BDI without suicide item

[mc625510]

Hi all,

I am trying to get my undergraduate honors thesis started and I am using the BDI, but since I have no training in suicide assessment both me and my advisor think it would be best to omit this item on the questionnaire. Do any of you know of studies that have done the same thing? I am struggling to find one right now. Thanks!

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[thewesternsky]

The BDI is copyrighted. Does your advisor have funding to pay for it? If not, look into alternate measures. The DASS is used a lot in research and gets around your difficulty with suicidality assessment. I like the CESD-R, but it also has a suicidality item.

That said, if you're recruiting a potentially suicidal population on purpose, ignoring the issue might not be the best solution.

 

[AcronymAllergy]

I've not seen that done, but I also don't do much depression-specific (or bdi-specific) research. If it's an older population, you could consider using the geriatric depression scale (GDS); it's not quite as "pure" a depression measure as the BDI, but it doesn't have a suicidal ideation question.

 

[mc625510]

Thanks for the responses! I am controlling for depression which is why I needed a depression measure. I will look into the suggested alternatives to this though

 

[thewesternsky]

Awesome. Yes, if you just want to control for depressive symptoms, I'd suggest using the depression items from the DASS.

 

[neuronic]

You need to include the item if you use the BDI, or as others suggested, switch to a different one. However, I think the best thing would be to try to get training in how to address possible suicide ideation, as it will likely come up (multiple times), even if you do not specifically ask the question. With-or without a depressed population, some patients will endorse a 1 on that question (e.g., I have vauge thoughts but would not carry them out). It is highly common for individuals (regardless of presence of clinic depression) to endorse passive SI. A better actually predictor of intent btw, is question 2 (hopelessness). Nonetheless, you should/can not "ethically" exclude it because of potential ramifications/fears of asking it. In the consent form, participants should know of possible questions asked, and the IRB will/should make sure you have a plan with how to handle high risk patients. I do not write this to sway you, but I think a lot of the hesitancy is just anxiety regarding the what-if of the situation. From my experience (with depression research at that), I have never had to have anyone hospitilized But the training can be a rewarding experience and get you and your advisor the confidence to handle those situations.

 

[modestmousktr]

PHQ-8 and CES-D without the suicidal ideation item are as valid as the BDI, you can look them up on google scholar or PsycInfo to find the exact psychometrics, but I think they're both good scales.

 

[DynamicDidactic]

From my experience (not my own research), it is common for researchers to exclude the suicide item from the BDI-II (usually at the behest of an IRB). On the other hand, a protocol for appropriate assessment is put in place when the item is used. However, I have never seen the latter done by an undergraduate. As others have mentioned, just use a different measure. Similarly, if you desired to use a questionnaire available in the public domain you may want to look at another measure.

I prefer the QIDS-SR
http://www.ids-qids.org/translations/english/QIDS-SREnglish2page.pdf

You could just use that and omit the suicide item.

 

[WisNeuro]

Agree with most posts. If you are measuring depression, you need a protocol in place to deal with suicidality whether or not you directly ask about it. Anything else is poor research/clinical work, and resides in that shady grey area. Don't practice or do research in that area.

 

[psypsypsy]

Agree with most other posts. I'd use the CES-D, which is free and doesn't have a suicide item, rather than pay for the BDI (you should not be using the BDI unless you're paying for use).

But, you should have a protocol in place where your mentor or another licensed health professional who is part of the study is calling participants who meet the clinical cut-off (in CES-D, 16 is clinical cut-off) to check in and provide appropriate referrals.

 

[MCParent]

But, you should have a protocol in place where your mentor or another licensed health professional who is part of the study is calling participants who meet the clinical cut-off (in CES-D, 16 is clinical cut-off) to check in and provide appropriate referrals.

This is the standard I am aware of, with the survey being open only at specific times if online (e.g., 9am-4 pm) and researchers being prompted with text messages if a participant trips the suicidality items, or if in-person getting a flag for the person running the participants to quickly intervene.

OP, I'd ask your IRB how they want it handled.

 

[smalltownpsych]

My IRB required me to have a protocol to address potential suicidality for my dissertation. I am surprised that any IRB would not include that in any research using human subjects with a clinical issue.

 

[Member1928]

Sometimes there is a practical element to conducting research that must be balanced with the "this is the gold standard of how things should be carried out."

If the IRB or your research mentor says, you need to omit the suicide item, then you omit the item rather than getting bogged down in a back-and-forth debate with the IRB or your mentor.

 

[LM02]

Sometimes there is a practical element to conducting research that must be balanced with the "this is the gold standard of how things should be carried out."

If the IRB or your research mentor says, you need to omit the suicide item, then you omit the item rather than getting bogged down in a back-and-forth debate with the IRB or your mentor.

In complete agreement. When I was a graduate student, the IRB required that we administer the BDI-II without the suicide item in a study that we were conducting using the undergraduate participant pool. When administered in a clinical sample, this was fine. In the latter case, we had established safety procedures in place. In the former, we simply pro-rated the BDI-II score, and published the paper without even a blink of an eye (in fact, this was a paper that was accepted for publication at the first submission). It is a careful balance.

In the case of an undergraduate who is conducting and administering the research, this is an uphill battle with the IRB. They are typically fierce on this issue - I have been a faculty member in the psychiatry department at a medical school for numerous years now, and issues around suicide assessment continue to be a battle with my IRB. And I'm a licensed psychologist with access to hospital security and an emergency room just down the hall (for those worst case scenarios). Just pro-rate and move along...