Further Validation of the BDI-II Among People With Chronic Pain Originating From Musculoskeletal Disorders

OBJECTIVE: One criticism of the BDI-II for assessing depressive symptoms in people experiencing chronic pain has been the potential overlap between the physical or psychological origins of some of the symptoms. Furthermore, previous studies have reported both two-factor and three-factor solutions, so that the factor solution of the instrument in this population remains unclear. The main objective of the present study was to validate the BDI-II with a chronic pain population experiencing musculoskeletal disorders. Three specific objectives were: (1) to modify the BDI-II for people with musculoskeletal disorders by adding sub-questions to better identify the perceived cause of the depressive symptoms, (2) to assess the validity and reliability of this modified version of the BDI-II, and (3) to explore the perceptions of the causes/origins of symptoms reported on the BDI-II. Results of the confirmatory factor analysis supported the presence of three dimensions within the BDI-II: Cognitive, Affective and Somatic. METHODS: A total of 206 participants experiencing chronic pain answered a modified version of the BDI-II, the CES-D and a sociodemographic questionnaire. RESULTS: Results confirmed the three-dimensional factorial structure of the BDI for this population. Overall, participants experienced higher levels of somatic symptoms compared to symptoms belonging to other dimensions. The percentages of answers to the sub-questions were also similarly distributed between 'pain', and 'pain and state of mind',' regardless of the dimension. DISCUSSION: The importance of assessing somatic symptoms of depression in pain patients and of thoroughly examining the underlying perceived cause of symptoms, regardless of the dimension, are discussed