Can Gender and Age Impact on Response Pattern of Depressive Symptoms Among College Students? A Differential Item Functioning Analysis.

Background: Self-reported depressive complaints among college students might indicate different degrees of severity of depressive states. Through the framework of item response theory, we aim to describe the pattern of responses to items of the Beck Depression Inventory-II (BDI-II), in terms of endorsement probability and discrimination along the continuum of depression. Potential differential item functioning of the scale items of the BDI-II is investigated, by gender and age, to compare across sub-groups of students. Methods: The 21-item BDI-II was cross-sectionally administered to a representative sample of 12,677 Brazilian college students. Reliability was evaluated based on Cronbach's alpha coefficient. Severity (b i ) and discrimination (a) parameters of each BDI-II items were calculated through the graded response model. The influence of gender and age were tested for differential item functioning (DIF) within the item response theory-based approach. Results: The BDI-II presented good reliability (α = 0.91). Women and younger students significantly presented a higher likelihood of depression (cut-off > 13) than men and older counterparts. In general, participants endorsed more easily cognitive-somatic items than affective items of the scale. "Guilty feelings," "suicidal thoughts," and "loss of interest in sex" were the items that most likely indicated depression severity (b ≥ 3.60). However, all BDI-II items showed moderate-to-high discrimination (a ≥ 1.32) for depressive state. While two items were flagged for DIF, "crying" and "loss of interest in sex," respectively for gender and age, the global weight of these items on the total score was negligible. Conclusions: Although respondents' gender and age might present influence on response pattern of depressive symptoms, the measures of self-reported symptoms have not inflated severity scores. These findings provide further support to the validity of using BDI-II for assessing depression in academic contexts and highlight the value of considering gender- and age-related common symptoms of depression.

Response pattern of depressive symptoms among college students: What lies behind items of the Beck Depression Inventory-II?

BACKGROUND: This study examines the response pattern of depressive symptoms in a nationwide student sample, through item analyses of a rating scale by both classical test theory (CTT) and item response theory (IRT). METHODS: The 21-item Beck Depression Inventory-II (BDI-II) was administered to 12,711 college students. First, the psychometric properties of the scale were described. Thereafter, the endorsement probability of depressive symptom in each scale item was analyzed through CTT and IRT. Graphical plots depicted the endorsement probability of scale items and intensity of depression. Three items of different difficulty level were compared through CTT and IRT approach. RESULTS: Four in five students reported the presence of depressive symptoms. The BDI-II items presented good reliability and were distributed along the symptomatic continuum of depression. Similarly, in both CTT and IRT approaches, the item 'changes in sleep' was easily endorsed, 'loss of interest' moderately and 'suicidal thoughts' hardly. Graphical representation of BDI-II of both methods showed much equivalence in terms of item discrimination and item difficulty. The item characteristic curve of the IRT method provided informative evaluation of item performance. LIMITATION: The inventory was applied only in college students. CONCLUSION: Depressive symptoms were frequent psychopathological manifestations among college students. The performance of the BDI-II items indicated convergent results from both methods of analysis. While the CTT was easy to understand and to apply, the IRT was more complex to understand and to implement. Comprehensive assessment of the functioning of each BDI-II item might be helpful in efficient detection of depressive conditions in college students.

Psychological and Cognitive Profile of Hypertensive and Diabetic Patients.

Chronic disorders such as hypertension and diabetes mellitus are often associated with depressive and anxiety symptoms, as well as cognitive decline. Once developed, psychological support is essential for improving the quality of life. This study is aimed at identifying impaired mental health in connection with these systemic metabolic disorders. A total of 34 patients were included in this cross-sectional study: 17 hypertensive individuals with a mean age of 59 ± 10 years, and 17 diabetic patients aged 54 ± 10 years. The following psychometric tests were used: Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and self-reporting questionnaire (SRQ-20). A large number of patients with high blood pressure or diabetes was associated with mental health problems (82% or 65%, respectively; p = 0.246). Affective disorder, especially moderate to severe depression, was seen mainly in diabetic patients (76%), whereas hypertensive individuals had higher prevalence of anxiety (64%). There was no cognitive impairment in this middle-aged population. This study shows a high proportion of depression and anxiety symptoms in patients with hypertension or diabetes mellitus, reinforcing the importance of psychiatric support for appropriate control of these metabolic disorders.

Improved cognitive, affective and anxiety measures in patients with chronic systemic disorders following structured physical activity.

Mental illnesses are frequent co-morbid conditions in chronic systemic diseases. High incidences of depression, anxiety and cognitive impairment complicate cardiovascular and metabolic disorders such as hypertension and diabetes mellitus. Lifestyle changes including regular exercise have been advocated to reduce blood pressure and improve glycaemic control. The purpose of this project was to evaluate the effect of physical training on the most prevalent corollary psychiatric problems in patients with chronic organic ailments. This longitudinal study assessed the mental health of hypertensive (age: 57 ± 8 years) and/or diabetic (age: 53 ± 8 years) patients using mini-mental state examination, Beck's depression inventory, Beck's anxiety inventory and self-reporting questionnaire-20 before and after a 3-month supervised resistance and aerobic exercise programme comprising structured physical activity three times a week. Clinically relevant improvement was observed in the Beck's depression inventory and Beck's anxiety inventory scores following the 12-week training (61%, p = 0.001, and 53%, p = 0.02, respectively). Even though statistically not significant (p = 0.398), the cognitive performance of this relatively young patient population also benefited from the programme. These results demonstrate positive effects of active lifestyle on non-psychotic mental disorders in patients with chronic systemic diseases, recommending exercise as an alternative treatment option.