Psychometric validation of the BDI-II among HIV-positive CHARTER study participants

Abstract

Rates of depression are high among individuals living with HIV. Accurate assessment of depressive symptoms among this population is important for ensuring proper diagnosis and treatment. The Beck Depression Inventory-II (BDI-II) is a widely used measure for assessing depression, however its psychometric properties have not yet been investigated for use with HIV-positive populations in the United States. The current study was the first to assess the psychometric properties of the BDI-II among a large cohort of HIV-positive participants sampled at multiple sites across the United States as part of the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. The BDI-II test scores showed good internal consistency (α = .93) and adequate test-retest reliability (internal consistency coefficient = 0.83) over a 6-mo period. Using a "gold standard" of major depressive disorder determined by the Composite International Diagnostic Interview, sensitivity and specificity were maximized at a total cut-off score of 17 and a receiver operating characteristic analysis confirmed that the BDI-II is an adequate diagnostic measure for the sample (area under the curve = 0.83). The sensitivity and specificity of each score are provided graphically. Confirmatory factor analyses confirmed the best fit for a three-factor model over one-factor and two-factor models and models with a higher-order factor included. The results suggest that the BDI-II is an adequate measure for assessing depressive symptoms among U.S. HIV-positive patients. Cut-off scores should be adjusted to enhance sensitivity or specificity as needed and the measure can be differentiated into cognitive, affective, and somatic depressive symptoms.

Figure 1

Two-Factor Model derived from Beck et al., 1996 with a higher-order factor.

Figure 2

Three-Factor Model derived from Buckley et al., 2001 with a higher-order factor.

Figure 3

Sensitivity and Specificity of the BDI-II. Sensitivity is the proportion of participants diagnosed with MDD that are correctly identified by the BDI-II cut-off score. Specificity is the proportion of participants not diagnosed with MDD that are correctly identified by the BDI-II cut-off score. Correctly diagnosed/ not diagnosed was determined by Composite International Diagnostic Interview.

Figure 4

Positive and negative predictive value of the BDI-II. Positive predictive value (PPV) is the probability that a participant has MDD given that they are above the designated BDI-II cut off score. Negative predictive value (NPV) is the probability that a participant does not have MDD given that they are below the designated BDI-II cut off score. Correctly diagnosed/ not diagnosed was determined by Composite International Diagnostic Interview.