The utility of the Beck Depression Inventory in a bariatric surgery population

The Beck Depression Inventory (BDI) is commonly used in bariatric surgery psychological assessments. However, several items may be measuring physical consequences of obesity (e.g., sleep disturbance, chronic pain, or sexual dysfunction) rather than depressive symptoms.

Bariatric surgery candidates (n = 210) completed a series of assessments including the BDI, a chronic pain assessment, and a semistructured clinical interview. Total BDI scores, subscale scores, and endorsement patterns of somatic versus cognitive-affective items were examined based on (1) the presence or absence of a depressive diagnosis or (2) the presence or absence of chronic pain, and optimal cut points were determined.

Both the total BDI and cognitive-affective subscale had good discriminating accuracy between participants with and without depression, with an optimal cut point of 12 for the BDI and 7 for the cognitive-affective subscale. Bariatric surgery candidates with chronic pain had significantly higher mean total scores on the BDI (M = 12.5 +/- 7.5) than those without chronic pain (M = 9.02 +/- 6.7; p < 0.01), and those with chronic pain were significantly more likely to endorse many of the physical items than those without chronic pain.

The BDI, with or without the somatic items, appears to be a reasonable screening measure for depressive symptoms among bariatric surgery candidates and the subpopulation of those with chronic pain, although future investigations may wish to examine whether other measures would have improved discrimination accuracy.