The Benzodiazepine Dependence Questionnaire (BDEPQ): Development of a brief version and validation of a French adaptation

Context

Benzodiazepines (BZDs) are the most widely-used pharmaceutical treatment for anxiety and insomnia. While effective for short term protocols, their risk–benefit tradeoff for long-term protocols should be considered with caution. Similar to alcohol, these substances act on the GABA system, and are known to result in rapid tolerance, (sometimes intense) withdrawal syndromes, and fast dependence. Long-term consumption aggravates sleep disorders and anxiety, and increases the risk of accidents. Both the French and the Swiss are high users of BZDs. It is estimated that between 2–5% of adults take them for longer than recommended. Commercialized since the 1970s, there is still no freely available French-language questionnaire assessing dependence.

Aim/Purpose

The principal objective of this study was to empirically assess the original Benzodiazepine Dependence Questionnaire (BDEPQ) of 30 items, as well as a herein developed abridged version of 11 items, the BDEPQ-11 specific to sleep use. As the abridged version is of practical length, was found efficient, and likewise does not require the purchase of a license, it is appreciable for clinical applications and research, and serves the interest of public health. These two scales were empirically assessed respective to their adaptation to the French language, currently observed as the 5th most-spoken language in the world.

Method

The process of scale adaptation followed the important norms established by Guillemin et al. (1993): translation, back-translation, committee review, and pre-testing. A large sample of n = 531 participants who have been taking BZDs since at least 12 months were recruited and responded to the questionnaire, along with other scales in order to assess the adaptation’s convergent and divergent validity. Clinical diagnoses of BZD dependence were also available for a subset of the sample, n = 165 by which discriminability of the scale for distinguishing severe dependance could also be assessed.

Result

Both the full-length and brief versions of the French-adapted BDEPQ satisfied the confirmatory factor analysis norms, and in which the brief version surpassed the original. The two versions also displayed appropriate convergent and divergent validity results with other scales. However, in regard to the exploratory factor analysis norms and correspondence with clinical diagnoses from professionals, only the brief version excelled, especially with regard to its subscale that quantifies BZD drug tolerance and misuse.

Discussion

French is an official language in more than 25 countries and the availability of this adaptation responds to a growing clinical and research need regarding BZD dependence, as well as for important cross-cultural research. In both English and French, few scales on BZD dependence apart from the BDEPQ are available and freely available to practitioners. Future research may consider innovating a modernized full-length version that is well-grounded in the statistical analyses available today, such as those that were utilized in the current work.