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BEHAVIORALMEASUREMENTS

Letter

BehavioralMeasurementDatabaseServices

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Enriching the health and behavioral sciences by broadening instrument access Vol. 3, No.2

Spring 1996. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introduction to This Issue

This issue of The Behavioral Measurements Letter(BML) features a column by Aaron T. Beck andRobert A. Steer who discuss the Beck DepressionInventory-II. The BDI-II is a complete revisionof the BDI-IA, itself an amended version of theoriginal Beck Depression Inventory. In theircolumn, Beck and Steer first describe the changesto the BDI-IA contained in the Bbl-II, changesthat address the diagnostic criteria for depressivedisorders in the Diagnostic and Statistical Manualof Mental Disorders, 4th edition (the DSM-IV),discuss the need for these changes, present thenew scoring system for the BDI-II, and then offerdata on validity and reliability of the BDI-IIobtained using samples of psychiatric outpatientsand college students. Given the high incidence ofdepressive disorders, long-standing reliance onthe Beck Depression Inventory by both cliniciansand researchers, and accumulated knowledge ofthe symptoms of depressive disorders reflectedin the DSM-JV, the BDI-II should receive a warmreception from present users of the BDI-IA andgenerate deservedly heavy usage by clinicians andresearchers.

Also in this issue, Fred Bryant and I discuss aninnovative use of the computer mouse to measuredynamic variables in social judgment. "Themouse paradigm'-' involves the use of the mousepointer to symbolize the person making thejudgment, a circle representing the object of thejudgment, and movement of the mouse pointertoward or away from the target to symbolize theperson's feelings about the object of judgment ona moment-to-moment basis. The data, inCartesian coordinates, is transformed by acomputer program to indicate the extent of the

Vol. 3, No.2, 1996

judge's positive or negative feelings about theobject of judgment, changes in those feelings, andthe speed of these changes in feelings. Further,using an algorithm and decision rules developedby physicists, a measure of complexity of theperson's judgment system is calculated as well.As pointed out in the column, this novel techniquemay be applied in studies of many phenomenaother than social judgment, such as self-evaluation, pain, stereotyping, and the making ofmoral judgments.

"HaPlnings" offers news on BMDS' effort toexpand coverage of studies of instrument usagewith diverse populations, a note on coverage ofpain measures in the HaPI database, notice .thatBMDS will be showcased at The -Ohio StateUniversity Health Sciences Center MultimediaFair '96, and a word about expansion ofBMDS'document delivery services to make moreinstruments available to potential users. Withregard to the latter, authors of instruments areasked to cooperate by giving their permission fordissemination through BMDS and by supplyingcopies of their instruments and supportingmaterials to BMDS.

"HaPI Thoughts" is a cartoon on something facedby innumerable researchers, practitioners,instructors, students and administrators daily -by many unHaPI and HaP[I]less potential usersfrom Beijing to Buffalo: the quest for anappropriate "psychosocial instrument."

Attention Authors and Journal Editors: TheFall issue of The Behavioral Measurements Letterwill contain a special insert of particular interestto authors of research papers and journal editors,

(Continued on page 2)

The Behavioral Measurements Letter

Introduction to this Issue (Continued)

"Guidelines for Reporting the Use of Health andBehavioral Measures in Research." Throughlong-standing experience in building the HaPIdatabase, as well as the experience of thousandsof instrument seekers, it has been found that muchinformation about the attributes and use of healthand psychosocial instruments is not disseminatedand utilized because it is not adequatelydocumented. The special insert cites problems andmakes suggestions in two areas - instrumentidentification and citation of instruments.

As stated in our last issue, we want any commentsor suggestions you have on The BML. Ifwarranted and as space permits, yourcommunication may appear as a letter to theeditor. Address your comments and suggestionsto .The Editor, The Behavioral MeasurementsLetter, Behavioral Measurement DatabaseServices, PO Box 110287, Pittsburgh, PA15232-0787. Whether published or not, yourfeedback will be considered seriously andappreciated.

We also are soliciting contributions to The BML.Submit, at any time, a brief article, opinion pieceor book review on a BML-relevant topic to TheEditor at the above address. Each submission willbe given careful consideration for possiblepublication.

HaPI reading .

StaffDirector Evelyn Perloff, PhDDocument Delivery

Coordinator Johanna Kehler, D PhilTechnical Specialist Linda S. Perloff, PhDNewsletter Editor ; Al K. DeRoy, PhDEditorial Specialist Philip Mabry, MAComputer Consultant Alfred A. Cecchetti, MSComputer Programmer/

Analyst lain F. Cameron, M DivMeasurement Consultant Fred B. Bryant, PhDDatabase System

Coordinator DeeAnna Cavinee, MLSInformation Specialists Gina M. Neish, MLS

Adele Barsh, MLSRecord Analysts Cheri L. Britt, MS

Sara Kortum, MARama Rao, MLS

Record Reviewer Jacqueline A. Reynolds, BAFile Processor Betty HubbardBusiness Services Manager .. Diane Cadwell

The Behavioral' Measurements Letter

'HaPlnings

Weare continuing to expand and improve theHaPI database in order to provide more and betterservices to our users. Thus:

• BMDS is increasing its coverage of instrumentusage in studies that focus on African-Americans. This is another step in ourcontinuing efforts to assist instrument seekersand users working with populations diverseill-gender, sexual orientation, race/ ethnicity ,age, and/or language.

• BMDS is expanding its document deliverysystem to make more instruments available topotential users. Instrument Authors: We askauthors of instruments in the HaPI databaseto cooperate by giving their written permissionfor dissemination through BMDS on the formwe provide, and by supplying copies ofinstruments to Behavioral MeasurementDatabase Services, PO Box 110287,Pittsburgh, PA 15232-0787.

• Also of interest:

• In an unpublished letter to the NewEngland Journal of Medicine, Drs. FredBryant, BMDS Measurement Consultant,and Evelyn Perloff, BMDS Director,reported finding 120 pain measures ofvarious types in the HaPI database,including instruments for use with variousage groups, types of health careprofessionals, diagnoses, medical!surgical procedures, and pain locations.

• HaPI will be showcased at The Ohio StateUniversity Health Sciences CenterMultimedia Fair '96. The Multimedia Fairwill be held on Friday" May 17, 1996 inthe lobby of Meiling Hall at the OSUCollege of Medicine, 370 West 9thAvenue, Columbus. All are welcome tothe Fair.

No bird soars too high, if hesoars with his own wings.

William Blake

Phone: (412) 687-6850 Fax: (412) 687-5213

Vol. 3, No.2, 19962

Beck Depression Inventory-II

Aaron T. Beck and Robert A .. Steer

After 35 years, the symptom content of the BeckDepression Inventory (BDI-I; Beck, Ward,Mendelson, Mock, & Erbaugh, 1961, Archivesof General Psychiatry, 4, 561-571) has beenupgraded to correspond to the diagnostic criteriafor Depressive Disorders now listed' in theDiagnostic and Statistical Manual of MentalDisorders (4th ed.) (DSM-IV; AmericanPsychiatric Association, 1994, Washington, DC).Although an amended (revised) Beck DepressionInventory (BDI-IA; Beck, Rush, Shaw, & Emery,1979, Cognitive therapy of depression. NewYork: Guilford) has been available since the1970s, the amended version only reflectedchanges in the layout and wording of the original21 symptoms. However, in the upgraded BeckDepression Inventory-II (BDI-II; Beck, Steer, &Brown, in press), * the BDI-IA Weight Loss, BodyImage Change, and Somatic Preoccupation itemshave been replaced with Work Difficulty,Agitation, Concentration Difficulty, Worth-lessness, and Loss of Energy items. These changesshould have an important impact upon theevaluation of self-reported depression because theBDI-IA is one of the most widely used measuresfor assessing the severity of depression inpsychiatric patients and screening for possibledepression in normal populations (Piotrowski &Keller, 1992, Journal of Training in the Practiceof Professional Psychology, 6, 74-82).

The first suggestion about upgrading the symptomcontent of BDI-IA was made by Moran andLambert (1983, The assessment of psychotherapyoutcome. New York: Wiley), who reported thatits 21 items adequately met only six of the ninediagnostic criteria given for Affective Disordersby the American Psychiatric Association (1980)in the Diagnostic and Statistical Manual of MentalDisorders (3rd ed.) (DSM-III). For example,decreases in appetite and sleep were addressed,but increases in appetite and sleep were not.Explicit items addressing psychomotor activityand agitation, which the DSM-ill criteria includein the diagnosis of Major Depressive Disorders,were also missing. Vredenburg, Krames, andFlett (1985, Reports, 57, 767-778) later raisedsimilar questions about how adequately the BDI-I addressed DSM-III criteria.

Vol. 3, No.2, 1996

Evidence supporting the need for upgrading theBDI-IA's symptom content was also provided byBeck and Steer (1984, Journal of ClinicalPsychology, 40, 1365-1367), who found that theWeight Loss, Somatic Preoccupation, and BodyImage Change items were less useful in assessingthe severity of depression in outpatients than theyhad been in long-term hospitalized patients. TheWeight Loss item is probably less effective inevaluating depression in outpatients because theamount of weight loss is dependent on the lengthof the depression, and depressed patients are nowbeing treated at an earlier stage of their illnessthan they had been in 1961 when Beck constructedthe BDI-1. '

For detailed comparative purposes, several broaddifferences between the BDI-II and BDI-IA shouldbe stressed. First, 18 items addressing similarsymptoms in the BDI-IA were retained in theBDI-II, but only three of these BDI-IA items werenot reworded, Punishment Feelings, SuicidalThoughts or Wishes, and Loss of Interest in Sex.Second, the old BDI-IA labels for the symptomgroups were also changed in some instances inthe BDI-II to reflect new clinical nuances thatwere attached to some items. For example, theBDI-IA label of Social Withdrawal was changedto Loss of Interest because both people andactivities are now stressed in the BDI-II, whereasonly interpersonal activities were emphasized inthe BDI-IA. Third, the directions for the BDI-IIwere changed from those given for the BDI-IA.Respondents are now asked to describethemselves for the "Past Two Weeks, IncludingToday, " instead of for one week as they are inthe BDI-IA, to be consistent with DSM-IV criteriafor major depressive disorders. However, like theBDI-IA, the BDI-II is scored by summing thehighest ratings for each' of the 21 items. Each itemis,rated on a four-point scale ranging from 0 to3, and the total scores can range from 0 to 63 -the higher the total score, the greater the severityof symptoms.

In evaluating the psychometric characteristics ofthe BDI-II, Beck, Steer, and Brown (in press)studied 500 psychiatric outpatients who weredrawn from four different psychiatric outpatientclinics, and 120 college students. With respect todata bearing on the reliability and validity of the

(Continued on page 4)

3 The Behavioral Measurements Letter

Beck Depression Inventory-II (Continued)

BDI-II, they found, as expected, that the meanBDI-II score (M = 22.45), SD = 12.75) of theoutpatients was higher than the student group'smean BDI-II score (M = 12.56, SD = 9.92),1 (618) = 7.94, P < .001. For 191 of theoutpatients who were administered the BDI-JAand BDI-II on the same day, the correlationbetween both instruments was .93,~ < .001.These outpatients' mean BDI-IA and BDI-IIscores were 18.92 (SD = 11.32) and 21.88(SD = 12.69), respectively, and the meanBDI-II score was 2.96 points higher than that ofthe BDI-IA, paired 1(190) = 8.56,...2 < .001.Furthermore, the mean number of BDI-II itemsendorsed by the 191 outpatients was 13.54(SD = 5.45), whereas the mean number ofBDI-IA items endorsed by the same outpatientswas 12.14 (SD = 5.33). The mean differenceof 1.40 items indicated that the outpatients wereendorsing more items on the BDI-II than theywere on the BDI-IA, paired 1(190) = 9.63,Q < .001. Therefore, Beck, Steer, and Brown(in press) suggested that higher cut-off score limitsbe used with the BDI-II than those proposed byBeck and Steer (1993, Manual for the BeckDepression Inventory, PsychologicalCorporartion) for the BDI-IA. Thus BDI-II totalscores ranging from 0 to 13 are considered to be"Minimal," those from 14 to 19 "Mild," from20 to 28 "Moderate," and total scores from 29to 63 are considered to be "Severe."

With respect to the reliability of the BDI-II, thecoefficients alpha of the 500 outpatients and 120college students were high at .92 and .93,respectively. All of the corrected item-totalcorrelations for the 21 BDI-II items in both theoutpatient and college student samples weresignificant beyond the .05 level, one-tailed test.The stability of the BDI-II for 26 outpatients whowere administered the BDI-II at the times of theirfirst and second cognitive therapy sessions, whichwere approximately one week apart, was also highCI = .93,...2 < .001).

The BDI-II displayed convergent and discriminantvalidity with respect to clinically rated depressionand anxiety; it was more positively correlated withthe revised Hamilton Psychiatric Rating Scale forDepression (Riskind, Beck, Brown, & Steer,

The Behavioral Measurements Letter

1987, Journal of Nervous and Mental Disease,175, 474-479) (! = .71) than with the revisedHamilton Rating Scale for Anxiety (Riskind et al. ,1987) (! = .47), Hotelling I (84) = 2.96,Q < .01) for 87 outpatients.

Furthermore, the BDI-II was positively correlated(Q < .001) to both the Beck Hopelessness Scale(BHS; Beck & Steer, 1993, Manual for the BeckHopelessness Scale, Psychological Corporation)(! = .68) and the Scale for Suicide Ideation(SSI; Beck, Kovacs, Weissman, 1979, Journal ofConsulting and Clinical Psychology, 47,343-352)(! = .37) in 158 outpatients; the BHS and theSSI have repeatedly been described as positivelyrelated to depression.

Finally, iterated-principal factor analyses withoblique rotations were also performed by Becket al. (in press), separately, on theintercorrelations among the 21 BDI-II responsesof the 500 outpatients and 120 college students.Two highly correlated cognitive-affective andsomatic dimensions were found in both samples,and the symptom compositions of similarly-namedfactors in both samples were comparable.

In summary, the initial findings about thepsychometric properties of the BDI-II indicate thatit is a reliable and valid instrument for measuringthe severity of self-reported depression in lateadolescents and adults. Although the BDI-JA andthe BDI-II share 18 similar symptoms, theBlfl-II's overall symptom content is more comparableto that used by the DSM -IV for diagnosingdepressive disorders than is that of the BDI-IA.Therefore, when evaluating the severity ofdepression according to DSM-IV criteria, theBDI-II should be more discriminating than theBDI-IA.

*Copies of the BDI-II and the Preliminary Manualfor the Beck Depression Inventory II (Beck, Steer,& Brown, in press) are available from ThePsychological Corporation, 555 Academic Court,San Antonio, TX 78204-2498.

4 Vol. 3, No.2, 1996

Aaron T. Beck, MD, is UniversityProfessor of Psychiatry Emeritus,University of Pennsylvania School ofMedicine, where he has served on thefaculty since 1954. Dr. Beck is the authoror co-author of more than 300 articles andten books. He is best known for his workon cognitive therapy jor depressive illnessand for development of the widely-usedBeck Depression Inventory. Dr. Beck hasreceived the American PsychiatricAssociation Foundation's Prize forResearch in Psychiatry and the AlbertEinstein Award from the Albert EinsteinCollege of Medicine, among other awards.

Robert A. Steer, EdD, is Professor ofPsychiatry and Adjunct Professor ofObstetrics and Gynecology, School ofOsteopathic Medicine, University ofMedicine and Dentistry of the StateUniversity of New Jersey, and AdjunctProfessor of Psychology and Psychiatry,Department of Psychiatry, University ofPennsylvania. In addition to teachingpsychometrics to medical students andresidents, Dr. Steer also developscomputer programs for the administrationand interpretation of psychological tests.

As far as the laws of mathematicsrefer to reality, they are not certain;

and as far as they are certain;they do not refer to reality.

Albert Einstein

Vol. 3, No.2, 1996

HaPI Advisory BoardAaron T. Beck, MDUniversity of Pennsylvania School of Medicine

Timothy C. Brock, PhDOhio State University, Psychology

William C. Byham, PhDDevelopment Dimensions International

Donald Egolf, PhDUniversity of Pittsburgh, Communication

Sandra J. Frawley, PhDYale University School of Medicine, Medical Informatics

David F. Gillespie, PhDGeorge Warren Brown School of Social WorkWashington UniversityRobert C. Like, MD, MSUniversity of Medicine and Dentistry of New JerseyRobert Wood Johnson Medical SchoolJoseph D. Matarazzo, PhDOregon Health Sciences UniversityVickie M. Mays, PhDUniversity of California at Los Angeles, PsychologyMichael S. Pallak, PhDBehavioral Health FoundationKay Pool, PresidentPool, Heller & Milne, Inc.Ellen B. Rudy, PhD, RN, FAANUniversity of Pittsburgh School of NursingGerald Zaltman, PhDHarvard University Graduate School ofBusiness Administration

Stephen J. Zyzanski, PhDCase Western Reserve University School of Medicine

The Mouse Paradigm

Al K. DeRoy and Fred B. Bryant

For many years psychologists and educators haveused computers to facilitate measurement, firstin automated scoring and analysis, and later intest administration. More recently, computers arebeing used as actual measurement tools. In thiscolumn we describe use of the computer tomeasure variables directly using the computermouse ("the mouse paradigm"), record and storethe measurements made, manipulate and analyzemeasurement data, and report experimentalresults.

This innovative computer application wasdeveloped by Vallacher, Nowak, and Kaufman(Journal of Personality and Social Psychology,

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5 The Behavioral MeasurementsLetter

The Mouse Paradigm (Continued)

1994,67,'20-34), who describe the use of thecomputer mouse to measure dynamic variablesin social judgment. Vallacher et al. present arationale for viewing social judgment phenomenaas dynamic rather than static once the socialjudgment system is activated. Because the purposeof this column is not to discuss social judgment,that rationale is not examined here. Rather, in thiscolumn we discuss the mouse paradigm, describeits .use in measuring the dynamics of socialjudgment,and list other potential applications.

Most prior research on social judgment hasinvolved measurement of judgments as snapshotsin time and the measurement of changes injudgment over relatively long periods of time(days, weeks, months). As discussed in Vallacheret al. (1994), this research suggests that social'judgment is typically stable over such long timeperiods. As indicated by cognitive theory andempirical research, however, social judgments areunstable over the shorter periods of time whenthey are being formed or re-examined. To test thisidea, a tool was needed to measure changes insocial judgment over very short time periods -intervals of seconds and fractions of seconds.Thus, Vallacher and his colleagues developed themouse paradigm for this purpose.

The mouse paradigm is based on the idea thatsocial judgment involves approach-avoidance, aconcept put forth by Hovland, Janis, and Kelley(Communication and Persuasion, Yale UniversityPress, 1953). This notion implies that one'sfeelings about a person, object, or event at anypoint in time can be represented as the distancebetween a symbol designating the target person,object or event, and a symbol designating thejudge. The nearer the judge symbol to the targetsymbol, the more positive the subject feels aboutthe target person, object, or event; the farther thejudge symbol from the target symbol, the morenegative the subject feels about the target. If thejudge symbol is neither near nor far from thetarget symbol, i.e., it is somewhere closer to thecenter than either the positive or negative pole,it may be inferred that the subject has ambivalentfeelings about the target.

The Behavioral Measurements Letter

Given the above, Vallacher et al. (1994)innovatively employed the computer mouse tomeasure moment-to-moment changes in distancebetween the target and judge symbols to determinethe judge's continually changing feelings towardthe target person, object, or event (see, also,Vallacher & Nowak, Dynamial Systems in SocialPsychology, 1994, pp. 257-69). As described inthese references, a small circle, representing thetarget, and the computer mouse pointer (an arrowsymbol), representing the judge, are initiallypositioned in the middle of the computer screen.The circle remains stationary, while the arrow ismobile reflecting movement of the mouse. Judgesare asked to think about a particular person (orobject or event) with whom s/he is familiar.This target is to be someone (or something)toward whom the judge feels either positively,negatively, or ambivalently (both positively andnegatively), depending upon the experimentalcondition being tested. The judge is then askedto move the arrow (by moving the mouse) towardor away from the circle, or to allow the arrowto remain in one place, depending upon how s/hefeels about the target individual at the moment.Cartesian coordinates, representing the positionof the mouse pointer, are collected ten times persecond over a two-minute period, yielding a totalof 1,200 data points per session. ,.

The mouse data are then transformed through useof a FORTRAN program into four measures ofsocial judgment: linear distance of the arrow fromthe target (measured in pixels), representing thejudge's overall evaluation of the target; averagespeed of travel of the arrow .uneasured in pixelsper O. 1 second), representing change in thejudge's evaluation of the target; acceleration/deceleration of mouse travel (measured as changein number of pixels traveled per 0.1 second),representing the rate of change in the judge'sevaluation; and time the mouse remains at rest,representing the amount of time the judgmentsystem is at equilibrium.

The mouse data are further manipulated using aC++ program to calculate the dimensionality ofthe social judgment system. Dimensionality is ameasure of a dynamic system's order (complexity)using the temporal trajectory of a single variable.The program uses the Grassberger-Procacciaalgorithm (Physical Review Letters, 1983, 50,

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6 Vol. 3, No.2, 1996

HaPI Thoughts

The Mouse Paradigm (Continued)

346-350), which determines the number ofvariables required to specify the state of thesystem. This algorithm is used to distinguishbetween a random system (many variables, loworder) and a deterministic system (few variables,high order). Because human judgment must beexercised in separating noise in the system (errorvariance) from dynamic functioning of the system,guidelines provided by Ben Mizarahi, Procacciaand Grassberger (Physical Review Letters, 1984,50,975-977) may be used to assist in making suchdeterminations.

In their experiments, Vallacher et al. (1994)calculated dimensionality in the beginning (first40 seconds) and ending (last 40 seconds) portionsof two-minute sessions. Because they found thatdimensionality was best estimated using onlyevery other data point, dimensionality wascalculated for both even-numbered and odd-

WE'vE GOT GUITARS, PIANOS,FlODlES, DRVMS, FRENCH HORNSand MORE, aUT W~AT'.s THAT YOUSAID YOU'f\E LOOKING FOR?

R.P./ J.8.

Vol. 3, No.2, 1996

numbered 0.1 second intervals. The two sets ofscores were found to correlate highly (p < 0.001)across subjects, r(71) = .88 and .82 for beginningand ending period scores, respectively, indicatingthat the dimensionality measure is reliable.

To date the mouse paradigm has been used toexplore the dynamics of social judgmentphenomena and probe the structure of the socialjudgment system. By logical extension, the mouseparadigm could be used in the future to investigatea variety of intrapsychic phenomena, such as self-evaluation, stereotyping, causal attribution, moraljudgment, pain, and emotional experience. Themouse paradigm, coupled with appropriateanalytical techniques, could be employed toexplicate the dynamic properties of thesephenomena and the underlying structures andprocesses that govern them. In sum, the mouseparadigm is a creative new approach to, andconceptual advance in, psychologicalmeasurement that will find increasing application.

NOT THOSE INSTRUMENTS, aUTHEALTH .and PSYCHOSOCIAL

INSTRUMENTS ••.

HEALTH and PSYCHOSOCIALINSTRUMENTS !

INSTR\JMHI.TSALE.'

7 The Behavioral Measurements Letter

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BEHAVIORALMEASUREMENTS

Letter

BehavioralMeasurementDatabaseServices

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

In This Issue:

~ Introduction to this Issue 1

• HaPInings 2

• Beck Depression Inventory-II-Aaron T. Beckand Robert A. Steer 3

• The Mouse Paradigm-AI K. DeRoy andFred B. Bryant 5

• HaPI Thoughts 7

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