Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample

Affiliations


Abstract

Background: An understanding of depressive symptomatology from the perspective of confirmatory factor analysis (CFA) could facilitate valid and interpretable comparisons across cultures. The objectives of the study were: (i) using the responses of a sample of Arab college students to the Beck Depression Inventory (BDI-II) in CFA, to compare the "goodness of fit" indices of the original dimensional three-and two-factor first-order models, and their modifications, with the corresponding hierarchical models (i.e., higher - order and bifactor models); (ii) to assess the psychometric characteristics of the BDI-II, including convergent/discriminant validity with the Hopkins Symptom Checklist (HSCL-25).

Method: Participants (N = 624) were Kuwaiti national college students, who completed the questionnaires in class. CFA was done by AMOS, version 16. Eleven models were compared using eight "fit" indices.

Results: In CFA, all the models met most "fit" criteria. While the higher-order model did not provide improved fit over the dimensional first - order factor models, the bifactor model (BFM) had the best fit indices (CMNI/DF = 1.73; GFI = 0.96; RMSEA = 0.034). All regression weights of the dimensional models were significantly different from zero (P < 0.001). Standardized regression weights were mostly 0.27-0.60, and all covariance paths were significantly different from zero. The regression weights of the BFM showed that the variance related to the specific factors was mostly accounted for by the general depression factor, indicating that the general depression score is an adequate representation of severity. The BDI-II had adequate internal consistency and convergent/discriminant validity. The mean BDI score (15.5, SD = 8.5) was significantly higher than those of students from other countries (P < 0.001).

Conclusion: The broadly adequate fit of the various models indicates that they have some merit and implies that the relationship between the domains of depression probably contains hierarchical and dimensional elements. The bifactor model is emerging as the best way to account for the clinical heterogeneity of depression. The psychometric characteristics of the BDI-II lend support to our CFA results.


Figures


Similar articles

Relationship between symptoms of anxiety and depression in a sample of Arab college students using the Hopkins Symptom Checklist 25.

Al-Turkait FA, Ohaeri JU, El-Abbasi AH, Naguy A.Psychopathology. 2011;44(4):230-41. doi: 10.1159/000322797. Epub 2011 Apr 19.PMID: 21502775

Exploratory factor analytical study of depressive symptomatology: an Arab experience with a sample comprising college students, using the revised Beck Depression Inventory.

Al-Turkait FA, Ohaeri JU.Ann Saudi Med. 2012 Jan-Feb;32(1):19-26. doi: 10.5144/0256-4947.2012.19.PMID: 22156635 Free PMC article.

[A study of the psychometric properties of the Icelandic translation of Obsessive Thoughts Checklist (OTC) with confirmatory factor analysis].

Smári J, Thor Olason D.Encephale. 2005 Mar-Apr;31(2):144-51. doi: 10.1016/s0013-7006(05)82381-4.PMID: 15959441 French.

On the validity of the Beck Depression Inventory. A review.

Richter P, Werner J, Heerlein A, Kraus A, Sauer H.Psychopathology. 1998;31(3):160-8. doi: 10.1159/000066239.PMID: 9636945 Review.

Psychometric properties of the Beck Depression Inventory-II: a comprehensive review.

Wang YP, Gorenstein C.Braz J Psychiatry. 2013 Oct-Dec;35(4):416-31. doi: 10.1590/1516-4446-2012-1048. Epub 2013 Dec 23.PMID: 24402217 Review.


Cited by

Online Mindfulness-Based Logotherapy Program: A Pilot Study Targeting Depressive Symptoms of Cyberbullied Adolescents During the Covid-19 Pandemic.

Maria Michael J, Reyes MES.J Technol Behav Sci. 2023;8(1):1-9. doi: 10.1007/s41347-022-00279-x. Epub 2022 Sep 10.PMID: 36117749 Free PMC article.

Psychological Problems in a Sample of Jordanian Healthcare Workers Involved in Caring for Patients With COVID-19: A Cross-Sectional Study.

Alhalaiqa FN, Khalifeh AH, Al Omari O, Yehia DB, Khalil MMH.Front Psychol. 2021 Aug 26;12:679785. doi: 10.3389/fpsyg.2021.679785. eCollection 2021.PMID: 34512440 Free PMC article.

The Psychometric Properties of the Chinese Version of the Beck Depression Inventory-II With Middle School Teachers.

Wang X, Wang Y, Xin T.Front Psychol. 2020 Sep 29;11:548965. doi: 10.3389/fpsyg.2020.548965. eCollection 2020.PMID: 33132958 Free PMC article.

Evaluating hierarchical items of the geriatric depression scale through factor analysis and item response theory.

Wongpakaran N, Wongpakaran T, Kuntawong P.Heliyon. 2019 Aug 13;5(8):e02300. doi: 10.1016/j.heliyon.2019.e02300. eCollection 2019 Aug.PMID: 31463401 Free PMC article.

Dimensions of Anxiety, Age, and Gender: Assessing Dimensionality and Measurement Invariance of the State-Trait for Cognitive and Somatic Anxiety (STICSA) in an Italian Sample.

Carlucci L, Watkins MW, Sergi MR, Cataldi F, Saggino A, Balsamo M.Front Psychol. 2018 Nov 27;9:2345. doi: 10.3389/fpsyg.2018.02345. eCollection 2018.PMID: 30538658 Free PMC article.


KMEL References


References

  1.  
    1. Shafer AB. Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton and Zung. J Clin Psychol. 2006;62:123–146. doi: 10.1002/jclp.20213. - DOI - PubMed
  2.  
    1. Simms LJ, Gros DF, Watson D, O'Hara MW. Parsing the general and specific components of depression and anxiety with bifactor modeling. Depress Anxiety. 2008;25:E34–E46. doi: 10.1002/da.20432. - DOI - PubMed
  3.  
    1. Nuevo R, Dunn G, Dowrick C, Vázquez-Barquero JL, Casey P, Dalgard OS, Lehtinen V, Ayuso-Mateos JL. Cross-cultural equivalence of the Beck Depression Inventory: a five-country analysis from the ODIN study. J Affect Disord. 2009;114:156–62. doi: 10.1016/j.jad.2008.06.021. - DOI - PubMed
  4.  
    1. Duncan LE, Hutchison KE, Carey G, Craighead WE. Variation in brain-derived neurotrophic factor (BDNF) gene is associated with symptoms of depression. J Affect Disord. 2009;115:215–219. doi: 10.1016/j.jad.2008.08.016. - DOI - PMC - PubMed
  5.  
    1. Schotte CK, Maes M, Cluydts R, De Doncker D, Cosyns P. Construct validity of the Beck Depression Inventory in a depressive population. J Affect Disord. 1997;46:115–125. doi: 10.1016/S0165-0327(97)00094-3. - DOI - PubMed
  6.  
    1. Pujol J, Bello J, Deus J, Cardoner N, Martí-Vilalta JL, Capdevila A. Beck Depression Inventory factors related to demyelinating lesions of the left arcuate fasciculus region. Psychiatry Res. 2000;99:151–159. doi: 10.1016/S0925-4927(00)00061-5. - DOI - PubMed
  7.  
    1. Thombs BD, Ziegelstein RC, Parakh K, Stewart DE, Abbey SE, Grace SL. Probit structural equation regression model: general depressive symptoms predicted post-myocardial infarction mortality after controlling for somatic symptoms of depression. J Clin Epidemiol. 2008;61:832–839. doi: 10.1016/j.jclinepi.2007.09.008. - DOI - PubMed
  8.  
    1. Grunebaum MF, Keilp J, Li S, Ellis SP, Burke AK, Oquendo MA, Mann JJ. Symptom components of standard depression scales and past suicidal behavior. J Affect Disord. 2005;87:73–82. doi: 10.1016/j.jad.2005.03.002. - DOI - PubMed
  9.  
    1. Bennett DS, Ambrosini PJ, Bianchi M, Barnett D, Metz C, Rabinovich H. Relationship of Beck Depression Inventory factors to depression among adolescents. J Affect Disord. 1997;45:127–134. doi: 10.1016/S0165-0327(97)00045-1. - DOI - PubMed
  10.  
    1. Demyttenaere K, De Fruyt J. Getting what you ask for: on the selectivity of depression rating scales. Psychother Psychosom. 2003;72:61–70. doi: 10.1159/000068690. - DOI - PubMed
  11.  
    1. American Psychiatric Association. Arlington VA. 4 1994. Diagnostic and statistical manual for mental disorders.
  12.  
    1. Beck AT, Steer RA, Brown GK. Beck Depression Inventory manual. 2. San Antonio, TX: Psychological Corporation; 1996.
  13.  
    1. Harris CA, D'Eon JL. Psychometric properties of the Beck Depression Inventory - second edition (BDI-II) in individuals with chronic pain. Pain. 2008;137:609–622. doi: 10.1016/j.pain.2007.10.022. - DOI - PubMed
  14.  
    1. Byrne BM. Factor analytic models: viewing the structure of an assessment instrument from three perspectives. J Pers Assess. 2005;85:17–32. doi: 10.1207/s15327752jpa8501_02. - DOI - PubMed
  15.  
    1. Steer RA, Ball R, Ranieri WF. Dimensions of the Beck Depression Inventory -II in clinically depressed outpatients. J Clin Psychol. 1999;55:117–128. doi: 10.1002/(SICI)1097-4679(199901)55:1<117::AID-JCLP12>3.0.CO;2-A. - DOI - PubMed
  16.  
    1. Whisman MA, Perez JE, Ramel W. Factor structure of the Beck Depression Inventory- second edition (BDI-II) in a student sample. J Clin Psychol. 2000;56:545–551. doi: 10.1002/(SICI)1097-4679(200004)56:4<545::AID-JCLP7>3.0.CO;2-U. - DOI - PubMed
  17.  
    1. Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory -second edition in a sample of college students. Depress Anxiety. 2004;19:187–189. doi: 10.1002/da.20002. - DOI - PubMed
  18.  
    1. Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the Beck Depression Inventory-II. Psychol Assess. 1998;10:83–89. doi: 10.1037/1040-3590.10.2.83. - DOI
  19.  
    1. Palmer EJ, Binks C. Psychometric properties of the Beck Depression Inventory-II with incarcerated male offenders aged 18-21 years. Crim Behav Ment Health. 2008;18:232–242. doi: 10.1002/cbm.701. - DOI - PubMed
  20.  
    1. Munoz DJ, Chen E, Fischer S, Roehrig M, Sanchez-Johnson L, Alverdy J, Dymek-Valentine M, le Grange D. Considerations for the use of the Beck Depression Inventory in the assessment of weight-loss surgery seeking patients. Obes Surg. 2007;17:1097–101. doi: 10.1007/s11695-007-9185-0. - DOI - PubMed
  21.  
    1. Basker M, Moses PD, Russell S, Russell PS. The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. Child Adolesc Psychiatry Ment Health. 2007;1(1):8. doi: 10.1186/1753-2000-1-8. - DOI - PMC - PubMed
  22.  
    1. Poole H, Bramwell R, Murphy P. Factor Structure of the Beck Depression Inventory-II in patients With chronic pain. Clin J Pain. 2006;22:790–8. doi: 10.1097/01.ajp.0000210930.20322.93. - DOI - PubMed
  23.  
    1. Visser M, Leentjens AF, Marinus J, Stiggelbout AM, van Hilten JJ. Reliability and validity of the Beck depression inventory in patients with Parkinson's disease. Mov Disord. 2006;21:668–72. doi: 10.1002/mds.20792. - DOI - PubMed
  24.  
    1. Penley JA, Wiebe JS, Nwosu A. Psychometric properties of the Spanish Beck Depression Inventory-II in a medical sample. Psychol Assess. 2003;15:569–77. doi: 10.1037/1040-3590.15.4.569. - DOI - PubMed
  25.  
    1. Kojima M, Furukawa TA, Takahashi H, Kawai M, Nagaya T, Tokudome S. Cross-cultural validation of the Beck Depression Inventory-II in Japan. Psychiatry Res. 2002;110:291–9. doi: 10.1016/S0165-1781(02)00106-3. - DOI - PubMed
  26.  
    1. Wiebe JS, Penley JA. A psychometric comparison of the Beck Depression Inventory-II in English and Spanish. Psychol Assess. 2005;17:481–485. doi: 10.1037/1040-3590.17.4.481. - DOI - PubMed
  27.  
    1. Ghassemzadeh H, Mojtabai R, Karamghadiri N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21:185–192. doi: 10.1002/da.20070. - DOI - PubMed
  28.  
    1. Gorenstein C, Andrade L, Zanolo E, Artes R. Expression of depressive symptoms in a nonclinical Brazilian adolescent sample. Can J Psychiatry. 2005;50:129–136. - PubMed
  29.  
    1. Bonilla J, Bernal G, Santos A, Santos D. A revised Spanish version of the Beck Depression Inventory: psychometric properties with a Puerto Rican sample of college students. J Clin Psychol. 2004;60:119–130. doi: 10.1002/jclp.10195. - DOI - PubMed
  30.  
    1. Hayden MJ, Dixon JB, Dixon ME, O'Brien PE. Confirmatory Factor Analysis of the Beck Depression Inventory in Obese Individuals Seeking Surgery. Obes Surg. 2009. Epub Sep18. - PubMed
  31.  
    1. Vanheule S, Desmet M, Groenvynck H, Rosseel Y, Fontaine J. The factor structure of the Beck Depression Inventory-II: an evaluation. Assessment. 2008;15:177–87. doi: 10.1177/1073191107311261. - DOI - PubMed
  32.  
    1. Dunkel D, Froehlich S, Antretter E, Haring C. Replication of a two-factor model of the Beck Depression Inventory in alcohol dependents and suicide attempters. Psychopathology. 2002;35:228–33. doi: 10.1159/000063828. - DOI - PubMed
  33.  
    1. Buckley TC, Parker JD, Heggie J. A psychometric evaluation of the BDI-II in treatment-seeking substance abusers. J Substance Abuse Treat. 2001;20:197–204. doi: 10.1016/S0740-5472(00)00169-0. - DOI - PubMed
  34.  
    1. Tashakkori A, Barefoot J, Mehryar AH. What does the Beck Depression Inventory measure in college students? Evidence from a non-western culture. J Clin Psychol. 1989;45:595–602. doi: 10.1002/1097-4679(198907)45:4<595::AID-JCLP2270450415>3.0.CO;2-4. - DOI - PubMed
  35.  
    1. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory: a review. Psychopathology. 1998;31:160–168. doi: 10.1159/000066239. - DOI - PubMed
  36.  
    1. Al-Musawi NM. Psychometric properties of the Beck Depression Inventory-II with university students in Bahrain. J Personal Assessment. 2001;77:568–579. doi: 10.1207/S15327752JPA7703_13. - DOI - PubMed
  37.  
    1. Cook KF, Kallen MA, Amtmann D. Having a fit: impact of number of items and distribution of data on traditional criteria for assessing IRT's unidimensionality assumption. Qual Life Res. 2009;18:447–460. doi: 10.1007/s11136-009-9464-4. - DOI - PMC - PubMed
  38.  
    1. Siegert RJ, Walkey FH, Turner-Stokes L. An examination of the factor structure of the Beck Depression Inventory-II in a neurorehabilitation inpatient sample. J Int Neuropsychol Soc. 2009;15:142–147. doi: 10.1017/S1355617708090048. - DOI - PubMed
  39.  
    1. Arnarson TO, Olason DT, Smári J, Sigurethsson JF. The Beck Depression Inventory Second Edition (BDI-II): psychometric properties in Icelandic student and patient populations. Nord J Psychiatry. 2008;62:360–365. doi: 10.1080/08039480801962681. - DOI - PubMed
  40.  
    1. Grothe KB, Dutton GR, Jones GN, Bodenlos J, Ancona M, Brantley PJ. Validation of the Beck Depression Inventory-II in a low-income African American sample of medical outpatients. Psychol Assess. 2005;17:110–114. doi: 10.1037/1040-3590.17.1.110. - DOI - PubMed
  41.  
    1. Novy DM, Nelson DV, Berry LA, Averill PM. What does the Beck Depression Inventory measure in chronic pain?: a reappraisal. Pain. 1995;61:261–270. doi: 10.1016/0304-3959(94)00191-G. - DOI - PubMed
  42.  
    1. Thombs BD, Ziegelstein RC, Beck CA, Pilote L. A general factor model for the Beck Depression Inventory-II: validation in a sample of patients hospitalized with acute myocardial infarction. J Psychosom Res. 2008;65:115–121. doi: 10.1016/j.jpsychores.2008.02.027. - DOI - PubMed
  43.  
    1. Ward LC. Comparison of factor structure models for the Beck Depression Inventory -II. Psychol Assess. 2006;18:81–88. doi: 10.1037/1040-3590.18.1.81. - DOI - PubMed
  44.  
    1. Patrick CJ, Hicks BM, Nichol PE, Krueger RF. A bifactor approach to modeling the structure of the psychopathy checklist -revised. J Pers Disord. 2007. pp. 118–141. - DOI - PMC - PubMed
  45.  
    1. Holzinger K, Swineford F. The bi-factor method. Psychometrika. 1937;2:41–54. doi: 10.1007/BF02287965. - DOI
  46.  
    1. Yang FM, Jones RN. Measurement differences in depression: chronic health-related and socio-demographic effects in older Americans. Psychosom Med. 2008;70:993–1004. doi: 10.1097/PSY.0b013e31818ce4fa. - DOI - PMC - PubMed
  47.  
    1. Chen FF, West SG, Sousa KH. A Comparison of Bifactor and Second-Order Models of Quality of Life. Multivariate Behav Res. 2006;41:189–225. doi: 10.1207/s15327906mbr4102_5. - DOI - PubMed
  48.  
    1. Zinbarg RE, Barlow DH. Structure of anxiety and the anxiety disorders: a hierarchical model. J Abnormal Psychol. 1996;105:181–193. doi: 10.1037/0021-843X.105.2.181. - DOI - PubMed
  49.  
    1. Watson D, O'Hara MW, Stuart S. Hierarchical structures of affect and psychopathology and their implications for the classification of emotional disorders. Depress Anxiety. 2008;25:282–288. doi: 10.1002/da.20496. - DOI - PubMed
  50.  
    1. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report inventory. Behav Sci. 1974;19:1–15. doi: 10.1002/bs.3830190102. - DOI - PubMed
  51.  
    1. Hamdan A, Hawamdeh S, Hussein A. The prevalence and correlates of depressive symptoms among Arab women in a primary health care setting. Int J Psychiatry Med. 2008;38:453–67. doi: 10.2190/PM.38.4.e. - DOI - PubMed
  52.  
    1. Al-Otaibi B, Al-Weqayyan A, Taher H, Sarkhou E, Gloom A, Aseeri F, Al-Mousa E, Al-Zoubi H, Habeeba S. Depressive symptoms among Kuwaiti population attending primary healthcare setting: prevalence and influence of sociodemographic factors. Med Princ Pract. 2007;16:384–8. doi: 10.1159/000104813. - DOI - PubMed
  53.  
    1. Arbuckle JL, Wothke W. AMOS 4.0 User's Guide. SmallWaters, Corporation, Chicago, IL. 1999.
  54.  
    1. Hooper D, Coughlan J, Mullen MR. Structural Equation Modelling: Guidelines for Determining Model Fit. Electronic J Business Res Methods. 2008;6:53–60.
  55.  
    1. West SG, Finch JF, Curran PJ. Structural equation models with non-normal variables. Problems and remedies. In R. Hoyle (ed), Structural Equation Modeling: concepts, issues and applications. Newbury Park, CA: Sage. 1995. pp. 56–75.
  56.  
    1. Crowley SL, Xitao F. Structural equation modeling: basic concepts and applications in personality assessment research. J Person Assess. 1997;68:508–531. doi: 10.1207/s15327752jpa6803_4. - DOI - PubMed
  57.  
    1. Bech P. Applied psychometrics in clinical psychiatry: the pharmacopsychometric triangle. Acta Psychiatr Scand. 2009;120:400–409. doi: 10.1111/j.1600-0447.2009.01445.x. - DOI - PubMed
  58.  
    1. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnormal Psychol. 1991;100:316–336. doi: 10.1037/0021-843X.100.3.316. - DOI - PubMed
  59.  
    1. Reise SP, Morizot J, Hays RD. The role of the bifactor model in resolving dimensionality issues in health outcome measures. Qual Life Res. 2007;16(suppl 1):19–31. doi: 10.1007/s11136-007-9183-7. - DOI - PubMed
  60.  
    1. Toplak ME, Pitch A, Flora DB, Iwenofu L, Ghelani K, Jain U, Tannock R. The unity and diversity of inattention and hyperactivity/impulsivity in ADHD: evidence for a general factor with separable dimensions. J Abnormal Child Psychol. 2009;37:1137–1150. doi: 10.1007/s10802-009-9336-y. - DOI - PubMed
  61.  
    1. Al-Turkait FA, Ohaeri JU. Prevalence and correlates of posttraumatic stress disorder among Kuwaiti military men according to level of involvement in the First Gulf War. Depress Anxiety. 2008;25:932–941. doi: 10.1002/da.20373. - DOI - PubMed
  62.  
    1. Al-Turkait FA, Ohaeri JU. Posttraumatic stress disorder among wives of Kuwaiti veterans of the First Gulf War. J Anxiety Disord. 2008;22:18–31. doi: 10.1016/j.janxdis.2007.01.011. - DOI - PubMed
  63.  
    1. Al-Turkait FA, Ohaeri JU. Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war. Child Adolesc Psychiatry Ment Health. 2008;2(1):12. doi: 10.1186/1753-2000-2-12. - DOI - PMC - PubMed
  64.  
    1. Tanios CY, Abou-Saleh MT, Karam AN, Salamoun MM, Mneimneh ZN, Karam EG. The epidemiology of anxiety disorders in the Arab world: a review. J Anxiety Disord. 2009;23:409–419. doi: 10.1016/j.janxdis.2008.10.009. - DOI - PubMed
  65.  
    1. Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect and autonomic arousal. J Abnormal Psychol. 1998;107:179–192. doi: 10.1037/0021-843X.107.2.179. - DOI - PubMed
  66.  
    1. Eid M, Lischetzke T, Nussbeck F, Trierweiler L. Separating trait effects from trait-specific method effects in multi-trait-multimethod models: A multiple indicator CT-C(M-1) model. Psychol Methods. 2003;8:38–60. doi: 10.1037/1082-989X.8.1.38. - DOI - PubMed
  67.  
    1. Krueger RF, Piasecki TM. Toward a dimensional and psychometrically-informed approach to conceptualizing psychopathology. Behav Res Ther. 2002;40:485–499. doi: 10.1016/S0005-7967(02)00016-5. - DOI - PubMed
  68.  
    1. Krueger RF, Markon KE, Patrick CJ, Benning SD, Kramer MD. Linking Antisocial Behavior, Substance Use, and Personality: An integrative quantitative model of the adult externalizing spectrum. J Abnorm Psychol. 2007;116:645–666. doi: 10.1037/0021-843X.116.4.645. - DOI - PMC - PubMed