WHAT DOES THE BECK DEPRESSION INVENTORY MEASURE IN CHRONIC PAIN - A REAPPRAISAL

The Beck Depression Inventory (BDI) is widely used to document the pre valence of depression in sufferers of chronic pain and in research des igns about this population. Williams and Richardson (1993) initially p osed the question, ''What does the BDI measure in chronic pain?''. Res ults from their study found 3 independent constructs, which differed s omewhat from those obtained in analyses with other non-pain subsamples . In our reappraisal of the question, we used confirmatory factor anal ytic procedures to assess the dimensionality of the BDI. Specifically, we questioned whether a hierarchical model in which a second-level de pression construct underlies 3 constituent first-level constructs is r easonable for the data. Our results, based on a sample of 247 chronic pain patients, corroborated the adequacy of this model. The first-leve l constituent constructs were labeled Negative Attitudes/Suicide, Perf ormance Difficulty, and Physiological Manifestations and were conceptu ally similar to first-level constructs obtained with other subsamples. Furthermore, external psychological measures and selected questionnai re items were used to assess convergent and discriminant validity of s cales operationalizing the factor-analytically derived constructs. Wit h these analyses, we clarify the constituents of depression as measure d by the BDI. The findings from this study have implications for more refined epidemiologic and clinical research with chronic pain patients .