title: Rasch analysis of the Beck Depression Inventory-II in stroke survivors: a cross-sectional study.
abstract: BACKGROUND
  The Beck Depression Inventory-II (BDI-II) is often used to assess depressive symptoms among stroke patients, but more evidence is needed regarding its psychometric properties in this population. The purpose of this study was to assess the BDI-II׳s psychometric properties using a Rasch model application in a sample of patients 6 months after a first clinical stroke.
  
  
  METHODS
  Data were collected prospectively from patient medical records and from questionnaires (with assistance if needed) as a part of a longitudinal study of poststroke fatigue. Data from the 6-month follow-up were used in this analysis. The sample consisted of 106 patients with first-ever stroke recruited from two Norwegian hospitals between 2007 and 2008. Depressive symptoms were measured with the BDI-II. Rasch analysis was used to assess the BDI-II׳s psychometric properties in this sample.
  
  
  RESULTS
  Five BDI-II items did not demonstrate acceptable goodness-of-fit to the Rasch model: items 10 (crying), 16 (changes in sleep), 17 (irritability), 18 (changes in appetite), and 21 (loss of interest in sex). If these 5 items were removed, the resulting 16-item version not only had fewer items, it also had better internal scale validity, person-response validity, and person-separation reliability than the original 21-item version in this sample of stroke survivors.
  
  
  CONCLUSIONS
  The study did not include a clinical evaluation of depression.
  
  
  CONCLUSIONS
  A 16-item version of the BDI-II, omitting items 10, 16, 17, 18 and 21, may be more appropriate than the original 21-item BDI-II for use as a unidimensional measure of depression in patients following first-ever stroke.
authors.affiliation: Lovisenberg Diakonale Hospital, Lovisenberggata 17, NO-0440 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, Oslo, Norway. Electronic address: anners.lerdal@medisin.uio.no.
authors.forename: Anners
authors.initials: A
authors.lastname: Lerdal
authors.affiliation: Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. Electronic address: anders.kottorp@ki.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Kottorp
authors.affiliation: Lovisenberg Diakonale Hospital, Lovisenberggata 17, NO-0440 Oslo, Norway; Department of Family Health Care Nursing, University of California, San Francisco, CA, USA; Lovisenberg Diakonale University College, Oslo, Norway. Electronic address: caryl.gay@ucsf.edu.
authors.forename: Caryl L
authors.initials: CL
authors.lastname: Gay
authors.affiliation: Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, Oslo, Norway; Førde University College, Førde, Norway. Electronic address: e.k.grov@medisin.uio.no.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Grov
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco, CA, USA. Electronic address: kathryn.lee@nursing.ucsf.edu.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D020521:Stroke / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data
keywords: BDI-II; Depression; Psychometrics; Rasch analysis; Stroke; Validity