Factor structure and clinical utility of BDI-II factor scores in postpartum women

The purpose of the current study was to examine the factorial dimensions underlying Beck Depression Inventory-II (BDI-II) in a large ethnically and economically diverse sample of postpartum women and to assess their relative contribution in differentiating clinical diagnoses in a subsample of depressed women.

We administered the BDI-II to 953 women between 4 and 20 weeks postpartum. Women who had low (1-7) and high (>12) BDI-II total scores were administered the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I).

Exploratory (EFA) and confirmatory factor analysis (CFA) revealed three factors, Cognitive, Somatic, and Affective, that accounted for 49.09% of the overall variance of items. Logistic regression analyses showed that somatic and affective factors contributed to diagnosis of major depression, while the somatic factor alone contributed to the diagnosis of depression with comorbid anxiety. The cognitive factor differentiated women with major depression from women who were never depressed.

Our definition of clinical depression included episodes of depression during the child's lifetime, and depressive symptoms were not necessarily current at the time of the assessment, which may impact the relative contribution of BDI-II factors to clinical diagnosis.

Conceptualizing the structure of the BDI-II using these three factors could contribute to refining the measurement and scoring of depressive symptomatology and severity in postpartum women. Although somatic symptoms of depression may be difficult to differentiate from the physiological changes of normative postpartum adjustment, our results support the inclusion of somatic symptoms of depression in the calculation of a BDI-II total score.