Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

The greek translation of the symptoms rating scale for depression and anxiety: preliminary results of the validation study

  • Konstantinos N Fountoulakis1Email author,
  • Apostolos Iacovides1,
  • Soula Kleanthous1,
  • Stavros Samolis1,
  • Kyriakos Gougoulias1,
  • George St Kaprinis1 and
  • Per Bech2
BMC Psychiatry20033:21

DOI: 10.1186/1471-244X-3-21

Received: 12 September 2003

Accepted: 10 December 2003

Published: 10 December 2003

Abstract

Background

The aim of the current study was to assess the reliability, validity and the psychometric properties of the Greek translation of the Symptoms Rating Scale For Depression and Anxiety. The scale consists of 42 items and permits the calculation of the scores of the Beck Depression Inventory (BDI)-21, the BDI 13, the Melancholia Subscale, the Asthenia Subscale, the Anxiety Subscale and the Mania Subscale

Methods

29 depressed patients 30.48 ± 9.83 years old, and 120 normal controls 27.45 ± 10.85 years old entered the study. In 20 of them (8 patients and 12 controls) the instrument was re-applied 1–2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. CES-D and ZDRS were used for cross-validation purposes. The Statistical Analysis included ANOVA, the Spearman Correlation Coefficient, Principal Components Analysis and the calculation of Cronbach's alpha.

Results

The optimal cut-off points were: BDI-21: 14/15, BDI-13: 7/8, Melancholia: 8/9, Asthenia: 9/10, Anxiety: 10/11. Chronbach's alpha ranged between 0.86 and 0.92 for individual scales. Only the Mania subscale had very low alpha (0.12). The test-retest reliability was excellent for all scales with Spearman's Rho between 0.79 and 0.91.

Conclusions

The Greek translation of the SRSDA and the scales that consist it are both reliable and valid and are suitable for clinical and research use with satisfactory properties. Their properties are close to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Keywords

Scales depression transcultural psychiatry reliability validity Greece

Background

The Symptoms Rating Scale for Depression and Anxiety (SRSDA) [1] is based on the Beck Depression Inventory-I (BDI-I) [2]. It has been enlarged to include 42 items (double the number of BDI items and apart from the original 21 BDI items it contains several subscales [3], like the Asthenia subscale [4], the Melancholia Inventory [1], the Anxiety Inventory [1], and the Mania subscale [1]. Simultaneously one can calculate the BDI-I-13 and BDI-I-21 scores. The composition of the SRSDA subscales is as follows:

1. The 21-item Beck Depression Scale includes items 1 8, 11, 13, 14, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 28, 29, 31, 32, 34, 41. These are scored: a = 0, b = 1, c = 2, d = 3.

2. The 13-item Beck Depression Scale includes items 1, 8, 11, 13, 14, 19, 20, 22, 28, 29, 32, 34 and 41. These are scored a = 0, b = 1, c = 2, d = 3.

3. The 12-item Melancholia Subscaleincludes items 8, 11, 13, 17, 19, 20, 21, 22, 26, 29, 32 and 34. These are scored a = 0, b = 1, c = 2, d = 3.

4. The 12-item Asthenia Subscale includes items 2, 5, 9, 17, 21, 24, 25, 27, 28, 29, 32 and 38. These are scored: a = 0, b = 1, c = 2, d = 3.

5. The 14-item Anxiety Subscale includes items 3, 4, 5, 12, 15, 17, 21, 24, 25, 27, 33, 39, 40 and 42. These are scored: a = 0, b = 1, c = 2, d = 3.

6. The 5-item Mania Subscale includes items which all are graded 6, 10, 16, 30, 37. These are scored a = -1, b = 0, c = 0, d = +1

The SRSDA is not widely used, unlike the Zung Depression Rating Scale [5], the Beck Depression Inventory-I (BDI-I) [2] or the CES-D [6]. In any case, all these scales are supposed to be used as screening tools rather and not as substitutes for an in-depth interview[7].

The aim of the current preliminary study was to assess the reliability, validity and psychometric properties of the Greek translation of the Symptom Rating Scale for Depression and Anxiety (SRSDA) and its subscales.

Methods

Materials

Twenty-nine (29) depressed patients (16 males and 13 females) aged 30.48 ± 9.83 years (range 18–59) suffering from Major Depressive disorder according to DSM-IV [8] and depression according to ICD-10 criteria [9], and 120 normal controls (78 males and 42 females) aged 27.45 ± 10.85 years (range 18–55) entered the study. In 20 of them (8 patients and 12 controls) the instrument was re-applied 1–2 days later.

Patients were free of any medication for at least two weeks and were physically healthy with normal clinical and laboratory findings (Electroencephalogram, blood and biochemical testing, thyroid function, test for pregnancy, B12 and folic acid).

Patients came from the inpatient and outpatient unit of the 3rd Department of Psychiatry, Aristotle University of Thessaloniki, University Hospital AHEPA, Thessaloniki, Greece. They were consecutive cases and were chosen because they fulfilled the above criteria.

Members of the hospital staff, and students composed the control group. A clinical interview confirmed that they did not suffer from any mental disorder and their prior history was free from mental and thyroid disorder. They were free of any medication for at least two weeks and were physically healthy.

All patients and controls provided written informed consent before participating in the study.

Methods

Translation and Back Translation was made by two of the authors; one of whom did the translation and the other who did not know the original English text did the back translation. The final translation was fixed by consensus of both authors. For the original English text of the scale see additional file 1. For the Greek translation see additional file 2.

Clinical Diagnosis was reached by consensus of two examiners. The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.0 [10, 11] and the International Personality Disorders Examination (IPDE) [1215] were used. Both were applied by one of the authors (KNF) who has official training in a World Health Organization Training and Reference Centre. The IPDE did not contribute to the clinical diagnosis of depression, but was used in the frame of a global and comprehensive assessment of the patients. The second examiner performed an unstructured interview.

The Center for Epidemiological Studies-Depression (CES-D) [6] and the Zung Depression Rating Scale (ZDRS) [16] were applied to the subjects for purposes of cross-validation. The clinical diagnosis was used as the 'gold standard' for the validation of the SRSDA. The use of a semi-structured interview strengthens this approach, which however has certain inherent limitations.

Statistical Analysis

Analysis of Variance (ANOVA) [17], was used to search for differences between groups.

Item Analysis [18] was performed, and the values of Cronbach's alpha (α) for SRSDA subscales were calculated.

The Spearman Rank Correlation Coefficient (rho) was calculated to test the relationship between CES-D, ZDRS and SRSDA subscales and also to assess the test-retest reliability. However, the calculation of correlation coefficients is not a sufficient method to test reliability and reproducibility of a scale, because it is an index of correlation and not an index of agreement [17, 19, 20]. The calculation of means, standard deviations, averages and differences for each SRSDA subscale score during the 1st (test) and 2nd (retest) applications may provide an impression of the stability of results over time.

Also, the means and the standard deviations of the differences concerning each SRSDA subscale between test and retest were calculated and the plots of the test vs. retest and difference vs. average value for each variable were created. In fact it is not possible to use statistics to define acceptable agreement [17]. However these plots may assist decision. It is not possible to show all of these plots, but the respected concerning the total BDI-I-21 score is shown in figure 1. This method was used in previous studies concerning the validation of scientific methods [21].
https://static-content.springer.com/image/art%3A10.1186%2F1471-244X-3-21/MediaObjects/12888_2003_Article_39_Fig1_HTML.jpg
Figure 1

Bivariate scatterplots of the first vs second measurement and of the difference between measurements vs average value of measurements conceming the BDI-21 score. The points of the test-retest plot are very close to the regression line (which is a dichotomous) and the points of the difference vs. average are within the 2 SD from the mean difference (the scatterplots are based on test-retest data from 20 subjects, however some points overlap)

Results

Patients and controls did not differ in age, however they differed concerning all the SRSDA subscales (table 1).
Table 1

Means, standard deviations and Cronbach's alpha conceming the Beck Depression Inventory (BDI-I)-21, BDI-I-13, the Melancholia Subscale, the Asthenia Subscale, the Anxiety Subscale and the Mania Subscale in depressed patients and controls

 

controls N = 120

Depressed N = 29

   
 

Mean

Std. Dev.

Mean

Std. Dev.

F

p-level

alpha

Age

27.45

10.85

30.48

9.83

1.31

0.254

 

BDI-I-21

8.16

7.65

28.65

10.95

122.24

0.000

0.92

BDI-I-13

3.56

4.37

17.43

7.95

143.56

0.000

0.92

Melancholia Subscale

4.51

4.63

17.22

7.46

115.55

0.000

0.89

Asthenia Subscale

4.87

4.51

16.35

5.73

118.64

0.000

0.86

Anxiety Subscale

5.64

5.19

19.13

6.52

121.23

0.000

0.88

Mania Subscale

-0.42

0.70

-0.09

0.29

6.61

0.011

0.12

The calculation of sensitivity (Sn) and specificity (Sp) at various cut-off levels showed that the optimum cut-off points were: BDI-21: 14/15 (Sn = 0.90, Sp = 0.87), BDI-13: 7/8 (Sn = 0.93, Sp = 0.88), Melancholia: 8/9 (Sn = 0.87, Sp = 0.86), Asthenia: 9/10 (Sn = 0.87, Sp = 0.90), Anxiety: 10/11 (Sn = 0.90, Sp = 0.87).

Chronbach's alpha ranged between 0.86 and 0.92 for individual scales. More specifically: BDI-21: 0.92, BDI-13: 0.92, Melancholia: 0.89, Asthenia: 0.86, Anxiety: 0.88 and Mania: 0.12 (table 1).

It is obvious that only the Mania subscale had very low alpha (0.12), but the study sample was not appropriate for the validation of this subscale.

Both the ZDRS and the CES-D correlated highly with all SRSDA subscales. More specifically, the ZDRS Spearman coefficients were: with BDI-21: 0.84, BDI-13: 0.84, Melancholia: 0.82, Asthenia: 0.80, Anxiety: 0.82 and Mania: 0.37. The CES-D Spearman coefficients were: with BDI-21: 0.83, BDI-13: 0.81, Melancholia: 0.80, Asthenia: 0.77, Anxiety: 0.79 and Mania: 0.32. All the above correlations were significant at p < 0.01 (table 2).
Table 2

Correlation between ZDRS, CES-D and SRSDA subscales. All correlations are significant at p < 0.001

 

ZDRS

CES-D

BDI-I-21

0.84

0.83

BDI-I-13

0.84

0.81

Melancholia Subscale

0.82

0.80

Asthenia Subscale

0.80

0.77

Anxiety Subscale

0.82

0.79

Mania Subscale

0.37

0.32

The test-retest reliability was excellent for all scales with Spearman's R between 0.79 and 0.91. More specifically it was BDI-21: 0.90, BDI-13: 0.84, Melancholia: 0.88, Asthenia: 0.81, Anxiety: 0.79 and Mania: 0.91 (table 3).
Table 3

Spearman rho concerning test-retest results

 

Spearman Rho

BDI-I-21

0.95

BDI-I-13

0.89

Melancholia Subscale

0.95

Asthenia Subscale

0.85

Anxiety Subscale

0.80

Mania Subscale

0.92

The comparison between the values obtained during test vs. those obtained during retest revealed no differences (tables 4 and 5). The values that come from the division of the minimum and maximum difference to the standard deviation of the difference (table 5) is desirable to be generally between ±2. It is seems that some minor problems exist with melancholia and mania subscales The interpretion of the data shown in table 5 suggests that all subscales are reliable conceming test-retest. Figure 1 constitute a graphical representation of these results conceming BDI-I-21.
Table 4

Correlation coefficients concerning the test retest reliability of individual BDI items and total scores for BDI-13 and BDI-21. Items marked with an asterisk constitute the BDI-13 scale

SRDA item

R

Item 1*

0.52

Item 8*

0.88

Item 11*

0.64

Item 13*

0.22

Item 14*

0.74

Item 17

0.37

Item 18

1.00

Item 19*

0.35

Item 20*

0.64

Item 21

0.36

Item 22*

0.48

Item 23

0.89

Item 25

0.58

Item 26

0.49

Item 27

0.64

Item 28*

-0.05

Item 29*

0.78

Item 31

0.6

Item 32*

0.83

Item 34*

0.69

Item 41*

0.83

BDI-I-21

0.95

BDI-I-13

0.89

Table 5

Means, standard deviations, minimum and maximum for all SRSDA subscales conceming their test, retest, average and difference between the two applications. The two columns to the right represent the division of the minimum and maximum difference to the standard deviation of the difference. It is desirable these values to be generally between ±2. It is obvious that some minor problems exist with melancholia and mania subscales

 

Valid N

Mean

Minimum

Maximum

Std. Dev.

Lower deviance in SDs

Upper deviance in SDs

BDI-I-21

       

test

20

10.85

0.00

24.00

8.19

  

retest

20

10.80

0.00

27.00

9.50

  

average

20

10.83

0.50

23.50

8.65

  

difference

20

0.05

-7.00

8.00

3.89

-1.80

2.06

BDI-I-13

       

test

20

5.25

0.00

13.00

4.24

  

retest

20

4.85

0.00

13.00

5.20

  

average

20

5.05

0.00

11.50

4.55

  

difference

20

0.40

-4.00

5.00

2.72

-1.47

1.84

Melancholia subscale

       

test

20

6.30

0.00

16.00

4.78

  

retest

20

6.40

0.00

17.00

5.40

  

average

20

6.35

0.00

14.50

4.94

  

difference

20

-0.10

-6.00

4.00

2.53

-2.37

1.58

Asthenia subscale

       

test

20

6.05

0.00

12.00

4.11

  

retest

20

6.40

0.00

14.00

4.89

  

average

20

6.23

0.00

12.00

4.27

  

difference

20

-0.35

-5.00

4.00

2.94

-1.70

1.36

Anxiety subscale

       

test

20

6.75

0.00

17.00

5.54

  

retest

20

7.65

0.00

19.00

6.53

  

average

20

7.20

0.00

15.00

5.72

  

difference

20

-0.90

-8.00

5.00

3.99

-2.01

1.25

Mania subscale

       

test

20

-0.50

-2.00

0.00

0.69

  

retest

20

-0.55

-2.00

0.00

0.69

  

average

20

-0.53

-2.00

0.00

0.68

  

difference

20

0.05

0.00

1.00

0.22

0.00

4.55

Discussion

The present study is a preliminary effort to obtain data concerning the psychometric properties of the Greek translation of the Symptom Rating Scale for Depression and Anxiety (SRSDA) and its subscales. The fact that results are only preliminary should be stressed out, because there is a need for further study concerning the properties of the scale in larger and more representative samples.

The use of self-report scales is frequent in psychiatric research. However, it is also well known that this kind of scales heavily depend on the co-operation and reading ability of the patient. It is also known that the theoretical background of their development influences their performance. On the other hand they save time for the clinician. The SRSDA is a comprehensive self-rating scale for depression both in community and clinical settings. The literature concerning its transcultural reliability and validity is limited. The current study reports observations on the reliability, the validity and the psychometric properties of the Greek translation of the SRSDA. The results suggest that this translation is well suited for use in the Greek population with high sensitivity and specificity, high test-retest reliability and high internal consistency.

The reliability and validity of the SRSDA has been tested in a limited number of studies and no translation of this scale has been published. This is in contrast to the large literature concerning the Zung Depression Rating Scale (ZDRS) [16, 2225] or the CES-D [6, 2630]. Of course there is a large body of research concerning the BDI, which is the backbone of the SRSDA.

Various translations of the BDI have been published and this scale was proved to be psychometrically strong and appropriate for use in Argentina [31], Mexico [32], Brazil [33], Malaya [34], Germany [35], Egypt [36] and Saudi Arabia [37], while a Greek version has been applied to neurological patients [38].

The present study reports that the best cut-off point for the BDI-13 is 7/8 and for the BDI-21 is 14/15. The literature is vast especially for the BDI-21 and opinions vary. It is reported that the best cut-off point for the BDI-21 is 13/14 [39], 21 [40], 18 [35], 13 [41], or 16 [42]. It seems that depending on the population, different cut-off points may be applicable.

When the BDI is used for the assessment of special populations, then the researcher should be very careful in the interpretation of the results. There are data concerning the use of the BDI in subjects with low education [43], postnatal depression [44], adolescent depression [45], geriatric patients [46, 47], neurological patients [38], rheumatoid arthritis patients [32], chronic fatigue syndrome [48], Parkinson's disease [49] and dialysis patients [50].

Concerning the psychometric properties of the BDI, it seems that a single cut-off point is not feasible [39]. There are data suggesting that there is a 40% decline in BDI scores over 8 weeks, a main effect that accounts for approximately 10% of the variance. This may be due to repeated measurement alone, not due to any intervention. This change likely represents measurement error with this instrument rather than any "real" change in depression [51]. Shortcomings of the BDI are its high item difficulty, lack of representative norms, and thus doubtful objectivity of interpretation, controversial factorial validity, instability of scores over short time intervals (over the course of 1 day), and poor discriminant validity against anxiety. Advantages of the inventory are its high internal consistency, high content validity, validity in differentiating between depressed and nondepressed subjects, sensitivity to change, and international propagation [52]. Generally a two factor model solution is proposed for the BDI, but only the first (general) factor seems to be stable [53]. It is also reported that very low scorers on the BDI tend to respond in a "fake-good" manner on the Minnesota Multiphasic Personality Inventory (MMPI) validity scales. This findings was interpreted as evidence of poor "low-end specificity" for the BDI [54].

There is a great controversy concerning which kind of scales (self-report or observer-rating) is best. Although some authors favour the BDI over observer rating scales [55], it seems that it has only moderate relationship to observer rating scales like the MADRS and the HDRS [5660]. This may mean that different aspects of depression are assessed by different instrument modalities, but also may mean that there is a need for a comprehensive and multimodal assessment of patients.

There is also a great debate concerning which one from the self report scales is best. Research provides no consistent data on the superiority of a specific scale over the others. It is reported that the BDI is equal to CES-D [40, 61] there is a significant relationship between the BDI and the MMPI-D scale [62]. The comparison between the BDI, the Zung Self-Rating Depression Scale (SDS), and the Taylor Manifest Anxiety Scale (TMAS) for specificity and validity as measures of anxiety and depression and their relationship to the Neuroticism scale of the Eysenck Personality Inventory (EPI-N), suggest all four tests tap an emotionality factor of stability-instability [63].

Review studies on various self-administered instruments suggest that there is no significant difference among these scales in terms of performance and overall sensitivity is around 0.84 and specificity around 0.72 [64]. These instruments are of particular value in primary care settings because it is clear that primary care providers fail to diagnose and treat as many as 35% to 50% of patients with depressive disorders [65, 66]. Depression is one of the most common psychiatric diagnoses in primary care populations [67]; major depressive disorders can be diagnosed in 6% to 9% of such patients. Obstacles to the appropriate recognition of depression include inadequate provider knowledge of diagnostic criteria; competing comorbid conditions and priorities among primary care patients; time limitations in busy office settings; concern about the implications of labelling; poor reimbursement mechanisms; and uncertainty about the value, accuracy, and efficiency of screening mechanisms for identifying patients with depression. Given that 50% to 60% of persons seeking help for depression are treated exclusively in the primary care setting, accurate detection in this setting is important [68] and self-administered instruments may help to ameliorate some of them.

On the other hand, it should be noted that the diagnosis of depression is itself based on symptoms. A patient cannot be truly asymptomatic and have major depressive disorder. Thus, these screening questionnaires are actually being evaluated for their ability to detect unrecognized, rather than true asymptomatic, depressive symptoms and disease. They are also useful for the assessment of severity but not for the diagnosis per se.

It should be also stressed that the current study offers only preliminary data. The study sample is small; retest data are available for only 18 subjects and the factor analysis included both patients and controls. The complete validation demands the application of the scale in larger samples and more sophisticated methodology, including the use of borderline severity samples.

Conclusions

The Greek translation of the SRSDA and its subscales is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Declarations

Authors’ Affiliations

(1)
3rd Department of Psychiatry, Aristotle University of Thessaloniki
(2)
Frederiksborg General Hospital Department of Psychiatry

References

  1. Bech P: Rating scales for Psychopathology, Health Status and Quality of Life. 1993, Berlin, Heidelberg, New York, Springer-Verlag, 325-340.View ArticleGoogle Scholar
  2. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An Inventory for Measuring Depression. Archives of General Psychiatry. 1961, 4: 53-63.View ArticleGoogle Scholar
  3. Bech P: Rating scales for Mood disorders: applicability, consistency and construct validity. Acta Psychiatrica Scandinavica. 1988, 78: 45-55.View ArticleGoogle Scholar
  4. Bech P, Hey H: Depression or asthenia related to metabolic disturbances in obese patients after intestinal bypass surgery. Acta Psychiatrica Scandinavica. 1979, 59: 462-470.View ArticlePubMedGoogle Scholar
  5. Zung WWK: A Self-Rating Depression Scale. Archives of General Psychiatry. 1965, 12: 63-70.View ArticlePubMedGoogle Scholar
  6. Fountoulakis KN, Iacovides A, Kleanthous S, Samolis S, Kaprinis SG, Sitzoglou K, Kaprinis GS, Bech P: Reliability, Validity and Psychometric Properties of the Greek Translation of the Center for Epidemiological Studies-Depression (CES-D) Scale. BMC Psychiatry. 2001, 1: 3-10.1186/1471-244X-1-3.View ArticlePubMedPubMed CentralGoogle Scholar
  7. Zung WW, Richards CB, Short MJ: Self-rating depression scale in an outpatient clinic. Further validation of the SDS. Archives of General Psychiatry. 1965, 13: 508-515.View ArticlePubMedGoogle Scholar
  8. APA: Diagnostic and Statistical Manual of Mental Disorders. 1994, Washington DC, American Psychiatric Press, 4th, DSM-IVGoogle Scholar
  9. WHO: The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. 1993, Geneva, 81-87.Google Scholar
  10. Wing JK, Babor T, Brugha T: SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry. 1990, 47: 589-593.View ArticlePubMedGoogle Scholar
  11. WHO: Schedules for Clinical Assessment in Neuropsychiatry-SCAN version 2.0) Mavreas V: Greek Version. 1995, Athens, Research University Institute for Mental HealthGoogle Scholar
  12. Loranger AW, Sartorious N, Andreoli A: The World Health Organisation/Alcohol, Drug Abuse and Mental Health Administration International Pilot Study of Personality Disorders. Archives of General Psychiatry. 1994, 51: 215-224.View ArticlePubMedGoogle Scholar
  13. WHO: International Personality Disorders Examination. 1995, GenevaGoogle Scholar
  14. WHO: International Personality Disorders Examination, Greek Edition. (Translation: Fountoulakis KN, Iacovides A, Kaprinis G, Ierodiakonou Ch). 3rd Department of Psychiatry, Aristotle University of Thessaloniki Greece (unpublished)
  15. Fountoulakis KN, Iacovides A, Ioannidou Ch, Bascialla F, Nimatoudis I, Kaprinis G, Janca A, Dahl A: Reliability and cultural applicability of the Greek version of the International Personality Disorders Examination. BMC Psychiatry. 2002, 17: 6-10.1186/1471-244X-2-6.View ArticleGoogle Scholar
  16. Fountoulakis KN, Iacovides A, Samolis S, Kleanthous S, Kaprinis SG, Kaprinis GS, Bech P: Reliability, Validity and Psychometric Properties of the Greek Translation of the Zung Depression Rating Scale. BMC Psychiatry. 2001, 1: 6-10.1186/1471-244X-1-6.View ArticlePubMedPubMed CentralGoogle Scholar
  17. Altman DG: Practical Statistics for Medical Research. 1991, London, Chapman and HallGoogle Scholar
  18. Anastasi A: Psychological Testing. 1988, New York, Macmillan Publishing Company, 202-234. 6thGoogle Scholar
  19. Bland JM, Altman DG: Statistical Methods for Assessing Agreement between two methods of Clinical Measurement. Lancet. 1986, 1: 307-310.View ArticlePubMedGoogle Scholar
  20. Bartko JJ, Carpenter W: On the Methods and Theory of Reliability. Journal of Nervous and Mental Disorders. 1976, 163: 307-317.View ArticleGoogle Scholar
  21. Fotiou F, Fountoulakis KN, Goulas A, Alexopoulos L, Palikaras A: Automated Standardized Pupilometry with Optical Method for Purposes of Clinical Practice and Research. Clinical Physiology. 2000, 20: 336-347. 10.1046/j.1365-2281.2000.00259.x.View ArticlePubMedGoogle Scholar
  22. Lopez VC, deEstebanChamorro T: Validity of Zung's Self-Rating Depression Scale. Archives of Neurobiology (Madr). 1975, 38: 225-246.Google Scholar
  23. Xu MY: Using the SDS (self-rating depression scale) for observations on depression. Chung Hua Hu Li Tsa Chih. 1987, 22: 156-159.PubMedGoogle Scholar
  24. Chen XS: Masked depression among patients diagnosed as neurosis in general hospitals. Chung Hua I Hsueh Tsa Chih. 1986, 66: 32-33.PubMedGoogle Scholar
  25. Jegede RO: Psychometric characteristics of Yoruba versions of Zung's self-rating depression scale and self-rating anxiety scale. African Journal of Medicine and Medical Science. 1979, 8: 133-137.Google Scholar
  26. Foelker GA, Shewchuk RM: Somatic complaints and the CES-D. Journal of the American Geriatrics Society. 1992, 40: 259-View ArticlePubMedGoogle Scholar
  27. Callahan LF, Kaplan MR, Pincus T: The Beck Depression Inventory, Center for Epidemiological Studies Depression scale (CES-D), and General Well-Being Schedule depression subscale in rheumatoid arthritis. Arthritis Care and Research. 1991, 4: 3-View ArticlePubMedGoogle Scholar
  28. Schein RL, Koenig HG: The Center for Epidemiological Studies Depression (CES-D) Scale: assessment of depression in the medically ill elderly. International Journal of Geriatric Psychiatry. 1997, 12: 436-10.1002/(SICI)1099-1166(199704)12:4<436::AID-GPS499>3.3.CO;2-D.View ArticlePubMedGoogle Scholar
  29. Roberts RE, Chen YW: Depressive symptoms and suicidal ideation among Mexican-origin and Anglo adolescents. Journal of the American Academy of Child and Adolescence Psychiatry. 1995, 34: 81-90. 10.1097/00004583-199501000-00019.View ArticleGoogle Scholar
  30. Takeuchi K, Roberts RE, Suzuki S: Depressive symptoms among Japanese and American adolescents. Psychiatry Research. 1994, 53: 259-274. 10.1016/0165-1781(94)90054-X.View ArticlePubMedGoogle Scholar
  31. Bonicatto S, Dew AM, Soria JJ: Analysis of the psychometric properties of the Spanish version of the Beck Depression Inventory in Argentina. Psychiatry Research. 1998, 79: 277-285. 10.1016/S0165-1781(98)00047-X.View ArticlePubMedGoogle Scholar
  32. Suarez-Mendoza AA, Cardiel MH, Caballero-Uribe CV, Ortega-Soto HA, Marquez-Marin M: Measurement of depression in Mexican patients with rheumatoid arthritis: validity of the Beck Depression Inventory. Arthritis Care Res. 1997, 10: 194-199.View ArticlePubMedGoogle Scholar
  33. Gorenstein C, Pompeia S, Andrade L: Scores of Brazilian University students on the Beck Depression and the State Trait Anxiety Inventories. Psychological Reports. 1995, 77: 635-641.View ArticlePubMedGoogle Scholar
  34. Quek KF, Low WY, Razack AH, Loh CS: Beck Depression Inventory (BDI): a reliability and validity test in the Malaysian urological population. Medical Journal of Malaysia. 2001, 56: 285-292.PubMedGoogle Scholar
  35. Hautzinger M: [The Beck Depression Inventory in clinical practice]. Nervenarzt. 1991, 62: 689-696.PubMedGoogle Scholar
  36. Rader KK, Adler L, Schwibbe MH, Sultan AS: [Validity of the Beck Depression Inventory for cross-cultural comparisons. A study of German and Egyptian patients]. Nervenarzt. 1991, 62: 697-703.PubMedGoogle Scholar
  37. West J: An Arabic validation of a depression inventory. Int J Soc Psychiatry. 1985, 31: 282-289.View ArticlePubMedGoogle Scholar
  38. Lykouras L, Oulis P, Adrachta D, Daskalopoulou E, Kalfakis N, Triantaphyllou N, Papageorgiou K, Christodoulou GN: Beck Depression Inventory in the detection of depression among neurological inpatients. Psychopathology. 1998, 31: 213-219. 10.1159/000029042.View ArticlePubMedGoogle Scholar
  39. Leentjens AF, Verhey FR, Luijckx GJ, Troost J: The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease. Movement Disorders. 2000, 15: 1221-1224. 10.1002/1531-8257(200011)15:6<1221::AID-MDS1024>3.0.CO;2-H.View ArticlePubMedGoogle Scholar
  40. Leentjens AF, Verhey FR, Luijckx GJ, Troost J: The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease. Movement Disorders. 2000, 15: 1221-1224. 10.1002/1531-8257(200011)15:6<1221::AID-MDS1024>3.0.CO;2-H.View ArticlePubMedGoogle Scholar
  41. Geisser ME, Roth RS, Robinson ME: Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain. 1997, 13: 163-170. 10.1097/00002508-199706000-00011.View ArticlePubMedGoogle Scholar
  42. Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A: Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents. J Am Acad Child Adolesc Psychiatry. 1991, 30: 51-57.View ArticlePubMedGoogle Scholar
  43. Barrera M., Jr., Garrison-Jones CV: Properties of the Beck Depression Inventory as a screening instrument for adolescent depression. J Abnorm Child Psychol. 1988, 16: 263-273.View ArticlePubMedGoogle Scholar
  44. Westaway MS, Wolmarans L: Depression and self-esteem: rapid screening for depression in black, low literacy, hospitalized tuberculosis patients. Social Science and Medicine. 1992, 35: 1311-1315. 10.1016/0277-9536(92)90184-R.View ArticlePubMedGoogle Scholar
  45. Lee DT, Yip AS, Chiu HF, Leung TY, Chung TK: Screening for postnatal depression: are specific instruments mandatory?. Journal of Affective Disorders. 2001, 63: 233-238. 10.1016/S0165-0327(00)00193-2.View ArticlePubMedGoogle Scholar
  46. Bennett DS, Ambrosini PJ, Bianchi M, Barnett D, Metz C, Rabinovich H: Relationship of Beck Depression Inventory factors to depression among adolescents. J Affect Disord. 1997, 45: 127-134. 10.1016/S0165-0327(97)00045-1.View ArticlePubMedGoogle Scholar
  47. Snyder AG, Stanley MA, Novy DM, Averill PM, Beck JG: Measures of depression in older adults with generalized anxiety disorder: a psychometric evaluation. Depression and Anxiety. 2000, 11: 114-120. 10.1002/(SICI)1520-6394(2000)11:3<114::AID-DA5>3.0.CO;2-C.View ArticlePubMedGoogle Scholar
  48. Scogin F, Beutler L, Corbishley A, Hamblin D: Reliability and validity of the short form Beck Depression Inventory with older adults. J Clin Psychol. 1988, 44: 853-857.View ArticlePubMedGoogle Scholar
  49. Farmer A, Chubb H, Jones I, Hillier J, Smith A, Borysiewicz L: Screening for psychiatric morbidity in subjects presenting with chronic fatigue syndrome. Br J Psychiatry. 1996, 168: 354-358.View ArticlePubMedGoogle Scholar
  50. Levin BE, Llabre MM, Weiner WJ: Parkinson's disease and depression: psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry. 1988, 51: 1401-1404.View ArticlePubMedPubMed CentralGoogle Scholar
  51. Craven JL, Rodin GM, Littlefield C: The Beck Depression Inventory as a screening device for major depression in renal dialysis patients. Int J Psychiatry Med. 1988, 18: 365-374.View ArticlePubMedGoogle Scholar
  52. Ahava GW, Iannone C, Grebstein L, Schirling J: Is the Beck Depression Inventory reliable over time? An evaluation of multiple test-retest reliability in a nonclinical college student sample. J Pers Assess. 1998, 70: 222-231.View ArticlePubMedGoogle Scholar
  53. Richter P, Werner J, Heerlein A, Kraus A, Sauer H: On the validity of the Beck Depression Inventory. A review. Psychopathology. 1998, 31: 160-168. 10.1159/000066239.View ArticlePubMedGoogle Scholar
  54. Richter P, Werner J, Bastine R, Heerlein A, Kick H, Sauer H: Measuring treatment outcome by the Beck Depression Inventory. Psychopathology. 1997, 30: 234-240.View ArticlePubMedGoogle Scholar
  55. Beebe DW, Finer E, Holmbeck GN: Low-end specificity of four depression measures: findings and suggestions for the research use of depression tests. J Pers Assess. 1996, 67: 272-284.View ArticlePubMedGoogle Scholar
  56. Martinsen EW, Friis S, Hoffart A: Assessment of depression: comparison between Beck Depression Inventory and subscales of Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica. 1995, 92: 460-463.View ArticlePubMedGoogle Scholar
  57. Akdemir A, Turkcapar MH, Orsel SD, Demirergi N, Dag I, Ozbay MH: Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Comprehensive Psychiatry. 2001, 42: 161-165. 10.1053/comp.2001.19756.View ArticlePubMedGoogle Scholar
  58. Enns MW, Larsen DK, BJ Cox: Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables. Journal of Affective Disorders. 2000, 60: 33-41. 10.1016/S0165-0327(99)00156-1.View ArticlePubMedGoogle Scholar
  59. McCall WV, Reboussin BA, Cohen W: Subjective measurement of insomnia and quality of life in depressed inpatients. Journal of Sleep Research. 2000, 9: 43-48. 10.1046/j.1365-2869.2000.00186.x.View ArticlePubMedGoogle Scholar
  60. Smolka M, Stieglitz RD: On the validity of the Bech-Rafaelsen Melancholia Scale (BRMS). Journal of Affective Disorders. 1999, 54: 119-128. 10.1016/S0165-0327(98)00150-5.View ArticlePubMedGoogle Scholar
  61. Schotte CK, Maes M, Cluydts R, De Doncker D, Cosyns P: Construct validity of the Beck Depression Inventory in a depressive population. J Affect Disord. 1997, 46: 115-125. 10.1016/S0165-0327(97)00094-3.View ArticlePubMedGoogle Scholar
  62. Zich JM, Attkisson CC, Greenfield TK: Screening for depression in primary care clinics: the CES-D and the BDI. International Journal of Psychiatry in Medicine. 1990, 20: 259-277.View ArticlePubMedGoogle Scholar
  63. Carter CL, Dacey CM: Validity of the Beck Depression Inventory, MMPI, and Rorschach in assessing adolescent depression. J Adolesc. 1996, 19: 223-231. 10.1006/jado.1996.0021.View ArticlePubMedGoogle Scholar
  64. Meites K, Lovallo W, Pishkin V: A comparison of four scales for anxiety, depresison, and neuroticism. J Clin Psychol. 1980, 36: 427-432.View ArticlePubMedGoogle Scholar
  65. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C: Case-Finding Instruments for Depression in Primary Care Settings. Annals of Internal Medicine. 1995, 123: 913-921.View ArticleGoogle Scholar
  66. Simon GE, VonKorff M: Recognition, management, and outcomes of depression in primary care. Archives of Family Medicine. 1995, 4: 99-105. 10.1001/archfami.4.2.99.View ArticlePubMedGoogle Scholar
  67. Gerber PD, Barrett J, Barrett J, Manheimer E, Whiting R, Smith R: Recognition of depression by internists in primary care: a comparison of internist and gold standard psychiatric assessments. Journal of General Internal Medicine. 1989, 4: 7-13.View ArticlePubMedGoogle Scholar
  68. Katon W, Roy-Byrne PP: Antidepressants in the medically ill: diagnosis and treatment in primary care. Clinical Chemistry. 1988, 34: 829-836.PubMedGoogle Scholar
  69. Schurman RA, Krooner PD, Mitchell JB: The hidden mental health network. Treatment of mental illness by nonpsychiatric physicians. Archives of General Psychiatry. 1985, 42: 89-94.View ArticlePubMedGoogle Scholar
  70. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/3/21/prepub

Copyright

© Fountoulakis et al; licensee BioMed Central Ltd. 2003

This article is published under license to BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Advertisement