The Beck Depression Inventory (BDI)24[III] is one of the most widely used tests with chronic pain patients because it is a relatively quick measure of depression, a mood state closely interlinked with chronic pain.25 The most prevalent psychological characteristic of chronic pain patients is depression. Depression and chronic pain occur together so frequently it is often difficult to determine whether the depression is a precipitant of the pain or a consequence of living with intractable pain. Levels of depression can range from minor mood state disturbances to major clinical depressions with active suici dal ideation. In an unpublished study, the author has found that 25 percent of 821 chronic pain patients score in the moderate to severe range of depression on the BDI. The BDI is a 21-item questionnaire requiring the patient to endorse various symptoms of depression that produces a total score of depression ranging from 0 to 63. Scores above 10 reflect minor depressive states, while above 17, are indicative of a moderate to severe state. The BDI is easy to administer and score. The item on suicidal ideation is helpful in assessing suicidality in chronic pain patients. The BDI is predictive of many aspects of patient functioning.26 Comparing the BDI to another measure of depression, the CES-D, Geisser et al.27 found that both the BDI and the CES-D discriminated significantly between chronic pain patients who were depressed versus those who were not. One of the criticisms of the use of an instrument such as the BDI is that some of the physical "vegetative" items such as sleeplessness, which can be endorsed because of pain, can artificially elevate BDI scores for pain patients. Geisser et al.27 found, however, that removal of these somatic items did not improve its accuracy.
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