Symptom prevalence differences of depression as measured by BDI and PHQ scales in the Look AHEAD study

Authors: VAUGHAN, ELIZABETH - Baylor College Of Medicine; JOHNSTON, CRAIG - University Of Houston; MORENO, JENNETTE - Children'S Nutrition Research Center (CNRC); CHESKIN, LAWRENCE - George Mason University; DUTTON, GARETH - University Of Alabama At Birmingham; GEE, MOLLY - Baylor College Of Medicine; GAUSSOIN, SARAH - Wake Forest School Of Medicine; KNOWLER, WILLIAM - National Institute Of Diabetes And Digestive And Kidney Diseases; REJESKI, W - Wake Forest School Of Medicine; WADDEN, THOMAS - University Of Pennsylvania; YANOVSKI, SUSAN - National Institute Of Diabetes And Digestive And Kidney Diseases; FOREYT, JOHN - Baylor College Of Medicine

Submitted to: Obesity Science & Practice
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/7/2019
Publication Date: 2/1/2020
Citation: Vaughan, E.M., Johnston, C.A., Moreno, J.P., Cheskin, L.J., Dutton, G.R., Gee, M., Gaussoin, S.A., Knowler, W.C., Rejeski, W.J., Wadden, T.A., Yanovski, S.Z., Foreyt, J.P. 2020. Symptom prevalence differences of depression as measured by BDI and PHQ scales in the Look AHEAD study. Obesity Science & Practice. 6(1):28-38. https://doi.org/10.1002/osp4.378.
DOI: https://doi.org/10.1002/osp4.378

Interpretive Summary: The goal of this study was to compare symptoms of depression when measured by two frequently used measures of depression, the Beck Depression Inventory (BDI-1A) and the shorter Patient Health Questionnaire (PHQ-9). Investigators used an existing dataset collected as part of the Look AHEAD study, which is a large trial conducted among adults with type 2 diabetes. The two measures demonstrated a high level of agreement in the level of depressive symptoms identified by the two measures. Differing classifications (minimal, mild, moderate, and severe) occurred for about 17% of the sample. Higher levels of bodily symptoms reported on the BDI-1A, having a history of cardiovascular disease, lower health related quality of life, and racial/ethnic minority group membership were associated with higher levels of disagreement. Overall, the results suggest that both measures can be used to assess symptoms of depression; however, further assessment is needed in those with higher levels of somatic symptoms, history of cardiovascular disease, decreased quality of life, and among racial and ethnic minority group members.

Technical Abstract: The objective of this study was to compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI-1A) and Patient Health Questionnaire (PHQ-9). Investigators conducted a cross-sectional secondary analysis of data collected as part of the follow-up observational phase of the Look AHEAD study. Rates of agreement between the BDI-1A and PHQ-9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease). A high level of agreement (kappa=0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI-1A and PHQ-9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI-1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health-related quality of life, and minority racial/ethnic classification. Either the BDI-1A or PHQ-9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.