Assessing depression symptoms in those with insomnia: an examination of the beck depression inventory second edition (BDI-II).

BACKGROUND: Due to concerns about overlapping symptomatology between medical conditions and depression, the validity of the beck depression inventory (BDI-II) has been assessed in various medical populations. Although major depressive disorder (MDD) and primary insomnia (PI) share some daytime symptoms, the BDI-II has not been evaluated for use with insomnia patients. METHOD: Participants (N=140) were screened for the presence of insomnia using the Duke structured clinical interview for sleep disorders (DSISD), and evaluated for diagnosis of MDD using the structured clinical interview for DSM-IV-TR (SCID). Participants' mean BDI-II item responses were compared across two groups [insomnia with or without MDD) using multivariate analysis of variance (MANOVA), and the accuracy rates of suggested clinical cutoffs for the BDI-II were evaluated using a receiver operating characteristic (ROC) curve analysis. RESULTS: The insomnia with depression group had significantly higher scores on several items; however, the groups did not differ on insomnia, fatigue, concentration problems, irritability, libido, increased appetite, and thoughts relating to suicide, self-criticism and punishment items. The ROC curve analysis revealed moderate accuracy for the BDI-II's identification of depression in those with insomnia. The suggested BDI cutoff of >or=17 had 81% sensitivity and 79% specificity. Use of the mild cutoff for depression (>or=14) had high sensitivity (91%) but poor specificity (66%). CONCLUSION: Several items on the BDI-II might reflect sleep disturbance symptoms rather than depression per se. The recommended BDI-II cutoffs in this population have some support but a lower cutoff could result in an overclassification of depression in insomnia patients, a documented problem in the clinical literature. Understanding which items discriminate insomnia patients without depression may help address this nosological issue.

Women and cigarette smoking: does amount of weight gain following a failed quit attempt affect social disapproval?

This study examined the perception of social attractiveness and approval of smoking in a vignette of an American college female smoker after a failed quit attempt. It was hypothesized that she would be perceived more favorably when she was smoking to control her weight, compared to a non-weight related excuse during a failed quit attempt. The design was a 2 (gender: male vs. female)x4 (condition: control, 5, 10, 20 lb gain)x3 (participants' smoking status: never, former, or current smoker) factorial design with the Social Attraction Index and Perception of Smoking Index as dependent variables. Contrary to the hypothesis, perceptions of the female were not affected by her disclosed amount of weight gain. However, consistent with the literature on stigmatization of smokers, smoking participants perceived the female target as most socially attractive and nonsmokers perceived her to be the least attractive.