Evaluate the psychometric properties of a psychological assessment on DEPRESSION.

EBSCO Publishing Citation Format: APA (American Psychological Assoc.): NOTE: Review the instructions at http://support.ebsco.com.ezproxy.liberty.edu/help/? int=ehost&lang=&feature_id=APA and make any necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult your library resources for the exact formatting and punctuation guidelines.

References Barrick, C. B., & Correa, E. I. (2015). Correa-Barrick Depression Scale. Retrieved from

http://ezproxy.liberty.edu/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=mmt&AN=test.8046&site=ehost-live&scope=site

<!--Additional Information: Persistent link to this record (Permalink): http://ezproxy.liberty.edu/login? url=http://search.ebscohost.com/login.aspx?direct=true&db=mmt&AN=test.8046&site=ehost- live&scope=site End of citation-->

Correa-Barrick Depression Scale Review of the Correa-Barrick Depression Scale by M. MEGHAN DAVIDSON, Associate Professor of Counseling Psychology, University of Nebraska-Lincoln, NE: DESCRIPTION. The Correa-Barrick Depression Scale (CBDS) is a self-report measure intended to assess levels of depression, regardless of symptom severity. The CBDS is not intended to be used as a diagnostic instrument, but rather as a measure to screen for the severity of depression. The test authors state the CBDS appropriate for adults 18 years and older, and the measure may be used in a wide range of settings including private practices, hospitals, universities and colleges, health departments, clinics, and government/military agencies. In addition to its use as a screening tool, the CBDS can be used to evaluate client change in depression over time as respondents are instructed to indicate how they felt during the past 2 days. The average length of time needed to complete the CBDS is approximately 5 minutes, and it can be administered individually or in groups. The CBDS meets the criteria for major depression found in the Diagnostic and Statistical Manual of Mental Health Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013). The CBDS is composed of 20 items that describe a variety of depressive symptoms that include cognitive, emotional, physiological, and sensory difficulties as well as general outlook. Notably, the CBDS includes an item regarding color sensitivity impairment. Each item is answered using a visual analog scale (VAS). That is, respondents indicate their level of agreement with each of the 20 items by marking a position along a VAS, a continuous horizontal line between two endpoints (i.e., not at all and very much) with a length of 10 cm and hatch marks that are 1 cm apart. To score each of the 20 items, the mark made by the respondent is scored to the nearest half relative to the nearest value. That is, item scores range from 0 to 10 and include every 0.5. Additionally, about half of the items are reverse coded. Total scores on the CBDS are obtained by summing each of the 20 item scores, with 200 being the highest possible raw score. Raw scores are then grouped into five

categories of depression ratings: no evidence of depression (79 and under); borderline (80-99); mild (100-110); moderate (111-125), and severe (126 and over). DEVELOPMENT. The current CBDS is based on the original CBDS, which was developed in 1993. The CBDS is not rooted in any one theory; rather, a conceptual analysis of depression using criteria for major depression in the then-current DSM-III-R (APA, 1987) and literature regarding clinical descriptions was conducted to develop themes of depressive symptoms. These themes included physiological symptoms, cognitive disturbance, and emotional distress and guided item writing, which resulted in 30 items. These 30 items constituted the original CBDS, and were evaluated with normative and patient samples. The test authors state that 10 items were later deleted from the measure because of psychometric and/or conceptual concerns, as well as to shorten it. The test manual indicates that an inpatient sample and an outpatient sample were used to evaluate the revised version of the CBDS. However, the test manual provides no further information regarding the respective samples. TECHNICAL. Regarding validity evidence, the test authors report that scores on the original 30-item CBDS correlated highly (r = .81) with scores on the Inventory for Depressive Symptomology in a combined sample of university faculty and staff (n = 337) and patients (n = 50). Additionally, internal consistency reliability was reportedly high for both samples, with alpha coefficients of .93 and .96 for the normative and patient samples, respectively. A 2-week test-retest reliability analysis demonstrated acceptable stability with a correlation coefficient of .73. A principal components analysis was conducted on the original 30-item CBDS, which revealed a four-factor solution with the following factors: Cognitive-Emotional Disturbance, General Outlook, Physiological Symptoms, and Sensory/Perceptual Disturbance. No internal consistency reliability information is presented with respect to these four factors, nor are suggestions for how to use the four factors discussed. No factor analyses were conducted with the revised 20-item version of the CBDS. With respect to the current, revised CDSB with 20 items, scores demonstrated a moderately high correlation coefficient (r = .78) with scores on Zung’s (1965) Self-Rating Depression Scale for an inpatient sample (n = 25) and a moderate correlation coefficient (r = .55) for an outpatient sample (n = 96). Internal consistency reliability for the revised CBDS was reportedly high for this combined sample, with an alpha coefficient of .91. No test-retest reliability information is presented for the 20- item CBDS. COMMENTARY. The CBDS is a brief and easy-to-administer measure to screen for depressive symptomology. The primary strengths of the CBDS are its use of the visual analog scale as the response format and its inclusion of an item regarding color sensitivity impairment. Despite these strengths, the psychometric evidence for the revised 20-item CBDS needs further empirical support. No information regarding the normative or patient samples in the original study is provided in the test materials themselves, nor is any demographic data regarding the inpatient and outpatient samples provided for the revision study. Thus, from the test materials alone, it is unclear how these samples were recruited, and what constitutes normative, patient, inpatient, and outpatient groups. Moreover, there is no information provided regarding gender, age, ethnicity, education, or socioeconomic status for any of the samples. Additionally, no history of depression or other mental health concerns, nor previous counseling or treatment, is provided regarding the samples. Thus, test users need to go beyond the test materials to locate relevant empirical studies (e.g., Barrick, Taylor, & Correa, 2002) that will help them to evaluate with whom it is appropriate to use the CBDS.

In addition, the ways in which items were developed originally and how they were reduced for the revised version require further psychometric evaluation. For example, exploratory and confirmatory factor analyses should have been conducted to reduce the number of items for the revised CBDS. As well, much greater examination regarding convergent and discriminant validity should be conducted. It is unclear why relations with much more widely used depression measures, such as the Beck Depression Inventory-II (Bech, Steer, & Brown, 1996) and the Hamilton Depression Rating Scale (Hamilton, 1960), were not investigated. SUMMARY. The Correa-Barrick Depression Scale (CBDS) is a self-report measure of depression symptomology, including cognitive, emotional, physiological, and sensory difficulties, as well as general outlook. The CBDS should be used as a screening tool rather than a diagnostic instrument. Additionally, the assessment can be useful in monitoring client change in depressive symptoms. The current 20-item CBDS has demonstrated basic empirical evidence supporting its relationship to other measures of depression; however, further psychometric support would enhance the evidence supporting the validity of test scores from the CBDS and their users. REVIEWER'S REFERENCES American Psychiatric Association. (1997). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Barrick, C. B., Taylor, D. E., & Correa, E. I. (2002). Psychometric assessment and clinical application of the Correa-Barrick Depression Rating Scale. Clinical Nursing Research, 11, 363-381. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory: Manual (2nd ed.). San Antonio, TX: Pearson. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56-62. Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477-486. Zung, W. W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63-70.

Review of the Correa-Barrick Depression Scale by RENÉE M. TOBIN, Professor of Psychology, and LEANDRA PARRIS, Assistant Professor of Psychology, Illinois State University, Normal, IL: DESCRIPTION. Developed by a nurse and a psychiatrist, the Correa-Barrick Depression Scale (CBDS) is a self-report screening tool for assessing depression in adults. The CBDS consists of 20 items written at a second-grade reading level. This paper-pencil scale asks raters to indicate the extent to which they have felt each item in the past 2 days using a visual analog scale (VAS). Rather than asking respondents to rate their experiences on a numbered rating scale, the VAS system requires respondents to make a slash mark on each notched line to indicate how often they have experienced each item, ranging from not at all to very much. Each notch in the line allows administrators to assign a numeric value to the nearest half point (e.g., 5.5) on a scale ranging from 0 to 10 after the measure is completed. A subtle anchoring line for each item assists the administrator in scoring or reverse scoring each item accordingly. The scale developers suggest that this scoring system is useful for measuring emotional pain and is thus most appropriate for assessing symptoms of depression. A total raw score is determined by summing item scores. Raw scores are interpreted in levels associated with the severity of symptoms, with 79 and below indicating no evidence of depression,

80-99 classified as borderline, 100-110 as mild, 111-125 as moderate, and 126 and higher indicating severe symptomatology. The test manual provides information about steps to take should an individual fall within each level. For example, it is suggested that individuals with scores that fall in the moderate range receive therapeutic services and may benefit from seeking out psychiatric services. The symptoms assessed are consistent with the criteria for diagnosing major depression presented in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). Items included in the CBDS assess four areas of depression: cognitive-emotional disturbance (e.g., worry, restlessness), general outlook (e.g., looking forward to fun things, future outlook), physiological symptoms (e.g., sleep problems, body feels heavy), and sensory/perceptual disturbance (e.g., appetite change). Although these factors are described in the test manual, separate scores are not provided in these distinct areas. One unique feature of the CBDS is the inclusion of a color sensitivity item based on modest findings from the test developers demonstrating an association between depression severity and color sensitivity; the presence of this item resulted in the CBDS being awarded a U.S. patent. According to the test manual, an item related to thoughts of death and dying, as well as the color sensitivity item, are strongly indicative of severe depression and warrant special attention by scale administrators. Intended for use in clinical settings, the CBDS can be used by various service providers, including medical personnel, social workers, and psychologists to screen for symptoms of depression. Further, the test authors suggest using the screener to measure individual changes over time and response to treatment due to the sensitivity of the VAS rating system. DEVELOPMENT. The development of the CBDS took place over three studies (Barrick, Taylor, & Correa, 2002). The first was a pilot study designed to elicit feedback on item wording and to conduct preliminary validity and reliability analyses. The initial items were developed based on the diagnostic criteria for major depression in the DSM-III-R (APA, 1987) and input from practicing psychiatrists. This effort resulted in the 30-item Correa-Barrick Scale (CBS), which then was administered to 100 students and 16 university faculty and staff who also completed the Beck Depression Inventory (BDI) and the Inventory of Depression Symptomatology–Self Report (IDS- SR). Results indicated that the CBS demonstrated adequate evidence of reliability (alpha = .92) and correlated moderately and significantly with both the BDI (r = .71, p &lt; .01) and the IDS-SR (r = .72, p &lt; .01). The second study aimed to assess the CBS further with a larger sample including a control group. The CBS was administered to 337 university faculty and staff as well as 50 patients with a history of depression who received treatment at a private psychiatric clinic. With this sample, the CBS was correlated with the IDS-SR (r = .81, p &lt; .01), providing some evidence of concurrent validity. Factor analyses with varimax rotations indicated four subscales within the CBS: Cognitive- Emotional Disturbance, General Outlook, Physiological Symptoms, and Sensory/Perceptual Disturbance. Items were adjusted or deleted based on these analyses. With this sample, strong internal consistency was found for both the patient sample (alpha = .96) and the control sample (alpha = .93). Test-retest analyses with the control sample generated a sufficient correlation (r = .70) across a 2-week retest interval. Finally, results of t tests indicated that the CBS was able to differentiate between depressed and non-depressed groups with the patient sample reporting higher scores than the control sample. For the third study, described as a replication study, items from the CBS that showed an item-total

correlation less than .60 were removed. Additional items were also removed because of conceptual challenges and the desire to reduce the scale to fit on one page. This reduction resulted in the final Correa-Barrick Depression Scale (CBDS), which aligned with the criteria for major depression as described in the DSM-5 (APA, 2013), according to the test developers. TECHNICAL. Reliability, validity, and sensitivity of the CBDS were assessed through the replication study noted above. The CBDS and the Zung Self-Rating Depression Scale (SDS; Zung, 1965) were administered to 121 inpatient and outpatient participants who were experiencing or had a history of depression as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994). Significant correlation coefficients with the SDS were observed for the outpatient (r = .55), inpatient (r = .78), and combined samples (r = .60). The CBS demonstrated adequate internal consistency for the inpatient, outpatient, and combined samples (alpha = .82, .92, and .91, respectively). The detection sensitivity was evaluated by dividing the number of positive screens by the number of participants with a diagnosis of depression. Results indicated that the CBDS had a sensitivity of 58% in the outpatient sample, 87% in the inpatient sample, and 64% in the combined sample. Cut-off scores for each level of depression severity were determined by examining the sample distribution, the standard error of measurement, and the clinical judgment of psychiatrists. To address inconsistencies in these methods, the final cutoff scores were determined based on a “balance of sensitivity and specificity” (Barrick, Taylor, & Correa, 2002, p. 376) that favored higher sensitivity to increase the likelihood of detecting suicidal persons. COMMENTARY. The CBDS appears to be a helpful tool for assessing depressive symptoms in adults, particularly in settings in which time for survey completion is limited (e.g., medical settings). Because of the measure’s ease of completion and low reading level, this survey is also useful for populations that may feel that completing larger, wordier surveys requires too much energy. The CBDS is easy to score with clearly outlined cutoff scores for varying levels of depression severity. Providing suggestions for actions and next steps for patients whose score falls within each level is beneficial for the administrator. The short and straightforward format of the CBDS also allows for the use of the scale in progress and treatment monitoring, although the developers do not provide guidance for using the measure in this manner. Further, the CBDS provides some information related to changes in color sensitivity and the association with severe depression. Inclusion of an item assessing color sensitivity is unique and novel for depression scales. It is important to note, however, that research support for the connection between color sensitivity and depression is limited. The use of the VAS rating system is a distinctive feature of the CBDS that is especially appropriate in clinical applications, as the literature supports the use of such rating systems to assess emotional and physical experiences. Although the use of reverse scored items reduces the risk of response patterns influencing total scores, it may also increase the risk of scoring errors. Hatch marks indicate the direction of the numeric values (i.e., left is 0 or right is 0); however, the CBDS is presented as a measure that is quick and easy to administer and score. If done too quickly, it would be easy to overlook the reverse scoring. A transparent overlay with aligning numeric values would be a welcome addition that would make scoring easier. Although the simplicity of the CBDS is a strength, it also represents a weakness. The CBDS generates a single raw score, which is good for ease of use and interpretation; however, it provides less information about variations in symptoms and rater response patterns. For example, item analyses that provide information regarding rater consistency and tendency to provide socially

desirable answers would be beneficial. Further, the scale offers only a score for depression severity. Despite presenting a factor structure for the scale, scores related to the four constructs assessed are not available. As suggested in the test manual, it is important that the CBDS be used more as a screener for depression severity as opposed to a comprehensive examination of depression. Finally, the test manual indicates that the use of the VAS rating system makes the CBDS sensitive enough to change to be used for progress monitoring, but it does not present evidence to support its use in monitoring treatment effects over time. In general, relatively little research has been reported evaluating the use of the CBDS in clinical settings. Additional research into the application of the CBDS and its psychometric properties would be beneficial in further evaluating its usefulness. SUMMARY. The CBDS is a short and easy to administer screener for depressive symptoms in adults. It provides information about the more severe symptoms of depression, such as changes in appetite, color sensitivity, sleep patterns, and loss of concentration. The simplicity and length of the scale make it ideal as a screener, and the measure has the potential to act as a progress- monitoring tool for treatment effectiveness. Several studies provide evidence to support the reliability and validity of the scale; however, these studies are limited in number and are not recent. REVIEWERS' REFERENCES American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Barrick, C. B., Taylor, D. E., & Correa, E. I. (2002). Psychometric assessment and clinical application of the Correa-Barrick Depression Rating Scale. Clinical Nursing Research, 11, 363-381. doi: 10.1177/105477302237450 Zung, W. W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70. doi:10.1001/archpsyc.1965.01720310065008

*** Copyright © 2014. The Board of Regents of the University of Nebraska and the Buros Center for Testing. All rights reserved. Any unauthorized use is strictly prohibited. Buros Center for Testing, Buros Institute, Mental Measurements Yearbook, and Tests in Print are all trademarks of the Board of Regents of the University of Nebraska and may not be used without express written consent.