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

Psychometric properties of the Beck Depression Inventory-II: a comprehensive review

OBJECTIVE:\ud To review the psychometric properties of the Beck Depression Inventory-II (BDI-II) as a self-report measure of depression in a variety of settings and populations.\ud \ud METHODS:\ud Relevant studies of the BDI-II were retrieved through a search of electronic databases, a hand search, and contact with authors. Retained studies (k = 118) were allocated into three groups: non-clinical, psychiatric/institutionalized, and medical samples.\ud \ud RESULTS:\ud The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high and substantial overlap with measures of depression and anxiety was reported. The criterion-based validity showed good sensitivity and specificity for detecting depression in comparison to the adopted gold standard. However, the cutoff score to screen for depression varied according to the type of sample. Factor analysis showed a robust dimension of general depression composed by two constructs: cognitive-affective and somatic-vegetative.\ud \ud CONCLUSIONS:\ud The BDI-II is a relevant psychometric instrument, showing high reliability, capacity to discriminate between depressed and non-depressed subjects, and improved concurrent, content, and structural validity. Based on available psychometric evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity of depression, with broad applicability for research and clinical practice worldwide.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), 2008/11415-9Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

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 decisionsFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) - 2008/11415-9Conselho Nacional de Pesquisa (CNPq

Esposas de jogadores patológicos: traços de personalidade, sintomas depressivos e ajustamento social

Objective: Wives of pathological gamblers tend to endure long marriages despite financial and emotional burden. Difficulties in social adjustment, personality psychopathology, and comorbidity with psychiatric disorders are pointed as reasons for remaining on such overwhelming relationships. The goal was to examine the social adjustment, personality and negative emotionality of wives of pathological gamblers. Method: The sample consisted of 25 wives of pathological gamblers, mean age 40.6, SD = 9.1 from a Gambling Outpatient Unit and at GAM-ANON, and 25 wives of non-gamblers, mean age 40.8, SD = 9.1, who answered advertisements placed at the Universidade de São Paulo hospital and medical school complex. They were selected in order to approximately match demographic characteristics of the wives of pathological gamblers. Subjects were assessed by the Social Adjustment Scale, Temperament and Character Inventory, Beck Depression Inventory and State-Trait Anxiety Inventory. Results: Three variables remained in the final Multiple Logistic Regression model, wives of pathological gamblers presented greater dissatisfaction with their marital bond, and higher scores on Reward Dependence and Persistence temperament factors. Both, Wives of pathological gamblers and wives of non-gamblers presented well-structured character factors excluding personality disorders. Conclusion: This personality profile may explain wives of pathological gamblers emotional resilience and their marriage longevity. Co-dependence and other labels previously used to describe them may work as a double edged sword, legitimating wives of pathological gamblers problems, while stigmatizing them as inapt and needy.Objetivo: Esposas de jogadores patológicos tendem a permanecer casadas por muitos anos, apesar das dificuldades financeiras e emocionais. Dificuldades de ajustamento social, transtornos de personalidade, e comorbidades com transtornos psiquiátricos são apontados como razões para permanecerem nesses relacionamentos tão opressivos. O objetivo foi examinar o ajustamento social, a personalidade e as emoções negativas das esposas de jogadores patológicos. Método: A amostra foi constituída por 25 esposas de jogadores patológicos, média de idade 40,6 anos (DP = 9,1), do Ambulatório de Jogadores Patológicos e do Jog-Anon, e 25 esposas de não jogadores, média de idade 40,8 anos (DP = 9,1), que responderam a anúncios colocados no complexo do hospital da faculdade de medicina da Universidade de São Paulo. Foram selecionadas aquelas que apresentavam características demográficas próximas às das esposas de jogadores patológicos. Os sujeitos foram avaliados por meio da Escala de Ajustamento Social, do Inventário de Temperamento e Caráter, do Inventário de Depressão de Beck, e do Inventário de Ansiedade Traço-Estado. Resultados: Três variáveis permaneceram no modelo final da Análise de Regressão Logística Múltipla. Esposas de jogadores patológicos apresentaram maior insatisfação no relacionamento marital e escores mais altos nos fatores de temperamento Dependência de Gratificação e Persistência. Ambas, as esposas de jogadores patológicos e de não jogadores apresentaram fatores de caráter bem estruturados, excluindo transtornos de personalidade. Conclusão: Este perfil de personalidade pode explicar a resiliência emocional das esposas de jogadores patológicos e a longa duração de seus casamentos. Codependência e outros rótulos utilizados anteriormente para descrevê-las podem, de um lado, legitimar seus problemas e, de outro, estigmatizá-las como inaptas e carentes

Validade de um procedimento para indução de frustração

OBJECTIVE: To test a reliable and easily administered frustration-induction procedure for experimental research. METHOD: One hundred volunteers (81 women, mean age ± SD 34.2 ± 8 years) physically and psychiatrically healthy submitted to the frustration induction procedure were prevented from reaching reward level scores. Subjective aggressiveness feelings related to frustration were self-rated in a 13-item visual analogue scale before and after the procedure. RESULTS: Significant increases in aggressiveness-related feelings were detected in 12 of the 13 items. This was consistent with the observed overt behavior of the subjects during the task. CONCLUSIONS: The frustration-induction procedure is a simple, easy to administer frustration-induction procedure that can be used in experimental studies in normal subjects.OBJETIVO: Testar um procedimento de indução de frustração confiável e de simples aplicação para a pesquisa experimental. MÉTODO: Cem voluntários (81 mulheres, idade média ± DP 34,2 ± 8 anos), física e psiquiatricamente saudáveis, submetidos ao procedimento de indução de frustração, foram impedidos de atingir escores de recompensa. Os sentimentos de agressividade subjetivos relacionados à frustração foram autoclassificados em um escala analógica visual de 13 itens antes e após o procedimento. RESULTADOS: Foram detectados aumentos significativos nos sentimentos relacionados à agressividade em 12 dos 13 itens. Isto foi consistente com o comportamento manifestado pelos indivíduos e observado durante a tarefa. CONCLUSÕES: O procedimento de indução de frustração é simples, facilmente aplicável e que pode ser utilizado em estudos experimentais com indivíduos normais.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Resposta cardíaca e nível de ansiedade em homicidas psicopatas

OBJECTIVE: To compare the emotional response and level of anxiety of psychopathic murderers, non-psychopathic murderers, and nonpsychopathic non-criminals. METHOD: 110 male individuals aged over 18 years were divided into three groups: psychopathic murderers (n = 38); non-psychopathic murderers (n = 37) serving sentences for murder convictions in Maximum Security Prisons in the State of Sao Paulo; and non-criminal, non-psychopathic individuals (n = 35) according to the Psychopathy Checklist-Revised. The emotional response of subjects was assessed by heart rate variation and anxiety level (State-Trait Anxiety Inventory) after viewing standardized pictures depicting pleasant, unpleasant and neutral content from the International Affective Picture System. RESULTS: Psychopathic murderers presented lower anxiety levels and smaller heart rate variations when exposed to pleasant and unpleasant stimuli than nonpsychopathic murderers or non-psychopathic non-criminals. The results also demonstrated that the higher the score for factor 1 on the Psychopathy Checklist-Revised, the lower the heart rate variation and anxiety level. CONCLUSION: The results suggest that psychopathic murderers do not present variation in emotional response to different visual stimuli. Although the non-psychopathic murderers had committed the same type of crime as the psychopathic murderers, the former tended to respond with a higher level of anxiety and heart rate variation.OBJETIVO: Comparar a atividade cardíaca e nível de ansiedade de homicidas psicopatas e não psicopatas e não criminosos não psicopatas. MÉTODO: 110 homens com idade superior a 18 anos, divididos em três grupos: homicidas psicopatas (n = 38), homicidas não psicopatas (n = 37) cumprindo pena por homicídio em Prisões de Segurança Máxima do Estado de São Paulo e não criminosos e não psicopatas (n = 35) de acordo com a Escala de Avaliação de Psicopatia. A resposta emocional foi avaliada pela variação da freqüência cardíaca e níveis de ansiedade após a observação por seis segundos de imagens padronizadas de diferentes conteúdos emocionais (agradáveis, desagradáveis e neutras) do International Affective Picture System. RESULTADOS: Homicidas psicopatas apresentaram menores níveis de ansiedade e menor variação de frequência cardíaca quando expostos a estímulos agradáveis que os homicidas não psicopatas e o grupo de não criminosos e não psicopatas. Os resultados demonstram ainda que quanto maior o escore no fator 1 da Escala de Avaliação de Psicopatia, menor é a variação cardíaca e o nível de ansiedade. CONCLUSÃO: Os resultados sugerem que homicidas psicopatas não apresentam variação da resposta emocional frente aos diferentes estímulos visuais. Embora os homicidas não psicopatas compartilhem do mesmo tipo crime que os psicopatas, estes tendem a responder com maior nível de ansiedade e variação cardíaca

Learning and memory and its relationship with the lateralization of epileptic focus in subjects with temporal lobe epilepsy

Background : In medial temporal lobe epilepsy (MTLE), previous studies addressing the hemispheric laterality of epileptogenic focus and its relationship with learning and memory processes have reported controversial findings. Objective : To compare the performance of MTLE patients according to the location of the epileptogenic focus on the left (MTLEL) or right temporal lobe (MTLER) on tasks of episodic learning and memory for verbal and visual content. Methods : One hundred patients with MTLEL and one hundred patients with MTLER were tested with the following tasks: the Rey Auditory Verbal Learning Test (RAVLT) and the Logical Memory-WMS-R to evaluate verbal learning and memory; and the Rey Visual Design Learning Test (RVDLT) and the Visual Reproduction-WMS-R to evaluate visual learning and memory. Results : The MTLEL sample showed significantly worse performance on the RAVLT (p < 0.005) and on the Logical Memory tests (p < 0.01) than MTLER subjects. However, there were no significant between-group differences in regard to the visual memory tests. Discussion : Our findings suggest that verbal learning and memory abilities are dependent on the structural and functional integrity of the left temporal lobe, while visual abilities are less dependent on the right temporal lobe.Contexto : Estudos anteriores abordando a lateralidade hemisférica de foco epiléptico na epilepsia do lobo temporal mesial (ELTM) e sua relação com os processos de aprendizagem e memória têm relatado resultados controversos. Objetivo : Comparar o desempenho de pacientes com ELTM de acordo com a localização do foco epiléptico à esquerda (ELTME) ou à direita (ELTMD) em tarefas de aprendizagem e memória episódica para conteúdo verbal e visual. Métodos: Cem pacientes com ELTME e cem pacientes com ELTMD foram avaliados com os seguintes testes: Teste de Aprendizagem Auditiva Verbal de Rey (RAVLT) e Memória Lógica – WMS-R para avaliar aprendizagem e memória verbal e o Teste de Aprendizagem Visual para Desenhos de Rey (RVDLT) e Reprodução Visual – WMS-R para avaliar a aprendizagem e memória visual. Resultados : A amostra com ELTME mostrou desempenho significativamente pior no RAVLT (p < 0,005) e na Memória Lógica (p < 0,01) em comparação aos indivíduos ELTMD. No entanto, não houve diferenças significativas entre os grupos no que diz respeito aos testes de aprendizagem e memória visual. Conclusão : Nossos resultados sugerem que a aprendizagem e a memória verbais são dependentes da integridade estrutural e funcional do lobo temporal esquerdo, enquanto as capacidades de aprendizagem e memória visual são menos dependentes do lobo temporal direito