Toward more accurate use of the Beck Depression Inventory with chronic back pain patients

Objective: To improve the accuracy of the Beck Depression Inventory (BDI) in assessing depression in chronic back pain (CBP) patients, the pattern of depression symptomatology was evaluated. Design: Analyses of BDI data obtained from nondepressed and depressed CBP patients were conducted to identify the major factors that differentiated among the patient groups. Setting: CBP patients were recruited from a tertiary rehabilitation center. Patients: One hundred one nondepressed and 99 depressed CBP patients from the tertiary treatment center. Outcome Measures and Results: Analyses of the BDI data revealed a general factor of depression severity that excluded items reflecting weight loss, sleep disturbance, and work inhibition. In addition, these analyses yielded a second factor reflecting somatic concerns and disability. Weight loss, sleep disturbance, and work inhibition failed to differentiate the depressed from the nondepressed CBP subjects, suggesting that these symptoms have poor diagnostic potential for CBP patients. Conclusions: This study demonstrated that the BDI can be used to generate important information about the severity of interference posed by pain on the functioning of an individual, while allowing for an independent evaluation of subjective indices of depression and somatic disturbances that need to be attended to by clinicians.