title: Beck Depression Inventory II: determination and comparison of its diagnostic accuracy in cardiac outpatients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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; ΔAUC = -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.
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada Concordia University, Montreal, Canada gregory.moullec@crhsc.rtss.qc.ca.
authors.forename: Grégory
authors.initials: G
authors.lastname: Moullec
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada Université du Québec à Montréal (UQAM), Montreal, Canada.
authors.forename: Annik
authors.initials: A
authors.lastname: Plourde
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada Université du Québec à Montréal (UQAM), Montreal, Canada Montreal Heart Institute, Montreal, Canada.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada University of Montreal, Montreal, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Suarthana
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada Concordia University, Montreal, Canada Montreal Heart Institute, Montreal, Canada.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Coronary artery disease; depression; diagnostic accuracy; sensitivity; specificity