness, and resting-state functional connectivity (rsFC) for these individuals before training, immediately post-training, and 3 months post-training. After confirming that changes in BDI scores were independent of training group affiliation, we identified that the depressive-symptoms group showed reductions in BDI scores over time relative to the non-depressed TBI controls (p < .01). Within the depressive-symptoms group, reduced BDI scores was associated with improvements in scores for post-traumatic stress disorder, TBI symptom awareness, and functional status (p < .00625), increases in cortical thickness in four regions within the right prefrontal cortex (p_vertex  < .01, p_cluster <.05), and decreases in rsFC with each of these four prefrontal regions (p_vertex  < .01, p_cluster  < .0125). Overall, these findings suggest that cognitive training can reduce depressive symptoms in TBI even when the training does not directly target psychiatric symptoms. Importantly, cortical thickness and brain connectivity may offer promising neuroimaging markers of training-induced improvement in mental health status in TBI.

A biopsychosocial analysis of sexuality in adult males and their partners after severe traumatic brain injury

PURPOSE

The primary aim of this study was to investigate changes in sexual function in males and their partners following severe TBI. Secondary aims of the study were to explore the relationship between selected sociodemographic, emotional/behavioural and sexual function variables.

METHODS

Twenty males with a history of severe TBI and 20 healthy controls (HC) and their respective partners were recruited. Sexual life was assessed with the Sexuality Evaluation Schedule Assessment Monitoring (SESAMO). Study participant level of self-awareness was evaluated by the Awareness Questionnaire, whereas their neuropsychiatric and psychopathological statuses were assessed by the NPI, the HAM-D and STAI.

RESULTS

A reduction in desire and frequency of sexual intercourse was found in all survivors and their partners. Moreover, higher levels of survivor depression correlated with lower partner harmony. Survivor feelings toward their partners gradually decreased over time, as did the ability to make decisions as a couple. The comparison with HC couples revealed that both survivors' and their partners' exaggerated the extent of disease.

CONCLUSIONS

After male severe TBI, men appear to have a reduced quality of their sexual life, which may be more a result of relationship dysfunction than a sexual performance deficit related to their brain injury history.

Altered Amygdala Connectivity in Individuals with Chronic Traumatic Brain Injury and Comorbid Depressive Symptoms

Depression is one of the most common psychiatric conditions in individuals with chronic traumatic brain injury (TBI). Though depression has detrimental effects in TBI and network dysfunction is a "hallmark" of TBI and depression, there have not been any prior investigations of connectivity-based neuroimaging biomarkers for comorbid depression in TBI. We utilized resting-state functional magnetic resonance imaging to identify altered amygdala connectivity in individuals with chronic TBI (8 years post-injury on average) exhibiting comorbid depressive symptoms (N = 31), relative to chronic TBI individuals having minimal depressive symptoms (N = 23). Connectivity analysis of these participant sub-groups revealed that the TBI-plus-depressive symptoms group showed relative increases in amygdala connectivity primarily in the regions that are part of the salience, somatomotor, dorsal attention, and visual networks (p voxel < 0.01, p cluster < 0.025). Relative increases in amygdala connectivity in the TBI-plus-depressive symptoms group were also observed within areas of the limbic-cortical mood-regulating circuit (the left dorsomedial and right dorsolateral prefrontal cortices and thalamus) and the brainstem. Further analysis revealed that spatially dissociable patterns of correlation between amygdala connectivity and symptom severity according to subtypes (Cognitive and Affective) of depressive symptoms (p voxel < 0.01, p cluster < 0.025). Taken together, these results suggest that amygdala connectivity may be a potentially effective neuroimaging biomarker for comorbid depressive symptoms in chronic TBI.

Anxiety sensitivity and alexithymia as mediators of postconcussion syndrome following mild traumatic brain injury

OBJECTIVE

To examine the influence of anxiety sensitivity (AS) and alexithymia as potential mediators for the development of psychological distress and postconcussion syndrome after mild traumatic brain injury (mTBI).

PARTICIPANTS

Sixty-one patients with mTBI assessed at a mean of 2.38 weeks after injury and demographically matched healthy controls (n = 61).

MEASURES

Twenty-item Toronto Alexithymia Scale, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Rivermead Post Concussion Questionnaire.

RESULTS

The mTBI group reported significantly higher levels of AS, alexithymia, psychological distress, and postconcussion (PC) symptom scores than controls. High AS and alexithymia in the mTBI group were associated with a greater number of PC symptoms and higher levels of psychological distress than patients scoring low on these measures and controls. In the mTBI group, a combination of AS and low mood explained 52.6% of the variance in PC symptom reporting. A combination of trait-anxiety, alexithymia, and PC symptoms explained 77.2% of the variance in levels of mood.

CONCLUSION

A combination of low mood and high AS may act as a psychological diathesis for the development of persisting PC symptoms. Early identification could provide a focus for early intervention to prevent the development of postconcussion syndrome after mTBI.

Meta-Analysis of the Factor Structures of the Beck Depression Inventory-II

Two meta-analyses examined the factor structure of the Beck Depression Inventory-II (BDI-II). Study 1, which meta-analyzed 51 studies comprising 62 samples (N = 20,475) providing pattern matrices, determined that the two-factor solution comprising Cognitive and Somatic-Affective factors was supported for the full sample. The two-factor solution was also supported for subgroups of studies. As the factor structure varied somewhat between subgroups of studies, the strength of relationships between scale items and their underlying depressive symptoms varied. Hence, comparisons of mean BDI-II scores across subgroups can be misleading. Study 2 meta-analyzed 13 studies consisting of 16 samples (N = 5,128) providing covariance matrices among the 21 BDI-II items. The two-factor solution was again supported in Study 2. Nevertheless, the existence of a general depression factor was supported by the good fit of the one-factor model.

Actigraphic assessment of sleep disturbances following traumatic brain injury

The current study examined the use of actigraphy in measurement of sleep following traumatic brain injury (TBI). Twenty-one patients with TBI and self-reported sleep and/or fatigue problems and 21 non-injured controls were studied over seven days using actigraphy and sleep diary reports. Although strong associations between diary and actigraphic assessment of sleep duration were observed in both participant groups, agreement between these methods appeared to weaken in patients with TBI. Associations between sleep diary and actigraphic assessments of sleep disturbance, i.e., wake after sleep onset (WASO) and sleep onset latency (SOL) were not apparent in either group, although weaker agreement between methods for WASO was again observed in patients with TBI. Actigraphy may prove useful to supplement self-report measures of sleep following TBI. More work is required to understand the accuracy of these measures in this population.

Statistical Issues in TBI Clinical Studies

The identification and longitudinal assessment of traumatic brain injury presents several challenges. Because these injuries can have subtle effects, efforts to find quantitative physiological measures that can be used to characterize traumatic brain injury are receiving increased attention. The results of this research must be considered with care. Six reasons for cautious assessment are outlined in this paper. None of the issues raised here are new. They are standard elements in the technical literature that describes the mathematical analysis of clinical data. The purpose of this paper is to draw attention to these issues because they need to be considered when clinicians evaluate the usefulness of this research. In some instances these points are demonstrated by simulation studies of diagnostic processes. We take as an additional objective the explicit presentation of the mathematical methods used to reach these conclusions. This material is in the appendices. The following points are made: (1) A statistically significant separation of a clinical population from a control population does not ensure a successful diagnostic procedure. (2) Adding more variables to a diagnostic discrimination can, in some instances, actually reduce classification accuracy. (3) A high sensitivity and specificity in a TBI versus control population classification does not ensure diagnostic successes when the method is applied in a more general neuropsychiatric population. (4) Evaluation of treatment effectiveness must recognize that high variability is a pronounced characteristic of an injured central nervous system and that results can be confounded by either disease progression or spontaneous recovery. A large pre-treatment versus post-treatment effect size does not, of itself, establish a successful treatment. (5) A procedure for discriminating between treatment responders and non-responders requires, minimally, a two phase investigation. This procedure must include a mechanism to discriminate between treatment responders, placebo responders, and spontaneous recovery. (6) A search for prodromes of neuropsychiatric disorders following traumatic brain injury can be implemented with these procedures.

Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders

Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant's clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.

Sustained attention following traumatic brain injury: use of the Psychomotor Vigilance Task

OBJECTIVE

Deficits in sustained attention are common following traumatic brain injury (TBI), as a result of primary (i.e., neuropathology) and/or secondary factors (i.e., fatigue, sleep disturbance, depressed mood). The extent to which secondary factors play a role in attention deficits is relatively unexamined. Moreover, the Psychomotor Vigilance Task (PVT) is seldom used in TBI assessment despite its sensitivity to secondary factors observed following injury. The primary aim of the current study was to examine the usefulness of the auditory PVT in identifying attentional difficulties in patients with TBI compared with noninjured controls, and also to explore the impact of fatigue, sleep quality, and daytime sleepiness on sustained attention performances.

METHOD

Participants (n = 20 per group) completed the auditory PVT and self-report measures of fatigue, sleep quality, daytime sleepiness, and depression.

RESULTS

Compared to controls, patients with TBI had widespread PVT deficits including slower response times, increased response variability and attention lapses, and delayed responding in the slowest 10% of responses. Distribution analyses suggested this was likely due to generalized cognitive slowing. Self-reported secondary factors had varying impacts on aspects of PVT performance, with self-reported fatigue exhibiting a more global impact on attention performance.

CONCLUSIONS

The auditory PVT is a sensitive measure of sustained attention deficits in patients with TBI, with aspects of performance influenced by fatigue, sleep disturbance, and depression.

[Depression and risk factors in patients with Crohn's disease]

PURPOSE

This study was conducted to determine the risk factors among patients with depression with Crohn's disease.

METHODS

Data were collected by questionnaire from 276 patients who were diagnosed with Crohn's disease at a tertiary hospital located in Seoul. Measurements included patients' demographic characteristics, clinical characteristics, depression level, and health-related quality of life. Data were analyzed using t-test, χ²-test, Wilcoxon rank sum test, and logistic regression analyses.

RESULTS

The incidence rate of depression (BDI-II ≥ 14 scores) was 31.9% (n=88). Univariate analysis revealed that being a woman, school graduation status, economic status (low), BMI(<18.5 Kg/m²), disease duration (≥ 3 years), CDAI (≥ 150 scores), frequency of hospital admission (≥ 2), extra-intestinal manifestation (arthralgia, stomatitis), administration of 5-aminosalicylic acid, and disease related quality of life (SIBDQ<50 scores) were associated with depression. Multivariate analysis revealed that economic status (low), school graduation status, and quality of life (SIBDQ<50 scores) were more likely to report high level of depression.

CONCLUSION

Future research should consider managing depression as an essential component of comprehensive care for patients with Crohn's disease. In addition, further research is needed to develop strategies to better improve quality of life among patients with Crohn's disease who are depressed.

Association of depressive symptoms with functional outcome after traumatic brain injury

OBJECTIVE

To test whether improved functional status correlates with more depressive symptoms after traumatic brain injury (TBI). This is based on the concept that increasing awareness of deficits may exacerbate depression, even while survivors are making functional improvements.

PARTICIPANTS

A total of 471 individuals with TBI (72% white; 71% men; median Glasgow Coma Scale (GCS) score = 11) enrolled during acute care or inpatient rehabilitation and followed up at a median of 6 months.

MAIN MEASURE

Beck Depression Inventory-II (BDI-II), Glasgow Outcome Scale-Extended, and Functional Status Examination (FSE).

RESULTS

We found significant Spearman rank order correlations between BDI-II scores and the total FSE as well as all domains of the FSE. Lower functional levels correlated with more depressive symptoms. Modeling of predictive factors, including subject characteristics, injury-related characteristics, and outcome measures, resulted in 2 models, both containing age and GCS along with other factors.

CONCLUSION

The relation between depressive symptoms and functional outcomes is complex and a fertile area for further research. The authors would encourage clinicians to monitor patients for depressive symptoms to help to prevent the detrimental impact on recovery.

Brain morphometry changes and depressive symptoms after traumatic brain injury

Traumatic brain injury (TBI) is associated with an increased risk of depressive symptoms. Recent imaging studies on spontaneous depression have implicated several brain structures; however, few studies have done the same for post-TBI depression. We report on a pilot observational study correlating atrophy of brain regions of interest in subjects after TBI with depressive symptoms measured by the Beck Depression Inventory-II. Regional brain volumes were calculated on both acute and 6-month MRI using an automated segmentation algorithm (FreeSurfer). Percent volume changes in brain regions were correlated with BDI-II scores using Spearman's rank order correlation coefficient. Correction for multiple comparisons was performed using the false discovery rate (FDR). Three regions of interest (left rostral anterior cingulate and bilateral orbitofrontal cortex) were found to be significantly correlated with depressive symptoms (FDR 0.05). With FDR 0.1, six regions were significantly correlated. The use of volumetric analysis of brain regions of interest to study post-TBI depression is worthy of further study. Regions associated with depressive symptoms in this pilot study were similar to those implicated in study of spontaneous depression.

Measuring depression and PTSD after trauma: common scales and checklists

Traumatic injury is an important public health problem secondary to high levels of morbidity and mortality. Injured survivors face several physical, emotional, and financial repercussions that can significantly impact their lives as well as their family. Depression and posttraumatic stress disorder (PTSD) are the most common psychiatric sequelae associated with traumatic injury. Factors affecting the prevalence of these psychiatric symptoms include: concomitant TBI, the timing of assessment of depression and PTSD, the type of injury, premorbid, sociodemographic, and cultural factors, and co-morbid medical conditions and medication side effects. The appropriate assessment of depression and PTSD is critical to an understanding of the potential consequences of these disorders as well as the development of appropriate behavioural and pharmacological treatments. The reliability and validity of screening instruments and structured clinical interviews used to assess depression and PTSD must be considered. Common self-report instruments and structured clinical interviews used to assess depression and PTSD and their reliability and validity are described. Future changes in diagnostic criteria for depression and PTSD and recent initiatives by the National Institute of Health regarding patient-reported outcomes may result in new methods of assessing these psychiatric sequelae of traumatic injury.

The relationship between insomnia and depressive symptoms: genuine or artifact?

BACKGROUND

Somatic symptom overlap between depression and insomnia has emerged as a major concern. Self-report measures such as the Beck Depression Inventory Second Edition (BDI-II) include somatic symptoms related to depression that are also present in the research diagnostic criteria for insomnia. This study aimed firstly to examine the relationship between the cognitive and somatic factors of the BDI-II and global scores on the Pittsburgh Sleep Quality Index (PSQI) in individuals presenting for insomnia treatment and secondly to examine whether treating insomnia in depressed individuals with insomnia will lead to a reduction in their depressive symptoms and whether this reduction is related to a decrease in the somatic or cognitive factors of depressive symptoms.

METHODS

A total of 379 individuals (133 males and 246 females), with a mean (M) age of 49.95 (standard deviation [SD] = 14.15) years, were used to address the first aim. To address the second aim, a total of 64 participants (27 males and 37 females) with both insomnia and depressive symptoms were treated for their insomnia. Their ages ranged between 22 and 87 (M = 50.97, SD = 15.13) years.

RESULTS

A significant relationship was found between both the cognitive and somatic factors of the BDI-II and global scores on the PSQI. Furthermore, although results in this study are only suggestive, they lend support to the idea that the relationship between insomnia and depression is not due to somatic symptom overlap. Results may also support the hypothesis that insomnia is primary to the presentation of depressive symptoms.

CONCLUSION

Clinicians and health care providers could initially treat insomnia in individuals suffering from insomnia who also experience depressive symptoms, as this will not only remit insomnia but also abate the accompanying depressive symptoms.

A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population

The findings from the present study reveal that the Beck Depression Inventory (BDI) is a reliable and valid instrument for measuring depression in a variety of populations. This realization should enable nurses and other health professionals to utilize the tool with added confidence and assurance. * The main finding was that the BDI would probably be a reliable and valid screening tool in an alcohol-dependent population. This conclusion appears to echo the relationship that alcohol consumption generally has with depression. This finding is important to those practitioners using the BDI in this population in that it provides further evidence to enhance their practical experience. Abstract A psychometric evaluation of the Beck Depression Inventory (BDI) was carried out on contemporary studies to ascertain its suitability for use in an alcohol-dependent population. Three criteria were used for this: factor analysis, test-retest reliability and internal consistency reliability. Factor analysis revealed that its structure is consistent with either two or three factor models, depending on the population. Test-retest results concluded that the correlation coefficient remained above the recommended threshold and internal consistency reliability highlighted alpha coefficient results consistently above suggested scores, leading to the conclusion that the BDI is probably an effective screening tool in an alcohol-dependent population.

Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury

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.

Assessing depression symptoms in those with insomnia: an examination of the beck depression inventory second edition (BDI-II)

BACKGROUND

Due to concerns about overlapping symptomatology between medical conditions and depression, the validity of the beck depression inventory (BDI-II) has been assessed in various medical populations. Although major depressive disorder (MDD) and primary insomnia (PI) share some daytime symptoms, the BDI-II has not been evaluated for use with insomnia patients.

METHOD

Participants (N=140) were screened for the presence of insomnia using the Duke structured clinical interview for sleep disorders (DSISD), and evaluated for diagnosis of MDD using the structured clinical interview for DSM-IV-TR (SCID). Participants' mean BDI-II item responses were compared across two groups [insomnia with or without MDD) using multivariate analysis of variance (MANOVA), and the accuracy rates of suggested clinical cutoffs for the BDI-II were evaluated using a receiver operating characteristic (ROC) curve analysis.

RESULTS

The insomnia with depression group had significantly higher scores on several items; however, the groups did not differ on insomnia, fatigue, concentration problems, irritability, libido, increased appetite, and thoughts relating to suicide, self-criticism and punishment items. The ROC curve analysis revealed moderate accuracy for the BDI-II's identification of depression in those with insomnia. The suggested BDI cutoff of >or=17 had 81% sensitivity and 79% specificity. Use of the mild cutoff for depression (>or=14) had high sensitivity (91%) but poor specificity (66%).

CONCLUSION

Several items on the BDI-II might reflect sleep disturbance symptoms rather than depression per se. The recommended BDI-II cutoffs in this population have some support but a lower cutoff could result in an overclassification of depression in insomnia patients, a documented problem in the clinical literature. Understanding which items discriminate insomnia patients without depression may help address this nosological issue.

An examination of the factor structure of the Beck Depression Inventory-II in a neurorehabilitation inpatient sample

The Beck Depression Inventory-II (BDI-II) is widely used for assessing depression in neurorehabilitation. Given the concern that the somatic items might be misleading, we examined its factor structure in 353 inpatients. Exploratory factor analysis was undertaken to compare two- to five-factor solutions. Confirmatory factor analysis was then used to test the best exploratory solutions for goodness of fit on a subsample. Both provided strong support for a general depression factor and two specific factors, one somatic and one cognitive/affective. The BDI-II provides a meaningful score of overall depression, and it can also yield two subscores-one measuring somatic symptoms and the other measuring psychological symptoms of depression. To avoid confusing the common symptoms of neurological disability with depression in neurorehabilitation, clinicians need to consider all three scores carefully. (JINS, 2009, 15, 142-147.).

Inability to empathize following traumatic brain injury

This study examines: (a) the impact of traumatic brain injury (TBI) on emotional empathy, (b) the relationship between emotional empathy and neuropsychological ability, and (c) the influence of low emotional empathy on measures of affect. Eighty-nine patients completed the Balanced Emotional Empathy Scale (BEES), a number of neuropsychological tests, some of which were ecologically valid tests of executive ability, plus two measures of affect, the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The TBI cohort showed a high frequency (60.7%) of low emotional empathy scores compared to the control group (31%). There was no relationship between injury severity and the ability to empathize, or between emotional empathy and neuropsychological performance. There was no evidence to suggest that low scores on affective measures influenced emotional empathy scores. A high proportion of TBI patients lack the ability to empathize, but the deficit does not appear related to any specific cognitive impairment and cannot be predicted by measures of affect.

Psychometric properties of the Beck Depression Inventory--second edition (BDI-II) in individuals with chronic pain

Given the high prevalence of depression in individuals with chronic pain and the negative outcomes associated with such comorbidity, the importance of assessing depressive symptoms is widely acknowledged by chronic pain specialists. The BDI-II is a commonly employed measure of depressive symptomatology at pain centres; however, little is known about its psychometric properties in this population. This study evaluated factorial validity, internal consistency, and gender invariance of the BDI-II in 481 patients with chronic pain. Four competing models of the BDI-II factor structure were examined and confirmatory factor analysis supported the conceptualization of depression as a singular latent construct, within a hierarchical factor structure consisting of three first-order factors--Negative Attitude, Performance Difficulty, and Somatic Elements. Factor structure, item-total correlations, and correlations between subscale means and subjective pain experience support the inclusion of somatic items despite concerns regarding their overlap with pain symptoms. Internal consistency was good. Mean total scores were in the moderately severe range. Given the evidence of partial measurement invariance, an examination of mean gender differences was warranted. In contrast to the general population, the average scores of women and men were similar. Overall, results support the construct validity and internal consistency of the BDI-II for assessing depressive symptoms in both women and men with chronic pain. Results support the appropriateness of computing a total score and/or subscale scores. These results impact chronic pain researchers and clinicians, particularly given current trends toward empirically supported assessment.

Depression in schizophrenia: methodological artifact or distinct feature of the illness?

In schizophrenia, there is a conceptual overlap between depressive and negative symptoms. This study examined the dimensional structure of depressive symptoms and their overlap with negative symptoms in a large sample of older medicated schizophrenia outpatients. Self-reported depression was obtained with the Beck Depression Inventory-II (BDI-II). Three components from this scale (i.e., dysphoria, psychosomatic and regret domains) showed excellent factorability and good consistency. However, adequate construct validity and correlates with outcomes were found for the dysphoria and regret domains, but not for the total score or the psychosomatic domain. Thus, the evaluation of domains within the BDI-II provides a more pure and clinically-relevant assessment of depressed mood in schizophrenia than the use of this scale as a whole.

Self-assessment of impairment, impaired self-awareness, and depression after traumatic brain injury

OBJECTIVE

To identify patient features associated with early and late depression after traumatic brain injury (TBI).

PARTICIPANTS

3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others.

MEASURES

Preinjury: age, education, substance abuse, and psychiatric history; Injury severity: classification using Glasgow Coma Scale and cranial CT scan, posttraumatic amnesia; Early impairment: Neurobehavioral Functioning Inventory (NFI), Impaired Self-Awareness (ISA); Social and family support: Multidimensional Scale of Perceived Social Support, Family Assessment Device; Depression: NFI Depression Scale.

METHOD

Regression analyses of predictor variables on early and late measures of depression.

RESULTS

Depression rates did not differ among the 3 trauma groups. Preinjury level of education, previous psychiatric history, and perceived level of social support explained a small portion of the variance in depressive symptoms. Patients' self-assessment of their impairment at discharge was most strongly correlated with both early and late depression. ISA was associated with reduced self-report of depressive symptoms. However, when those with ISA were excluded from the analysis, self-assessment of impairment remained strongly associated with depression.

CONCLUSIONS

Patients' self-assessment of impairment is strongly associated with early and late depression. Presence and severity of TBI does not appear to play a direct role in depression but does appear related to ISA, which serves as a barrier to the development of depression. Focusing on impairment appears to be a cardinal feature of depression in both patients with TBI and an orthopedic trauma group.

Depression in neurological disorders: an update

PURPOSE OF REVIEW

Depressions are a heterogeneous group of conditions that contribute significantly to impairments in quality of life, independent of the severity of neurological illness. Depression may predate neurological signs and symptoms in the evolution of neurodegenerative disorders, and there is some evidence that depressive illness itself may be a risk factor in the aetiology of some dementias. This review aims to summarize the relevant current literature on diagnosis, aetiology and treatment of depression in neurology.

RECENT FINDINGS

Diagnosing depression in neurological conditions can be particularly difficult because of communication difficulties and changes in emotional expression as a result of the underlying neurological disease. Rating scales loaded towards somatic symptoms can show poor validity for screening or rating of severity in this setting. The evidence for the treatment of depression in neurological disease is scant, and often the treatment advice is based on consensus views of clinicians. Nevertheless, there have been some clinical trials, which are reported.

SUMMARY

Depression is common in neurology. It is underrecognized and undertreated. Recent research has allowed us to define depression more clearly in this setting. Trials of treatment are urgently needed, especially as depression is a significant factor in quality of life and may affect prognosis.

Psychiatric disturbances after traumatic brain injury: neurobehavioral and personality changes

Traumatic brain injuries (TBI) are frequently accompanied by psychiatric disturbances, which can include striking to relatively minor alterations in personality, behavior, and emotional regulation. The persistence of these neurobehavioral syndromes often leads to deleterious effects on recovery and rehabilitation outcomes. A recent surge of studies has emerged in the past several years to quantify the extent of psychiatric disorders in TBI and to describe differential clinical presentations. Various pre- and post-injury factors also have been hypothesized to contribute to the development and maintenance of psychiatric symptoms in survivors of brain injuries. The identification of high-risk individuals with distinct neuropathophysiological and psychosocial features permits the development of multidisciplinary and tailored approaches to the assessment, prevention, and management of the negative effects of personality and behavioral changes in TBI. This article summarizes the most recent research in these areas and highlights the gaps that need to be filled in subsequent future.