Considerations for the use of the beck depression inventory in the assessment of weight-loss surgery seeking patients

Background: The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many patients seeking bariatric surgery have medical symptomatology and health concerns independent of the syndrome of depression, and thus scores on the BDI may inflate their actual level of depression. With depression viewed by some clinicians as contraindicated for bariatric surgery, clarification of the BDI items is necessary. Methods: Pre-surgical BDIs of 259 bariatric patients were reviewed. An exploratory factor analysis was conducted to examine the factor structure of the BDI in this population. Independent sample t-tests compared the means of the cognitive and somatic items. Results: A clear two-factor solution emerged on the BDI, indicating items mapped on to either a cognitive or a somatic domain. The patients in the present sample also were more likely to endorse somatic and health-related symptoms on the BDI. Conclusions: The factor structure of the BDI in this population is similar to that in other non weight-loss surgery populations. However, this population is more likely to endorse somatic complaints that may not be indicative of depression, rather an acknowledgement of actual medical complaints. Thus, assessors should be mindful of specific symptom endorsement, rather than a total depression score when utilizing the BDI to help determine surgery suitability.