Assessment of body-focused Beck Anxiety and Beck Depression Inventory items in chronic illness: A preliminary analysis of emotional versus physical causes

Jill Albertson, BS Candidate

Massachusetts General Hospital, Tufts University – Research Assistant

Scientific Abstract

Background: Before the recent example of “Long-COVID,” it has been known for decades that a subset of individuals will not fully recover from acute infectious illness, and many such patients fulfill criteria for the symptom-based syndrome diagnostic labels of chronic fatigue syndrome or myalgic encephalomyelitis (ME/CFS) Along with the sensation of an ongoing cold or flu, symptoms commonly include abnormally profound fatigue, autonomic problems, difficulty sleeping, and changes in appetite. While depression and anxiety can certainly be present and there is no hard binary between mind and body, many ME/CFS patients often report that they are not particularly depressed or anxious. However, studies consistently show that ME/CFS groups score higher than controls on the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Careful reading of the BAI and BDI reveals many items that could potentially be interpreted differently through the lens of emotional state versus illness. For instance, the BAI item asking about “tingling/numbness” may be endorsed by an anxious person but would also likely be endorsed by a person with small-fiber polyneuropathy, which is present in approximately 35% of individuals with the ME/CFS diagnosis.

Methods: We conducted on all-online questionnaire-based study that presented the BAI and BDI each twice, with questions or prompts about perceived basis of each item’s score. Inclusion criteria included self-reported diagnosis of ME or CFS by a licensed clinician, English proficiency, and 18 yrs or older. Current pilot analysis includes N=52 individuals (47 female), mean age 47 yrs (SD=12.20), mean time since illness onset 19 yrs (SD=11.95). 14 items from the BAI and 12 items from the BDI were selected based on possibility of misinterpretation.

Results: For the BAI self-report of total items with perceived cause was as follows: 66.7% due to ME/CFS, 5.3% due to emotional state, while the remaining 25.4% of patients did not experience the given symptoms, and 2.6% chose not to answer.

For the BDI, a paired t-test compared item scores between “emotional” and “illness” prompts There was a significant difference between severity of symptoms due to their physical ME/CFS illness (M=14.98, SD=5.04) compared to the symptoms due to their emotional state (M=7.17, SD=6.47), t(270)=16.481, p<.001.

Conclusion: These results call for clarity in the use of psychometric questionnaires in ME/CFS studies, and caution in their interpretation.

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research Areas


Albertson, Jill; Yarwood, Jennelle; Hsu, William; Adekola, Praise; Lara Mejia, Paula S; Bues, Hannah; VanElzakker, Michael B. PhD

Principal Investigator

VanElzakker, Michael B. PhD