VALIDITY AND RELIABILITY OF THE BECK DEPRESSION INVENTORY-SHORT FORM IN A GROUP OF ADULT BEREAVED FEMALES

JULIA M. LEAHY

National League for Nursing New York

This study investigated the reliability and validity of the Beck Depression Inventory (BDI) Short Form in a group of female bereaved adults. Two hundred fifty-five community-based women bereaved less than 2 years com- pleted the BDI. Estimate of the alpha coefficient indicates that the short- form BDI possesses adequate internal reliability for this sample. Principal- component factor analysis indicated a two-factor model for depression associated with bereavement. The first factor, which combined items related to anergy and dysphoria, corresponded to the affective and behavioral com- ponents of depression, while the second factor related to the cognitive domain of depression and was associated with a negative self-esteem.

The Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1%1) is a 21-item instrument designed to provide a quantitative assessment of the intensity of depression. This instrument has been validated in the general adult population (Beck, 1967); in the college-age population (Gould, 1982); in the elderly population (Gallagher, Nies, & Thompson, 1982); and in a group of methadone maintenance participants (Reynolds & Gould, 1981).

A shorter version of the BDI (Beck & Beck, 1972; Beck, Rial, & Rickels, 1974) was developed to facilitate more rapid administration, both in clinical and research set- tings. This form consists of 13 items, each of which relates to specific symptoms of depres- sion. Information on reliability and validity of the shorter form has been reported for psychiatric patients (Scogin, Beutler, Corbishley, & Hamblin, 1988; Vredenberg, Krames, & Flett, 1985), for undergraduate students (Gould, 1982), for elderly patients (Foelker, Shewchuk, & Nierderehe, 1987), and for participants in a methadone maintenance pro- gram (Reynolds & Gould, 1981).

Reynolds and Gould (1981) reported that factor analysis of the 13-item BDI-Short Form yielded three significant factors that accounted for 52% of the variance. These factors were described as negative affect toward self, performance difficulties, and general unhappiness. Foelker et al. (1987), who used a Linear Structural Relations Approach (LISREL), obtained three significant factors. The first factor, identified as negative self- esteem, included items of self-dislike, sense of failure, guilt, self-image changes, and suicidal ideas. The second factor, identified as anergy, loaded with items of indecisiveness, work difficulty, fatiguability, and anorexia. The third factor included items of dissatisfac- tion, pessimism, sadness, and social withdrawal and was labeled as dysphoria.

Data are not available on the reliability and validity of the BDI-Short Form with a group of middle-aged, bereaved adult females. This report focuses on the estimates of validity and reliability of the short-form BDI obtained in a study that examined the intensity of depression in a group of community-based female bereaved individuals who

The author wishes to extend her sincere appreciation to Dr. Pierre Woog, Adelphi University, for his

Reprint requests should be addressed to Dr. Julia M. Leahy, 526 East 20th Street, Apt. 2H, New York, assistance in this project.

NY 10009.

64

Beck Depression Inventory-Short Form 65

had suffered the loss of a spouse, a child, or a parent (Leahy, 1991). The sample included only females because previous studies have shown the presence of gender differences in both bereavement (Clayton, Herjanic, Murphy, & Woodruff, 1974; Parkes & Brown, 1972; Rando, 1983; Stroebe & Stroebe, 1987) and depression (Klerman, 1980; Newman, 1986; Weissman & Myers, 1978).

METHOD

Subjects The sample was composed of 255 bereaved individuals who were either members

of a bereaved counseling group or were affiliated with a hospice or terminal care pro- vider located in the New York/New Jersey metropolitan area. These subjects ranged in age from 30 to 65 (M = 51.2), and all were female. The subjects were predominantly Caucasian (92.2%) and had a period of bereavement that was less than 2 years (M = 10.7 months). The sample consisted of 117 persons who had lost a spouse, 58 who had lost a child, and 80 who had lost a parent.

Procedure Volunteer subjects who were members of a group for bereaved individuals or who

were affiliated with a hospice or terminal care facility were asked to complete a ques- tionnaire that included a demographic data sheet and the BDI-Short Form. There were 147 subjects who completed the questionnaire at bereavement group meetings, while 108 subjects received the questionnaire by mail and returned the completed form in a self-addressed, stamped envelope to the researcher.

Participants were provided with written, and in some instances verbal, instructions about the purpose of the study and the confidentiality of their responses.

RE s u L T s

Means and standard deviations for the total group and for each of the subsample are present in Table 1 .

Table 1 Beck Depression Inventory-Short Form Scores

Group N M SD

Loss of spouse 117 7.38 5.24

Loss of child 58 9.59 6.21

Loss of parent 80 5.48 5.46

Total 255 7.28 5.72

Internal consistency for the BDI-Short Form was assessed by computing the co- efficient alpha for the total sample. A coefficient of .88 was obtained, which is slightly lower than the coefficient of .90 reported by Scogin et al. (1988), but higher than a co- efficient of .83 reported by Beck and Beamesdorfer (1974), a coefficient of .78 reported by Gould (1982), coefficients of .74 and .80 reported by Foelker et al. (1987), and a coefficient of .86 by Vredenberg et al. (1985). This result indicates that the BDI-Short Form has satisfactory reliability in a bereaved population.

Principal-component factor analysis of scores of the Short Form yielded two fac- tors with eigenvalues greater than 1 .OO. These two factors accounted for 53.3% of the total variance (see Table 2). Items with loadings of .40 or greater on factor 1 were sadness,

66 Journal of Clinical Psychology, January 1992, Vol. 48, No. I

pessimism, dissatisfaction, social withdrawal, indecisiveness, work difficulty, fatiguability, and anorexia. Sense of failure, guilt, self-dislike, suicidal ideas, and self-image change loaded on the second factor.

Table 2 Factor Loadings for Beck Depression Inventory-Short Form

Factor Item 1 2

Sadness .717

Pessimism Dissatisfaction Social Withdrawal Indecisiveness Work Difficulty

.656 ,708 .653 .721 .MI

Fatiguability .718

Anorexia Sense of failure Guilt Self-dislike Suicidal ideas Self-image change

.581 .I72 .784 ,754 ,628 .575

E i g e n v a 1 u e s 07" total variance

5.48 1.44 42.2 1 1 . 1

The two factors that emerged in this analysis are consistent with the factors reported by Foelker et al. (1987) and Reynolds and Gould (1981). Items that loaded primarily on the first factor included those items that related to the affective and somatic domain of depression. This factor can be equated to the two factors obtained by Foelker et al. (1987), which were labeled anergy and dysphoria. The second factor included those items that related to the cognitive domain and can be labeled negative self-esteem.

DISCUSSION

This study examined the reliability and validity of the Beck Depression Inventory (BDI) Short Form with a group of bereaved adult females. Findings demonstrated that the estimates of internal consistency were sufficiently high to indicate that the short-form BDI is a reliable instrument for self-report of depression with a bereaved population.

The factor structure that emerged from the analysis is quite similar to the factors previously reported by Foelker et al. (1987) and Reynolds and Gould (1981). In addi- tion, this structure supports the construct validity of the short-form BDI because the factors validate the cognitive, affective, and somatic domains of depression.

Yet, the factors emerged differently in this analysis, possibly as a result of the type of depression that was being examined. The findings indicate that anergy and dysphoria combine to account for the largest variance in depression in this sample of bereaved adults. This tends to suggest that depression associated with the grief reaction is characterized by a syndrome primarily of affective and somatic symptoms, while the cognitive components of a negative self-esteem emerge to a lesser degree. Sadness,

Beck Depression Znventory-Short Form 67

indecisiveness, and dissatisfaction were the symptoms most frequently reported by this group, while self-dislike was the least-reported item.

Depression associated with bereavement relates to the loss of a loved relationship rather than to any perception about one's self-esteem. In grief, depression is displayed by an intense yearning for the deceased and by an excessive preoccupation with the deceased's memory (Stroebe & Stroebe, 1987). Sadness and vegetative symptoms have been the most frequently reported symptoms of unresolved grief (Ball, 1977; Bornstein, Clayton, Halikas, Maurice, & Robins, 1973; Clayton, 1975; Parkes, 1985; Raphael, 1983). The loss of a close attachment with another constitutes a challenge that usually exceeds the individual's normal coping threshold (Parkes, 1972). The process of griev- ing the loss is so painful that bereaved individuals often are impaired in their ability to function effectively in their world (Parkes & Weiss, 1983).

In conclusion, the factors that emerged in this analysis are similar to those reported by previous researchers, but can be generalized only to a bereaved population. The results of these validity and reliability studies indicate that the Beck Depression Inventory-Short Form is an appropriate screening method for rapid assessment of depression for a popula- tion of bereaved adult females.

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SENSITIVITY OF THE MINI-MENTAL STATE EXAMINATION TO FRONTAL LOBE DYSFUNCTION IN NORMAL AGING

BRADLEY N . AXELROD ROBERT S. GOLDMAN

Department of Veterans M a i m Allen Park, Michigan

Deparment of Veterans Maim Ann Arbor, Michigan

and University of Michigan

ROLAND0 R. HENRY

Vanderbilt University

The present study examined the sensitivity of the Mini-Mental State Examina- tion (MMSE) in detecting the frontal lobe dysfunction that occurs with nor- mal aging. Eighty normal, independently living older adults in four age groupings from 50 to 89 were administered the MMSE along with three neurocognitive measures sensitive to frontal lobe functioning. Results revealed age-related cognitive decline on frontal lobe tasks that also was detected by the MMSE. These findings are noteworthy because the MMSE was intended as a measure of gross cognitive status rather than of frontal lobe functioning.

The Mini-Mental State Examination (MMSE) is a short cognitive screening test that currently is enjoying an increase in use within aged populations. It has been shown to have 87% sensitivity and 82% specificity for detecting dementia (Folstein, Folstein, & McHugh, 1975). Additionally, test-retest reliability (.89) and interrater reliability (.82) have been shown to be adequate (Folstein et al., 1975). The majority of studies have

Portions of this manuscript were presented at the 98th annual meeting of the American Psychological

Please address correspondence to Bradley N. Axelrod, Ph.D., Department of Veterans Affairs Medical Association, Boston.

Center, Psychology Service (1 16B), Southfield and Outer Drive, Allen Park, MI 48101.