Article

OBJECTIVES: To evaluate the impact of covariates on performance accuracy of the
Beck Depression Inventory II (BDI-II) and to determine the optimal cut-off score
for the BDI-II in cardiac outpatients. Differences of optimal cut-off scores were
also verified across covariate subgroups. DESIGN AND SETTING: Prospective
cross-sectional study at the Department of Nuclear Medicine of the Montreal Heart
Institute (Quebec, Canada). METHODS: A total of 750 adult cardiac outpatients
(mean +/- SD age 58 +/- 10 years, 31% women) completed the BDI-II and the Primary
Care Evaluation of Mental Disorders (PRIME-MD; a psychiatric interview used as
the reference standard for determining diagnosis of major depressive disorder).
The receiver operating characteristics (ROC) curve of the BDI-II was adjusted for
age, sex, level of education, smoking status, obesity, anxiety disorder,
psychotropic medication, and history of coronary artery disease. The ROC analyses
were conducted to determine optimal cut-off scores. RESULTS: Forty-two (6%)
patients met criteria for current major depressive disorder according to the
PRIME-MD. After adjusted for covariates, the area under the ROC curve was
significantly smaller than the unadjusted curve (0.76, 95% CI 0.66 to 0.85 vs.
0.84, 95% CI 0.77 to 0.89; DeltaAUC = -0.07, 95% CI -0.13 to -0.02). While the
optimal cut-off score was 10 for the total sample (sensitivity 83%, specificity
73%), the analyses indicated different cut-off scores across covariate subgroups:
e.g. sex (women 13; men 10), and anxiety disorders (yes 15; no 10). CONCLUSIONS:
BDI-II is a good screening instrument for depression in cardiac outpatients.
However, the present results suggest that covariates can affect the
classification accuracy of the BDI-II's original recommended cut-off score.
Scholars and clinicians should be aware of the principle that a screening score
established in one population may not be relevant to another.
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Langue : ANGLAIS