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The greek translation of the symptoms rating scale for depression and anxiety: preliminary results of the validation study
BMC Psychiatry volume 3, Article number: 21 (2003)
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
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.
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.
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.
The Symptoms Rating Scale for Depression and Anxiety (SRSDA)  is based on the Beck Depression Inventory-I (BDI-I) . 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 , like the Asthenia subscale , the Melancholia Inventory , the Anxiety Inventory , and the Mania subscale . 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 , the Beck Depression Inventory-I (BDI-I)  or the CES-D . In any case, all these scales are supposed to be used as screening tools rather and not as substitutes for an in-depth interview.
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.
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  and depression according to ICD-10 criteria , 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.
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) [12–15] 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)  and the Zung Depression Rating Scale (ZDRS)  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.
Analysis of Variance (ANOVA) , was used to search for differences between groups.
Item Analysis  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 . 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 .
Patients and controls did not differ in age, however they differed concerning all the SRSDA subscales (table 1).
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).
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).
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.
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, 22–25] or the CES-D [6, 26–30]. 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 , Mexico , Brazil , Malaya , Germany , Egypt  and Saudi Arabia , while a Greek version has been applied to neurological patients .
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 , 21 , 18 , 13 , or 16 . 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 , postnatal depression , adolescent depression , geriatric patients [46, 47], neurological patients , rheumatoid arthritis patients , chronic fatigue syndrome , Parkinson's disease  and dialysis patients .
Concerning the psychometric properties of the BDI, it seems that a single cut-off point is not feasible . 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 . 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 . Generally a two factor model solution is proposed for the BDI, but only the first (general) factor seems to be stable . 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 .
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 , it seems that it has only moderate relationship to observer rating scales like the MADRS and the HDRS [56–60]. 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 . 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 .
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 . 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 ; 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  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.
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.
Bech P: Rating scales for Psychopathology, Health Status and Quality of Life. 1993, Berlin, Heidelberg, New York, Springer-Verlag, 325-340.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An Inventory for Measuring Depression. Archives of General Psychiatry. 1961, 4: 53-63.
Bech P: Rating scales for Mood disorders: applicability, consistency and construct validity. Acta Psychiatrica Scandinavica. 1988, 78: 45-55.
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.
Zung WWK: A Self-Rating Depression Scale. Archives of General Psychiatry. 1965, 12: 63-70.
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.
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.
APA: Diagnostic and Statistical Manual of Mental Disorders. 1994, Washington DC, American Psychiatric Press, 4th, DSM-IV
WHO: The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. 1993, Geneva, 81-87.
Wing JK, Babor T, Brugha T: SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry. 1990, 47: 589-593.
WHO: Schedules for Clinical Assessment in Neuropsychiatry-SCAN version 2.0) Mavreas V: Greek Version. 1995, Athens, Research University Institute for Mental Health
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.
WHO: International Personality Disorders Examination. 1995, Geneva
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)
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.
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.
Altman DG: Practical Statistics for Medical Research. 1991, London, Chapman and Hall
Anastasi A: Psychological Testing. 1988, New York, Macmillan Publishing Company, 202-234. 6th
Bland JM, Altman DG: Statistical Methods for Assessing Agreement between two methods of Clinical Measurement. Lancet. 1986, 1: 307-310.
Bartko JJ, Carpenter W: On the Methods and Theory of Reliability. Journal of Nervous and Mental Disorders. 1976, 163: 307-317.
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.
Lopez VC, deEstebanChamorro T: Validity of Zung's Self-Rating Depression Scale. Archives of Neurobiology (Madr). 1975, 38: 225-246.
Xu MY: Using the SDS (self-rating depression scale) for observations on depression. Chung Hua Hu Li Tsa Chih. 1987, 22: 156-159.
Chen XS: Masked depression among patients diagnosed as neurosis in general hospitals. Chung Hua I Hsueh Tsa Chih. 1986, 66: 32-33.
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.
Foelker GA, Shewchuk RM: Somatic complaints and the CES-D. Journal of the American Geriatrics Society. 1992, 40: 259-
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-
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.
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.
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.
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.
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.
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.
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.
Hautzinger M: [The Beck Depression Inventory in clinical practice]. Nervenarzt. 1991, 62: 689-696.
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.
West J: An Arabic validation of a depression inventory. Int J Soc Psychiatry. 1985, 31: 282-289.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Meites K, Lovallo W, Pishkin V: A comparison of four scales for anxiety, depresison, and neuroticism. J Clin Psychol. 1980, 36: 427-432.
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.
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.
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.
Katon W, Roy-Byrne PP: Antidepressants in the medically ill: diagnosis and treatment in primary care. Clinical Chemistry. 1988, 34: 829-836.
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.
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Fountoulakis, K.N., Iacovides, A., Kleanthous, S. et al. The greek translation of the symptoms rating scale for depression and anxiety: preliminary results of the validation study. BMC Psychiatry 3, 21 (2003). https://doi.org/10.1186/1471-244X-3-21
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