Evaluation Steps
An accurate Beck Depression Inventory (BDI) can aid in early detection of depression in at-risk patients. This quality improvement intervention will evaluate the accuracy of BDI as an evidence-based project (EBP) in the following steps.
- Reliability test – Pretest and posttest scores from a nonclinical sample (n=10) of respondents (adolescents at risk of depression) screened a week apart will be compared to determine the reliability of the tool for use in a longitudinal study.
- Expert reviews of BDI will be conducted to determine the content validity of the 21 items of the scale. It will involve educational psychologists who will assess if the items give a valid estimate of vital depressive symptoms.
- Baseline and post-intervention data will be compared to determine the proportion of positively screened candidates that are later diagnosed with depression. Higher BDI scores should lead to depression diagnosis.
Evidence
The reliability and validity of BDI in evaluating depression severity has been demonstrated in prior research. Lee, Lee, Hwang, Hong, and Kim (2017) found BDI to be a reliable procedure for screening depressive symptoms in Korean adolescents (Cronbach’s alpha = 0.89). The study established that the tool is internally consistent and showed a strong correlation with PHQ-9, a validated scale for measuring depression.
The highest scores have been seen in the altered sleep pattern item (Item 16) due to adolescence-related hormonal changes (Lee et al., 2017). Therefore, a higher result in this measure in a clinical evaluation could be attributed to affective moods, not anxiety. Accurate screening of predisposing symptoms can avoid misdiagnoses and ensure a timely depression diagnosis to prevent possible morbidity.
Selected Intervention, Stakeholders, and Model/Theory
The proposed intervention is the use of BDI for early detection of depression for optimal treatment at a clinic in the context of Lewin’s change model. Adults and adolescents aged 13 years and over can use this 21-item screening tool that is based on self-rating scales (Savilahti et al., 2018). It evaluates depressive symptoms related to mood, self-guilt, negative self-appraisal, and suicidal ideation and can be completed in 5-10 minutes.
This change project will involve a multi-stakeholder approach to ensuring that BDI becomes routine practice. The key stakeholders will include nurses, psychotherapists, case managers, quality improvement team, and patients. Lewin’s three stages will be used to achieve the desired change – routine screening with BDI. The unfreeze step will prepare staff for the change, which will become institutionalized as a usual practice.
Outcome Evaluated
The outcome that will be evaluated in this project is the rate of depression screening and diagnosis. This change project will be designed as EBP implemented using a team-based approach. Data on depression screenings (BDI) of patients aged 13-18 years presenting with chronic problems and subsequent diagnoses will be compared to values obtained using other tools. The goal is to assess the accuracy of the BDI instrument. The team will collect pretest and posttest data from the returned questionnaires and clients’ electronic health records. Data analysis will involve calculating correlations between positive BDI scores and depression diagnosis.
Project Dissemination
The scholarly product for disseminating the project’s findings will be a poster presentation. The project’s results will be presented to healthcare practitioners in conferences. The goal is to expand the use of BDI in depression screening of adolescents and ensure timely referral to psychiatric care.
References
Lee, E., Lee, S., Hwang, S., Hong, S., & Kim, J. (2017). Reliability and validity of the Beck depression inventory-II among Korean adolescents. Psychiatry Investigation, 14(1), 30-36. Web.
Savilahti, E. M., Haravuori, H., Ryatilä-Manninen, Lindberg, N., Kettunen, K., & Marttunen, M. (2018). High Beck depression inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style. Psychiatric Research, 263, 61-68. Web.