CHAPTER 64: BECK DEPRESSION INVENTORY-II (BDI-II)

Description

The Beck Depression Inventory-II (BDI–II), by Beck, Steer, Ball, and Ranieri (1996), is a self-report/interview questionnaire designed to quantify the amount of depression a person may be experiencing and its use is considered appropriate for a number of general client populations. Composed of 21 items, it assesses a wide range of depressive symptoms over a 2-week period. The original BDI instrument has gone through multiple revisions and today the BDI-II is arguably a gold standard of depression measurement. First mentioned in the literature in 1961, the most recent revision includes (1) the removal and replacement of 4 items that assess agitation, worthlessness, concentration difficulty, and loss of energy; (2) the time frame for responses was lengthened from 1 to 2 weeks; and (3) 2 items were changed to assess changes in appetite and sleep (Hall et al., 2013). Each item of the BDI-II is rated along a 4-point Likert scale from 0 to 3 where the descriptors for each item vary and include such answers as self-dislike, which is scored as (0) I feel the same about myself as ever, (1) I have lost confidence in myself, (2) I am disappointed in myself, and (3) I dislike myself. Items are summed to produce a total score with higher scores representing more depressive symptoms. Administration time can be less than 10 minutes.

Psychometrics

Beck et al. (1996) provided evidence that the BDI-II possesses adequate reliability and validity for clinical purposes where they found that for 26 subject in an outpatient setting the 1-week test-retest reliability was high (r = 0.93). With respect to its convergent and discriminant validities, they also reported that the BDI-II was more positively correlated with the revised Hamilton Psychiatric Rating Scale for Depression (0.71) than it was with the revised Hamilton Rating Scale for Anxiety (0.47). Measurement of depression among bariatric subjects established that total BDI-II scores demonstrated excellent internal consistency at α = 0.90, whereas factor analysis produced 3 items that explained a large percent of the variance: affective (0.72), cognitive (0.82), and somatic (0.80) (Hall et al., 2013). Osman et al. (1997) found that reliability estimates for the total BDI-II score resulted in a coefficient of r = 0.90, similar to that reported in the manual, whereas indices of a factor analysis produced 3 items that explained variance: negative attitude (0.84), performance difficulty (0.77), and somatic elements (0.68). An analysis of healthy college students showed that the mean score of women was 11.8, (SD = 8.65), which was significantly higher than men’s scores of 9.41 (SD = 6.44) (Osman et al., 1997). A study by Steer, Rissmillera, and Beck (2000) concurred with those results in which the mean BDI-II total scores of 80 geriatric women and 50 men were 25.42 (SD = 12.68) and 23.18 (SD = 12.86), respectively.

Advantages

There is a significant amount of evidenced-based research in support of the BDI in it various forms for use in clinical practice and no special training or certifications are needed. Web-based and local software administration, scoring, and reporting are available through Pearson Clinical where the assessment can be purchased.

Disadvantages

Factor analysis of the BDI–II has shown that scores typically break down into two or three latent symptom sets such as the somatic or cognitive, raising questions about its utility and meaningfulness (Quilty, Zhang, & Bagby, 2010). The issue is highlighted in a normative sample (n = 500) with various psychiatric disorders where scores were found to reflect two positively correlated dimensions: (1) a non-cognitive (somatic-affective) factor represented by somatic symptoms, such as loss of energy and affective symptoms, such as irritability and (2) cognitive factors composed of psychological symptoms, such as self-dislike and worthlessness (Steer et al., 2000).

Administration

The BDI-II examiner’s manual includes detailed instructions as well as standardized norms across a wide range of age groups. The recommended cutoff for minimal depression is 13, a score of 14 to 19 indicates mild depression, 20 to 28 indicates moderate depression, and 29 to 63 indicates serious depression (Skule et al., 2014). During assessment the subject is asked to consider each question and how it relates to his or her own personal experience over the preceding 2 weeks.

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