A Review of the BDI-FastScreen for Medical Patients

Choosing the most appropriate test that considers the unique context of the child, adolescent, or adult can be a daunting task for counselors (Cicchetti, 1994). In addition to determining an assessment's reliability and validity, determining the extent of qualifications necessary for its administration and scoring are equally critical. The following review of the Beck Depression Inventory FastScreen for Medical Patients (BDI-FastScreen) will examine general information for the instrument, its purpose and nature, technical considerations, and practical and general evaluation.

                                                   General Information

A. Title: BDI-FastScreen for Medical Patients (Beck, Steer, & Brown, 2003).

B. Author: Aaron T. Beck, Robert A. Steer, and Gregory K. Brown (Beck, Steer, & Brown, 2003).

C. Publisher: PsychCorp, A brand of Harcourt Assessment, Inc., 19500 Bulverde Road, San Antonio, TX (Beck, Steer, & Brown, 2003).

D. Forms, groups to which applicable: Previously called the Beck Depression Inventory for Primary Care and based on the Beck Depression Inventory-II. Designed for population ages 12 - 82 (Beck, Steer, & Brown, 2003).

E. Practical features: The BDI-FastScreen for Medical Patients is a self-report questionnaire containing seven psychological depression symptoms (Scheinthal, Steer, Giffin, & Beck, 2001). It is used by physicians assessing somatic and behavioral symptoms that may be associated with medical, biological, or substance abuse problems. The seven items are rated on a four-point scale (0-3) and assess frequency, over the past two weeks, of feelings of sadness, pessimism (hopelessness), sense of failure, loss of a sense of pleasure, loss of self-confidence, self-blame, and suicidal ideation. The items correspond to the DSM-IV-TR (Beck, Steer, & Brown, 2003).

F. General type: Serves as an indicator of depression as a result of medical, biological, or substance abuse problems (Beck, Steer, & Brown, 2003).

G. Date of publication: 2002 (Beck, Steer, & Brown, 2003).

H. Costs, booklets, answer sheets, scoring: 2003 price data: $67 per complete kit, including manual and 50 score forms; $39 per manual; $39 per 50 record forms; $43 per 50 scannable record forms; quantity discounts available. Scoring is easily accomplished by summing the point values from the seven items, and interpreting total scores (Beck, Steer, & Brown, 2003).

I. Time required to administer: Five minutes (Beck, Steer, & Brown, 2003).

J. Purpose for which evaluated: Designed to screen patients for depression that may be related to medical illness, chronic condition, or substance abuse (Beck, Steer, & Brown, 2003).

                                      Purpose and Nature of the Instrument

Stated Purpose

The BDI-FastScreen for Medical Patients (BDI-FastScreen), previously known as the BDI-Fast Screen was specifically designed for use in medical or clinical settings to identify the presence of depression in patients (ages 12-82) with existing biological, medical, or substance abuse problems (Hennessy & Pallone, 2003; Whiston & Eder, 2003).

Description of Test, Items, and Scoring
The BDI-FastScreen is a self-administered, five-minute test composed of seven items taken from the Beck Depression Inventory-II (BDI-II) that uses the diagnostic criteria for a major depressive disorder (MDD) in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) as a comparison (Beck, Steer, & Brown, 1996; Whiston & Eder, 2003). Patients report using a Likert-type scale that varies between 0 (not present) to 3 (severe) on test items related to sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts (Whiston & Eder, 2003). Scoring is easily accomplished by summing total scores, which are interpreted according to the manual guidelines, as follows: 0-3 minimal, 4-8 mild, 9-12 moderate, and 13-21 severe depression (Whiston & Eder, 2003).

Use in Counseling

The BDI-FastScreen is a quick and easy-to-use instrument for screening adolescent and adult depressive symptoms related to biological, medical, or substance abuse problems (Hennessey & Pallone, 2003; Whiston & Eder, 2003). The authors warn that the BDI-FastScreen is neither a substitute for the BDI-II, nor is it a diagnostic tool, but is a reliable information source when used as intended. Clinicians should give primacy to complete patient evaluations as a fundamental source of evaluation (Whiston & Eder, 2003). Although the test is reportedly highly reliable, it may not adequately differentiate adequately between major and less severe depressive symptoms. Non-zero responses should be evaluated for further examination (Hennessey & Pallone, 2003).

                                               Technical considerations

Normative Sample

The authors used four different groups for the normative sample for the BDI-FastScreen (Whiston & Eder, 2003). The first of group (a) consisted of 50 patients referred to psychiatric consultation after hospitalization for a medical condition. The second group (b) was 94 outpatients referred from family practices; the third (c) consisted of 100 pediatric patients between the ages of 12 and 17 scheduled for medical check-ups, and the fourth group (d) was comprised of 120 patients from a university outpatient facility. One reviewer (Hennessey & Pallone, 2003) concluded that the normative sample was inadequate because in the combined sample, 96 patients were known to have major depression and 268 had no depressive symptoms. Furthermore, the same reviewer found fault with 120 outpatients culled from the same medical facility and participants from all four samples were from one geographical location (Hennessey & Pallone, 2003). No information is provided for the selection methods and the criteria by which participants were selected.

Reliability

The authors used four different groups for the normative sample for the BDI-FastScreen (Whiston & Eder, 2003). The first of group (a) consisted of 50 patients referred to psychiatric consultation after being hospitalized for a medical condition. The second group (b) was 94 outpatients referred from family practices; the third (c) consisted of 100 pediatric patients between the ages of 12 and 17 scheduled for medical check-ups, and the fourth group (d) was comprised of 120 patients from a university outpatient facility. The coefficient alphas for the groups were a = .86, b = .85, c = .88, and d = .86. The manual for the test did not provide any additional sources for reliability evidence (Hennessey & Pallone, 2003). Some controversy exists over the lack of test-retest studies, especially in light of ongoing concerns regarding patients' ability to recall previous answers, given the abbreviated seven-item format. The authors report no response set effect, although that information was derived from a 1967 study (Hennessey & Pallone, 2003).

Validity

The authors of the BDI-FastScreen correlated this test with other instruments that measure depressive symptoms to demonstrate construct validity (Hennessey & Pallone, 2003). In three different studies, correlations were r = .62, r = .86, and a correlation to a DSM-IV-TR diagnosis for mood disorder was r = .69 (Hennessey & Pallone, 2003). A high correlation between the BDI-FastScreen and the Beck Anxiety Inventory for Primary Care suggested both evaluate the same variable, which may be anxiety rather than depression (Whiston & Eder, 2003). The test authors assert that the 40 years of evidence supporting the Beck assessments in general should be a gauge of validity, however that claim should not be the sole representation of validity for this specific instrument (Hennessey & Pallone, 2003). The same samples used for determining internal consistency were used to evaluate validity, and Hennessey and Pallone (2003) believed validity cannot be accurately gauged until additional studies are undertaken with a wider and more representative sample.

Generalizability

The BDI-FastScreen has been successfully implemented in a variety of patient groups with biological and medical issues (Whiston & Eder, 2003), including patients with multiple sclerosis (Benedict, Fishman, McClellan, Bakshi, & Weinstock-Guttman, 2003), patients with chronic pain (Poole, Bramwell, & Murphy (2009), geriatric medical patients (Scheinthal, Steer, Giffin, & Beck, 2001), and as a useful assessment for determining mood disorders in HIV patients with chronic pain (Krefetz, Steer, Jermyn, & Condoluci, 2004). Further study may be warranted for implementation in other specialized populations (Whiston & Eder, 2003). Although no evidence exists in support of cross-cultural generalizability, it does appear to be adequate across sex and age categories.

                                                       Practical Evaluation

Qualifications of Examiners

The BDI-FastScreen for Medical Patients (BDI-FastScreen) is a cost-effective, focused evaluation tool that can be self-administered in five minutes and easily scored (Segal & Hilsenroth, 2004). The BDI-FastScreen is listed for purchase with a B Qualification level, which means that the purchaser must retain membership in a professional organization that promotes or requires appropriate assessment training and qualification (Pearson Education, Inc., 2012). If the purchaser does not retain such a membership, he or she must have a master's degree in a field related to the intended use of the assessment (Pearson Education, Inc., 2012). This may include a master's degree in psychology, education, occupational therapy, speech-language pathology, or social work. There are no licensing requirements or special training specific to the BDI-FastScreen, and although qualification for purchase exists, the scoring can be done by office staff (Pearson Education, Inc., 2012).

As the vendor of the BDI-FastScreen, Pearson Education, Inc. (2012) expressed its commitment to maintaining standards in testing according to the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education. To facilitate the ethical and appropriate use of assessments, purchasers must use an established qualification system that requires the purchaser to register and submit to a verification of qualifications. The purchaser must comply with the registration process by completing a user acceptance form that requests basic demographic information as well as the primary work setting, professional degrees obtained, training or coursework completed in assessments, licenses or certifications received, and active organization memberships (Pearson Education, Inc., 2012).

General Administration

The answer sheet is a one page form whereon the examinee's name, age, gender, marital status, occupation, and level of education is documented. The BDI-FastScreen has seven items listed in two columns (Hennessey & Pallone, 2003). It can be easily attached to a clipboard along with other intake forms, if the clinician deems appropriate. Furthermore, the assessment can be read to clients who cannot read English (Whiston & Eder, 2003). The answer sheet contains a warning about the black and green ink colors on the form indicating the copy is not infringing on copyright laws.

Scoring Provisions

The manual is easy to understand although may pose some difficulty for untrained examiners (Hennessey & Pallone, 2003). Examiners should be particularly attentive to non-zero responses to the items regarding pessimism and suicidal thoughts (Hennessey & Pallone, 2003). The manual clearly explains how to add the scores from the seven test items to find the total score (Segal & Hilsenroth, 2004). The symptoms measured include: sadness, pessimism, past failure, loss of pleasure self-dislike, self-criticalness and suicidal thoughts (Strauss, Spreen, & Sherman, 2006). Each question is marked 0 through 3 using a Likert-type scale, and the highest score is 21 if the client responded with a 3 to all of the items. The lowest score is zero if the client answered each question with a 0 (Segal & Hilsenroth, 2004). The manual provides guidance on total test scores as follows: 0-3 is minimal; 4-8 is mild; 9-12 is moderate, and 13-21 is severe depression (Whiston & Eder, 2003). Some research indicates that when utilizing this assessment for individuals of diverse populations, there may be alternative cut scores, and the counselor may want to check validity for these populations (Strauss, Spreen, & Sherman, 2006).

                                                                    Evaluation
Comments of Reviewers

The BDI-Fast Screen is a refined version of BDI-II in a checklist format used similar to the way a clinician would utilize the DSM-IV (Hennessey & Pallone, 2003). This instrument is successful in evaluating the presence of depressive symptoms rather than their severity. Because of its ease of use by general practitioners, caution is advised to prevent excessive or inappropriate diagnoses of depressive disorders without further evaluation, especially if pharmacological treatment is warranted (Hennessey & Pallone, 2003). For example, when a patient is initially diagnosed with cancer, he or she may report significant emotional episodes of sadness, anger, pessimism, grief, and other feelings that are part of the normal process of coping with the tremendous shock of such a diagnosis. These experiences must be differentiated from major depressive tendencies. Consequently, the results of the BDI-FastScreen must be interpreted contextually (Hennessey & Pallone, 2003). The authors of this instrument should strongly discourage practitioners from making presumptions based on interpreting scores out of context (Hennessey & Pallone, 2003).

The BDI-FastScreen serves a special population in which depressive symptoms must be differentiated as a result of a medical diagnosis or alcohol or substance abuse. Some reviewers (Farmer, 2001; Whiston & Eder, 2003) believed the psychometric properties of the BDI-FastScreen and those of the BDI-II are closely aligned, and neither manual provides adequate psychometric information to justify its use. Even though the foundation of this assessment rests upon the well-established Beck reputation, the research that has been done on the BDI-FastScreen is somewhat limited (Hennessey & Pallone, 2003). Furthermore, the samples that have been studied are small and inadequately represent the diversity of individuals with substance abuse and other medical conditions (Hennessey & Pallone, 2003; Whiston & Eder, 2003). Forthcoming research on the BDI-FastScreen undoubtedly will include a more accurate representation of diverse populations and enlist participants from a wider range of geographical locations (Hennessey & Pallone, 2003). Regardless, the positive reviews of the BDI-II can be applied to the BDI-FastScreen for clinicians who seek further evaluative information (Whiston & Eder, 2003).

One reviewer (Whiston & Eder, 2003) concluded the cutoff scores are somewhat ambiguous and the manual contains an inadequate amount of information on the scoring categories of minimal, which ranges from 0 to 3; the mild category, ranging between 4 and 8, moderate between 9 and 12, and severe depression between 13 and 21. This same reviewer believed additional research was warranted on assessing the ability of the BDI-FastScreen to make a distinction between patients with major depressive disorders and those experiencing normal reactions and appropriate coping mechanisms (Hennessey & Pallone; Whiston & Eder, 2003).

General Evaluation

The BDI-FastScreen was specifically designed to fill a need in medical or clinical settings to identify the presence of depression in adolescents and adults with existing biological, medical, or substance abuse problems (Hennessy & Pallone, 2003; Whiston & Eder, 2003). The foundational research for this instrument is based on years of empirical study of the BDI-II and this abbreviated form shares its reliability and validity data. The 7 items, taken from the BDI-II address sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts (Whiston & Eder, 2003) and were designed to correspond to the diagnostic criteria for major depressive disorders defined in the DSM-IV (Hennessey & Pallone, 2003). As previously discussed, additional research is necessary to assess the BDI-FastScreen's ability to differentiate patients with major depressive disorders from those experiencing normal biological or psychological reactions to diagnosis or substance abuse (Whiston & Eder, 2003). Inasmuch, the recommendations of the authors should be heeded, that the BDI-FastScreen is neither a substitute for the BDI-II, nor is it a diagnostic tool, but it is a reliable information source when used as intended. One reviewer (Whiston & Eder, 2003) believed the high correlation between this instrument and measures of anxiety may imply that the BDI-FastScreen measures a construct that occurs in other psychological disorders. If this were the case, its value as a screen for depression in medical patients may be overestimated (Hennessey & Pallone, 2003).

                                                               Conclusion

Specifically designed to screen for depression in patients with biological, medical, or substance abuse problems, the BDI-FastScreen is a valuable tool that may also be used in counseling practice. Its ease of use and simple scoring procedures demonstrate its usability as a quick and easy assessment designed to screen a special population for depression. Leaning on the time-honored reputation of the Beck assessments and developing a reputation in its own right, the BDI-FastScreen should find widespread applicability for the populations for which it was designed. Its limitations should be considered, and it is not a diagnostic tool, but a source of valuable information used in concert with a comprehensive clinical evaluation (Whiston & Eder, 2003).

References

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Benedict, R., Fishman, I., McClellan, M., Bakshi, R., & Weinstock-Guttman, B. (2003). Validity of the Beck Depression Inventory-Fast Screen in multiple sclerosis. Multiple Sclerosis, 9(4), 393-396. doi: 10.1191/1352458503ms902oa

Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284-290. doi: 10.1037/1040-3590.6.4.284

Farmer, R. S. (2001). Review of the Beck Depression Inventory-II. In B. S. Plake & J. C. Impara (Eds.), The fourteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/

Hennessy, J., J. & Pallone, N., J. (2003). Review of the BDI-FastScreen for Medical Patients. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The seventeenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/

Krefetz, D. G., Steer, R. A., Jermyn, R. T., & Condoluci, D. V. (2004). Screening HIV-infected patients with chronic pain for anxiety and mood disorders with the Beck Anxiety and Depression Inventory-Fast Screens for medical settings. Journal of Clinical Psychology in Medical Settings, 11(4), 283-289. doi: 10.1023/B:JOCS.0000045348.28440.82

Pearson Education, Inc. (2012). Qualification Levels. Assessment and Information. Retrieved October 11, 2012, from http://www.pearsonassessments.com/haiweb/Cultures/en- US/Site/ProductsAndServices/HowToOrder/Qualifications.htm

Poole, H., Bramwell, R., & Murphy, P. (2009). The utility of the Beck Depression Inventory Fast Screen (BDI-FS) in a pain clinic population. European Journal of Pain, 13(8), 865-869. doi: 10.1016/j.ejpain.2008.09.017

Scheinthal, S. M., Steer, R. A., Giffin, L., & Beck, A. T. (2001). Evaluating geriatric medical outpatients with the Beck Depression Inventory-FastScreen for Medical Patients. Aging & Mental Health, 5(2), 143-148. doi: 10.1080/13607860120038320

Segal, D. L., & Hilsenroth, M. J. (2004). Comprehensive handbook of psychological assessment. Hoboken, NJ: John Wiley.

Strauss, E., Spreen, O., & Sherman, E. M. (2006). A Compendium of neuropsychological tests: Administration, norms, and commentary. New York: Oxford University Press.

Whiston, S., C. & Eder, K. (2003). Review of the BDI-FastScreen for Medical Patients. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The seventeenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/