title: The Beck Depression Inventory requires modification in scoring before use in a haemodialysis population in the UK.
abstract: BACKGROUND
  There are high rates of mental illness, especially depression in people with end-stage renal disease (ESRD) on haemodialysis (HD). Depression can be difficult to diagnose, as depression and the medical problem share many symptoms. It is essential that the diagnosis of a depressive illness be accurately made in order that subsequent psychiatric management can occur. This is the first study done in the UK which aims to validate a simple method for detecting depression, the Beck Depression Inventory (BDI), in people on HD against a structured psychiatric interview with a trained psychiatrist using the ICD-10 classification of depression. The BDI is validated in a normal population, but in patients with physical ill health there has been a difficulty in defining appropriate cut-off scores.
  
  
  METHODS
  Patients dialysing for over 3 months from a single HD unit were eligible for participation. Patients were excluded if a known psychiatric illness existed or if they were receiving medication for a psychiatric illness. Patients who had a recent major illness requiring hospitalisation were excluded. 57 consenting participants completed the self-reported BDI. Within the next week a psychiatrist carried out a clinical interview to diagnose depression, based on the ICD-10 classification of a depressive disorder. Patients were classified as not being depressed or having mild, moderate or severe depression according to their BDI score or the ICD-10 classification.
  
  
  RESULTS
  The BDI gave more scores for depression and more severe scores than ICD-10. 30 cases had scores which agreed, 27 cases resulted in a higher BDI score than the ICD-10 classification, in no case was the ICD-10 classification more severe (Wilcoxon signed rank test p < 0.001). All 7 diagnosed as being depressed by clinical interview were also depressed by BDI, although in 2 cases the BDI worsened the depression score.
  
  
  CONCLUSIONS
  Using the general population cut-off score, the BDI significantly overdiagnosed depression in this HD population. This study defines a BDI cut-off score which more reliably detects major depression in a HD population. Unrecognised depression remains high in those with no known psychiatric illness within the HD populations.
authors.affiliation: Department of General Adult Psychiatry, Brentwood, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: Grant
authors.forename: Michael K
authors.initials: MK
authors.lastname: Almond
authors.forename: Alison
authors.initials: A
authors.lastname: Newnham
authors.forename: Pauline
authors.initials: P
authors.lastname: Roberts
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
mesh_terms: D000368:Aged; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D006113:United Kingdom