Assessing depression symptoms in those with insomnia: an examination of the beck depression inventory second edition (BDI-II).

Journal Article (Journal Article)

BACKGROUND: Due to concerns about overlapping symptomatology between medical conditions and depression, the validity of the beck depression inventory (BDI-II) has been assessed in various medical populations. Although major depressive disorder (MDD) and primary insomnia (PI) share some daytime symptoms, the BDI-II has not been evaluated for use with insomnia patients. METHOD: Participants (N=140) were screened for the presence of insomnia using the Duke structured clinical interview for sleep disorders (DSISD), and evaluated for diagnosis of MDD using the structured clinical interview for DSM-IV-TR (SCID). Participants' mean BDI-II item responses were compared across two groups [insomnia with or without MDD) using multivariate analysis of variance (MANOVA), and the accuracy rates of suggested clinical cutoffs for the BDI-II were evaluated using a receiver operating characteristic (ROC) curve analysis. RESULTS: The insomnia with depression group had significantly higher scores on several items; however, the groups did not differ on insomnia, fatigue, concentration problems, irritability, libido, increased appetite, and thoughts relating to suicide, self-criticism and punishment items. The ROC curve analysis revealed moderate accuracy for the BDI-II's identification of depression in those with insomnia. The suggested BDI cutoff of >or=17 had 81% sensitivity and 79% specificity. Use of the mild cutoff for depression (>or=14) had high sensitivity (91%) but poor specificity (66%). CONCLUSION: Several items on the BDI-II might reflect sleep disturbance symptoms rather than depression per se. The recommended BDI-II cutoffs in this population have some support but a lower cutoff could result in an overclassification of depression in insomnia patients, a documented problem in the clinical literature. Understanding which items discriminate insomnia patients without depression may help address this nosological issue.

Full Text

Duke Authors

Cited Authors

  • Carney, CE; Ulmer, C; Edinger, JD; Krystal, AD; Knauss, F

Published Date

  • February 2009

Published In

Volume / Issue

  • 43 / 5

Start / End Page

  • 576 - 582

PubMed ID

  • 18954876

Pubmed Central ID

  • PMC2677199

International Standard Serial Number (ISSN)

  • 0022-3956

Digital Object Identifier (DOI)

  • 10.1016/j.jpsychires.2008.09.002


  • eng

Conference Location

  • England