2. BECK DEPRESSION INVENTORY Angela M. Theobald Fort Hays State University

3. DEPRESSION SCREENING IN PRIMARY CARE 25-49% of primary care patients who meet criteria for depressive disorders go undiagnosed. 25-49% of primary care patients who meet criteria for depressive disorders go undiagnosed. Current practice guidelines recommend increased screening and diagnosis of depressive disorders. Current practice guidelines recommend increased screening and diagnosis of depressive disorders. Barriers to mental health treatment place increased responsibility on primary care clinicians. Barriers to mental health treatment place increased responsibility on primary care clinicians. Roughly 1/3 of all treated patients with a mental disorder receive care solely through primary care. Roughly 1/3 of all treated patients with a mental disorder receive care solely through primary care.

4. HISTORY AND USE Original BDI developed in 1961 21 item questionnaire and since revised to a 13 item version Derived from clinical theory of depression and correlates well to professional clinical judgement Statements framed around somatic complaints over the past two weeks Severity of depression grouped into 4 categories NOT designed to diagnose depression – only for screening purposes

5. BDI VALIDITY AND RELIABILITY BDI studied extensively and has sound psychometric properties BDI studied extensively and has sound psychometric properties Miss few cases of persons meeting diagnostic criteria of depression but may capture a high number of false positive cases Miss few cases of persons meeting diagnostic criteria of depression but may capture a high number of false positive cases BDI use in current research studies BDI use in current research studies Alcohol-dependent population Alcohol-dependent population Post-MI and CHF patients Post-MI and CHF patients Healthy population Healthy population Established use in a variety of settings and populations Established use in a variety of settings and populations Long-term care facilities for the elderly Long-term care facilities for the elderly Medical outpatients Medical outpatients Treatment centers for drug abuse Treatment centers for drug abuse

6. IMPROVED TREATMENT OF DEPRESSION 1.Consider a broad psychiatric differential diagnosis 2.Make specific and appropriate referrals 3.Frame pt expectations when initiating an antidepressant 4.Monitor adherence during the first month 5.Use caution in selecting initial antidepressant for anxious pts 6.Do not be content with ‘good enough’ 7.Minimal improvement at 6wks = change treatment 8.Don’t use bupropion as 1 st line for pt’s with significant anxiety 9.Don’t use alprazolam for generalized anxiety 10.Evaluate anxious or depressed patients for alcohol or drug use (Dunlop, Scheinberg, & Dunlop, 2013).

7. REFERENCES Aalto, A. M., Elovainio, M., Kivimaki, M., Uutela, A. & Pirkola, S. (2012). The Beck Depression Inventory in the general population: A validation study using the Composite International Diagnostic Interview as the gold standard. Psychiatry Research, 197(1-2), 163-171. Delisle, V. C., Beck, A. T, Ziegelstein, R. C, & Thombs, B. D. (2012). Symptoms of heart disease or its treatment may increase Beck Depression Inventory scores in hospitalized post-myocardial infarction patients. Journal of Psychosomatic Research, 73(3), 157-162. Dunlop, B. W., Scheinberg, K., & Dunlop, A. L. (2013). Ten ways to improve the treatment of depression and anxiety in adults. Mental Health in Family Medicine, 10(3), 175-181. Lahlou-Laforet, K., Ledru, F., Niarra, R., & Consoli, S. M. (2015). Validity of Beck Depression Inventory for the assessment of depressive mood in chronic heart failure patients. Journal of Affective Disorders, 184(15), 256- 260. McPherson, A. & Martin, C. R. (2010). A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population. Journal of Psychiatric and Mental Health Nursing, 17(1), 19-30.