Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury

Arch Phys Med Rehabil. 2009 Apr;90(4):652-6. doi: 10.1016/j.apmr.2008.10.028.


Objectives: Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives.

Design: This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI.

Setting: This study was completed at a Veterans Affairs (VA) Medical Center.

Participants: Participants were veterans eligible to receive VA health care services.

Interventions: Not applicable.

Main outcome measures: Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV).

Results: We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%).

Conclusions: Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Brain Injuries / complications*
  • Confidence Intervals
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / etiology
  • Diagnostic and Statistical Manual of Mental Disorders
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Glasgow Coma Scale
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Psychiatric Status Rating Scales*
  • ROC Curve
  • Sensitivity and Specificity
  • Stress Disorders, Post-Traumatic / complications
  • Veterans