Major depressive disorder in adolescents is closely linked to poor social, cognitive, and academic outcomes, including suicidality. The Beck Depression Inventory (BDI), a screening tool, is one of the most widely used instruments for detecting depression; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to systematically review and perform a meta-analysis to evaluate the accuracy of the BDI for detecting depression in adolescents. In August 2020, a search was conducted in the EMBASE, MEDLINE, CINAHL, and PsycArticles databases, and following a review against predefined eligibility criteria, 22 studies were finally included. The quality of the included articles was evaluated, and a hierarchical regression model was used to calculate the pooled estimates of sensitivity and specificity; 73.0% (95% CI; 62.0%, 81.8%) and 80.3% (72.8%, 86.1%) in cutoff 16, respectively. The findings indicated the BDI is a reliable and useful tool to screen adolescents’ depression.
*AdewuyaA. O.OlaB. A.AlobaO. O. (2007). Prevalence of major depressive disorders and a validation of the beck depression inventory among nigerian adolescents. European Child & Adolescent Psychiatry, 16(5), 287–292. https://doi.org/10.1007/s00787-006-0557-0
2.
*AmbrosiniP. J.MetzC.BianchiM. D.RabinovichH.UndieA. (1991). Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 30(1), 51–57.
3.
American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders. American Psychiatric Association.
4.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Association.
5.
*ArayaR.Montero-MarinJ.BarroilhetS.FritschR.GaeteJ.MontgomeryA. (2013). Detecting depression among adolescents in Santiago, Chile: Sex differences. BMC Psychiatry, 13(1), 122.
6.
AvenevoliS.SwendsenJ.HeJ. P.BursteinM.MerikangasK. R. (2015). Major depression in the national comorbidity survey-adolescent supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 37–44.e2. https://doi.org/10.1016/j.jaac.2014.10.010
7.
*BarreraM.Garrison-JonesC. V. (1988). Properties of the Beck Depression Inventory as a screening instrument for adolescent depression. Journal of Abnormal Child Psychology, 16(3), 263–273.
8.
*BaskerM.MosesP. D.RussellS.RussellP. S. (2007). The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. Child and Adolescent Psychiatry and Mental Health, 1(1), 8. https://doi.org/10.1186/1753-2000-1-8
9.
BeckA. J.SingerP. M.BucheJ.ManderscheidR. W.BuerhausP. (2018). Improving data for behavioral health workforce planning: Development of a minimum data set. American Journal of Preventive Medicine, 54(6Suppl 3), S192–S198. https://doi.org/10.1016/j.amepre.2018.01.035
*BennettD. S.AmbrosiniP. J.BianchiM.BarnettD.MetzC.RabinovichH. (1997). Relationship of Beck Depression Inventory factors to depression among adolescents. Journal of Affective Disorders, 45(3), 127–134. https://doi.org/10.1016/S0165-0327(97)00045-1
12.
BjorkmanA.AnderssonK.BergströmJ.Salzmann-EriksonM. (2018). Increased mental illness and the challenges this brings for district nurses in primary care settings. Issues in Mental Health Nursing, 39(12), 1023–1030.
13.
ByrneB. M.BaronP.CampbellT. L. (1994). The Beck Depression Inventory (French version): Testing for gender-invariant factorial structure for nonclinical adolescents. Journal of Adolescent Research, 9(2), 166–179.
14.
*CanalsJ.BladéJ.CarbajoG.Domènech-LLaberíaE. (2001). The Beck Depression Inventory: Psychometric characteristics and usefulness in nonclinical adolescents. European Journal of Psychological Assessment, 17(1), 63–68. https://doi.org/10.1027//1015-5759.17.1.63
15.
Center for Behavioral Health Statistics and Quality. (2018). 2017 national survey on drug use and health: Methodological summary and definitions. Substance Abuse and Mental Health Services Administration.
16.
ChangS. M.MatcharD. B.SmetanaG. W.UmscheidC. A.GrayR.TorchiaM. (2012). Methods guide for medical test reviews. Agency for Healthcare Research and Quality.
17.
ClayborneZ. M.VarinM.ColmanI. (2019). Systematic review and meta-analysis: Adolescent depression and long-term psychosocial outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 58(1), 72–79. https://doi.org/10.1016/j.jaac.2018.07.896
18.
DevilléW. L.BuntinxF.BouterL. M.MontoriV. M.De VetH. C.Van der WindtD. A.BezemerP. D. (2002). Conducting systematic reviews of diagnostic studies: Didactic guidelines. BMC medical research methodology, 2(1), 1–13.
19.
*DolleK.Schulte-KörneG.O’LearyA. M.von HofackerN.IzatY.AllgaierA. K. (2012). The Beck depression inventory-II in adolescent mental health patients: Cut-off scores for detecting depression and rating severity. Psychiatry Research, 200(2-3), 843–848.
20.
EdelsteinB.Shreve-NeigerA.ScheckS. (2004). Depression in late life. In SpielbergerC. (Ed.), Encyclopedia of applied psychology (pp. 593–599). Academic Press.
21.
HagenB. (2007). Measuring melancholy: A critique of the Beck Depression Inventory and its use in mental health nursing. International Journal of Mental Health Nursing, 16(2), 108–115.
22.
HuangC.ChenJ. H. (2015). Meta-Analysis of the factor structures of the Beck Depression Inventory-II. Assessment, 22(4), 459–472. https://doi.org/10.1177/1073191114548873
23.
JohnsonD.DupuisG.PicheJ.ClayborneZ.ColmanI. (2018). Adult mental health outcomes of adolescent depression: A systematic review. Depression and Anxiety, 35(8), 700–716.
24.
*KashaniJ. H.ShermanD. D.ParkerD. R.ReidJ. C. (1990). Utility of the Beck Depression Inventory with clinic-referred adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 29(2), 278–282. https://doi.org/10.1097/00004583-199003000-00018
25.
KimK. W.LeeJ.ChoiS. H.HuhJ.ParkS. H. (2015). Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-part I. General guidance and tips. Korean Journal of Radiology, 16(6), 1175–1187.
26.
*KimM. H.MazengaA. C.DevandraA.AhmedS.KazembeP. N.YuX.NguyenC.SharpC. (2014). Prevalence of depression and validation of the Beck Depression Inventory-II and the Children’s Depression Inventory-short amongst HIV-positive adolescents in Malawi. Journal of the International Aids Society, 17(1), 18965. https://doi.org/10.7448/IAS.17.1.18965
27.
*KrefetzD. G.SteerR. A.GulabN. A.BeckA. T. (2002). Convergent validity of the Beck Depression Inventory-II with the Reynolds adolescent depression scale in psychiatric inpatients. Journal of Personality Assessment, 78(3), 451–460. https://doi.org/10.1207/S15327752JPA7803_05
LeeJ.KimK. W.ChoiS. H.HuhJ.ParkS. H. (2015). Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-part II. Statistical methods of meta-analysis. Korean Journal of Radiology, 16(6), 1188–1196.
30.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GøtzscheP. C.IoannidisJ. P.ClarkeM.DevereauxP. J.KleijnenJ.MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Journal of Clinical Epidemiology, 62(10), e1–e34.
31.
LimS. Y.LeeE. J.JeongS. W.KimH. C.JeongC. H.JeonT. Y.KimJ. B. (2011). The validation study of Beck Depression Scale 2 in Korean version. Anxiety and mood, 7(1), 48–53.
32.
MacaskillP.GatsonisC.DeeksJ.HarbordR.TakwoingiY. (2010). Cochrane handbook for systematic reviews of diagnostic test accuracy. Version 0.9. 0 (p. 83). The Cochrane Collaboration.
33.
*MartinsC. D. S. R.MottaJ. V. D. S.QuevedoL. A.de MatosM. B.PinheiroK. A. T.SouzaL. D. D. M.da SilvaR. A.PinheiroR. T.CoelhoF. M. D. C. (2015). Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in southern Brazil. Journal of Affective Disorders, 177, 95–100. https://doi.org/10.1016/j.jad.2015.01.051
34.
*MartonP.ChurchardM.KutcherS.KorenblumM. (1991). Diagnostic utility of the Beck Depression Inventory with adolescent psychiatric outpatients and inpatients. The Canadian Journal of Psychiatry, 36(6), 428–431. https://doi.org/10.1177/070674379103600608
35.
McInnesM. D. F.MoherD.ThombsB. D.McGrathT. A.BossuytP. M.CliffordT.CohenJ. F.DeeksJ. J.GatsonisC.HooftL.HuntH. A.HydeC. J.KorevaarD. A.LeeflangM. M. G.MacaskillP.ReitsmaJ. B.RodinR.RutjesA. W. S.SalamehJ. P.. . . WillisB. H. (2018). Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: The PRISMA-DTA statement. The Journal of the American Medical Association, 319(4), 388–396.
36.
NeinsteinL. S.KatzmanD. K.CallahanT.GordonC. M.JoffeA.RickertV. (2016). Neinstein’s adolescent and young adult health care (6th revis ed ed.). Lippincott Williams and Wilkins.
37.
ReitsmaJ. B.GlasA. S.RutjesA. W.ScholtenR. J.BossuytP. M.ZwindermanA. H. (2005). Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. Journal of Clinical Epidemiology, 58(10), 982–990.
38.
*RobertsR. E.LewinsohnP. M.SeeleyJ. R. (1991). Screening for adolescent depression: A comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry, 30(1), 58–66. https://doi.org/10.1097/00004583-199101000-00009
39.
RosemanM.KlodaL. A.SaadatN.RiehmK. E.IckowiczA.BaltzerF.KatzL. Y.PattenS. B.RousseauC.ThombsB. D. (2016). Accuracy of depression screening tools to detect major depression in children and adolescents: A systematic review. The Canadian Journal of Psychiatry, 61(12), 746–757.
40.
*RussellP. S.BaskerM.RussellS.MosesP. D.NairM. K. C.MinjuK. A. (2012). Comparison of a self-rated and a clinician-rated measure for identifying depression among adolescents in a primary-care setting. Indian Journal of Pediatrics, 79(S1), 45–51.
41.
*SalleE.RochaN. S.RochaT. S.NunesC.ChavesM. L. F. (2012). Escalas psicométricas como instrumentos de rastreamento para depressão em estudantes do ensino médio. Archives of Clinical Psychiatry, 39(1), 24–27. https://doi.org/10.1590/s0101-60832012000100005
42.
SavilahtiE. M.HaravuoriH.Rytilä-ManninenM.LindbergN.KettunenK.MarttunenM. (2018). High beck depression inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style. Psychiatry Research, 263, 61–68. https://doi.org/10.1016/j.psychres.2018.02.040
43.
*ShafferD.ScottM.WilcoxH.MaslowC.HicksR.LucasC. P.GarfinkelR.GreenwaldS. (2004). The Columbia SuicideScreen: Validity and reliability of a screen for youth suicide and depression. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 71–79. https://doi.org/10.1097/00004583-200401000-00016
44.
*SheanG.BaldwinG. (2008). Sensitivity and specificity of depression questionnaires in a college-age sample. The Journal of Genetic Psychology, 169(3), 281–292. https://doi.org/10.3200/gntp.169.3.281-292
45.
SpreenO. S. E. (1998). A compendium of neuropsychological tests. Administration, Norms and commentary (2 ed.). Oxford University Press.
46.
StockingsE.DegenhardtL.LeeY. Y.MihalopoulosC.LiuA.HobbsM.PattonG. (2015). Symptom screening scales for detecting major depressive disorder in children and adolescents: A systematic review and meta-analysis of reliability, validity and diagnostic utility. Journal of Affective Disorders, 174, 447–463. https://doi.org/10.1016/j.jad.2014.11.061
47.
*StroberM.GreenJ.CarlsonG. (1981). Utility of the Beck Depression Inventory with psychiatrically hospitalized adolescents. Journal of Consulting and Clinical Psychology, 49(3), 482–483.
48.
*SubramaniamG.HarrellP.HuntleyE.TracyM. (2009). Beck Depression Inventory for depression screening in substance-abusing adolescents. Journal of Substance Abuse Treatment, 37(1), 25–31. https://doi.org/10.1016/j.jsat.2008.09.008
49.
ThompsonR. D.CraigA. E.MrakotskyC.BousvarosA.DeMasoD. R.SzigethyE. (2012). Using the children’s depression inventory in youth with inflammatory bowel disease: Support for a physical illness-related factor. Comprehensive Psychiatry, 53(8), 1194–1199.
50.
TrikalinosT.BalionC.ColemanC.GriffithL.SantaguidaP. L.VandermeerB.FuR. (2012). Chapter 8: Meta-analysis of test performance when there is a “Gold Standard”. Journal of General Internal Medicine, 27, S56–66. https://doi.org/10.1007/s11606-012-2029-1
51.
*UsluR. I.KapciE. G.OncuB.UgurluM.TurkcaparH. (2008). Psychometric properties and cut-off scores of the Beck Depression Inventory-II in Turkish adolescents. Journal of Clinical Psychology in Medical Settings, 15(3), 225–233. https://doi.org/10.1007/s10880-008-9122-y
52.
WangY. P.GorensteinC. (2013). Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria, 35(4), 416–431. https://doi.org/10.1590/1516-4446-2012-1048
53.
WhismanM. A.PerezJ. E.RamelW. (2000). Factor structure of the Beck Depression Inventory—Second edition (BDI-II) in a student sample. Journal of Clinical Psychology, 56(4), 545–551.
54.
*WhitakerA.JohnsonJ.ShafferD.RapoportJ. L.KalikowK.WalshB. T.DolinskyA. (1990). Uncommon troubles in young people: Prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population. Archives of General Psychiatry, 47(5), 487–496.
55.
WhitingP. FRutjesA. W.ReitsmaJ. B.BossuytP. M.KleijnenJ. (2003). The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 3(1), 25–13.
56.
WhitingP. F.RutjesA. W.WestwoodM. E.MallettS.DeeksJ. J.ReitsmaJ. B.LeeflangM. M.SterneJ. A.BossuytP. M. (2011). QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine, 155(8), 529–536.
57.
WiebeJ. S.PenleyJ. A. (2005). A psychometric comparison of the Beck Depression Inventory-II in English and Spanish. Psychological Assessment, 17(4), 481–485.
58.
ZuckerbrotR. A.CheungA.JensenP. S.SteinR. E. K.LaraqueD. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), e20174081. https://doi.org/10.1542/peds.2017-4081
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