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Rehab Measures: Beck Depression Inventory

Link to instrument

Available to purchase through the publisher's website (other languages available below) 

Title of Assessment

Beck Depression Inventory 

Acronym

BDI-II (Revised 1996)

Instrument Reviewer(s)

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated by Theresa Gilsdorf, SPT and Stephanie Korso, SPT with chronic pain, psychiatric, cardiovascular, and SCI populations in 2011

Summary Date

4/26/2012 

Purpose

Quantifies severity of depression

Description

  • A self-report depression inventory 
  • Self or verbally administered
  • Identifies overt behavioral characteristics of depression
  • Items on a four-point scale that ranges from 0 to 3 
  • Ratings are summed to provide a total score ranging from 0 – 63
  • Scores >10 generally meet the threshold for a diagnosis of depression

Area of Assessment

Depression 

Body Part

Not Applicable 

ICF Domain

Body Function 

Domain

Emotion 

Assessment Type

Patient Reported Outcomes 

Length of Test

05 Minutes or Less 

Time to Administer

5-10 minutes

Number of Items

21-items 

Equipment Required

  • Testing form
  • Writing instrument

Training Required

  • Requires no training to administer 
  • A doctorate in psychology, education, or a related field is required to purchase the measure  
  • Health care or allied health care field, or individuals who have formal supervised training in mental health, speech/language, and/or educational training settings can also acquire the measure
  • More information is available on the publisher’s website

Type of training required

No Training 

Cost

Not Free 

Actual Cost

$115 (complete kit includes a manual and 25 record forms)

Age Range

Adolescent: 13-17 years; Adult: 18-64 years 

Administration Mode

Paper/Pencil 

Diagnosis

Stroke 

Populations Tested

  • Stroke
  • Medical Patients
  • Proxy
  • Chronic Pain
  • Mental Disorders
  • Cardiovascular Disease
  • Spinal Cord Injury

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Psychiatric patients: (Beck et al, 1988; n = 1,086 psychiatric outpatients; mean age = 36.35 (12.41) years)
  •  10.9 (SD = 8.1) for minimal depression
  •  18.7 (SD = 10.2) for mild depression
  •  25.4 (SD = 9.6) for moderate depression
  •  30.0 (SD = 10.4) for severe depression

Normative Data

Acute Stroke: (Kotila et al, 1998; n = 423; 3 months post-stroke; Finnish sample)

In a treatment study the following percent of patients and caregivers were found to have depressive symptoms:

Patients
Caregivers
0-9
minimal
64
45.7
41
58.5
10-18
mild to moderate
43
30.7
20
28.6
19-29
moderate to severe
24
17.2
7
10
30-63
severe
9
6.4
2
2.9
Total
140
100%
70
100%

Chronic Stroke: (Kotila et al, 1998; BDI scores 12 months post-stroke)

Patients
Caregivers
BDI Score
Level of Depression
n
%
n
%
0-9
minimal
57
44.6

40

58.0
10-18
mild to moderate
53
41.4
16
23.2
19-29
moderate to severe
15
11.7
8
11.6
30-63
severe
3
2.3
5
7.2
Total
128
100%
69
100%

Acute SCI: (Chan et al, 2000; n = 66; mean age = 45.2 (10.66) years; mean time since injury = 13.3 (10.01) years; Chinese sample)

  • The mean BDI score for persons with SCI = 15.79 (9.61) points.
  • The Mean BDI score for persons in the pre-injury marriage sub-group = 18.67 (9.09) points
  • The Mean BDI score for persons in the post-injury marriage sub-group = 10.71 (7.90) points

Test-retest Reliability

Non-psychiatric college-aged subjects: (Wiebe & Penley, 2005; taken in English (n = 539) Spanish (n = 355) or Both languages (n = 254))

  • Adequate test-retest reliability (ICC = 0.73)
  • There was no difference between scores on the English and Spanish versions

Parkinson’s Disease: (Visser et al, 2006;  n = 101)

  • Excellent test–retest reliability (ICC = 0.89)
    • Test–retest reliability for individual items ranged from 0.31 to 0.86

Psychiatric outpatient: (Poole et al, 2006; n = 500)

  • Excellent test-retest reliability (coefficient alpha = 0.92)

College students: (Poole et al, 2006; n = 120)

  • Excellent test-retest reliability (coefficient alpha = 0.93)

 

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Acute Stroke: (Aben et al, 2002; n = 202, mean age = 68.5 (11.6) years) 

  • Excellent internal consistency (Cronbach's alpha = 0.83) 

Psychiatric Out-patients meta-analysis: (Beck & Steer, 1988)

  • Excellent internal consistency (Cronbach's alpha = 0.86)

Non-Psychiatric subjects meta-analysis: (Beck & Steer, 1988)

  • Excellent internal consistency (Cronbach's alpha = 0.81)

Chronic Pain: (Poole et al, 2006; n = 1227; mean age = 46. 73 (11.30) years; mean duration of pain = 8.8 (7.8) years)

  • Excellent internal consistency (Cronbach’s alpha = 0.92)

Psychiatric samples meta-analysis: (Richter, Werner, Heerlein, Kraus & Sauer, 1998)

  • Excellent internal consistency (average alpha-coefficient = 0.88)

Non-Psychiatric samples meta-analysis: (Richter, et al., 1998)

  • Excellent internal consistency (average alpha-coefficient = 0.82)

 

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:
  • Increased BDI scores have been associated with higher ratings on the Depth of Depression Scale  (p < 0.01) (Beck et al, 1961)

BDI was evaluated against the following clinical rating tools: (Beck et al, 1988, meta-analysis): 

  • Excellent correlation with HRSD (psychiatric r = 0.61–0.86; non-psychiatric r = 0.73 – 0.80)
  • Adequate to excellent correlation with Zung Self-Rating Depression Scale (psychiatric r = 0.57 – 0.83; non-psychiatric r = 0.66 – 0.86)
  • Adequate to Excellent correlation with MMPI-D (psychiatric r = 0.41 – 0.70; non-psychiatric r = 0.56 - 0.75)
  • Adequate to Excellent correlation with MAACL-D (psychiatric r = 0.66 and 0.59; non psychiatric r = 0.63)
  • Excellent correlations with clinical ratings (r > 0.60)

Predictive validity:

Stroke: (Desrosiers et al, 2002; n = 132; mean age = 60.9 (13.5) years)

  • Adequate correlation with stroke survivor handicap situation (LIFE-H) at discharge (r = -0.48; p < 0.001)
  • Poor correlation with handicap situation (LIFE-H) 6-months post discharge (r2 = 0.23; p < 0.001)

Construct Validity (Convergent/Discriminant)

Psychiatric Out-patients: (Snyder et al, 2000)

  • Excellent correlation between the BDI and the Geriatric Depression Scale (r = 0.78)

Psychiatric Out-patients: (Richter et al, 1998)

  • Moderate to Excellent mean correlation coefficients (0.58-0.79)

Psychiatric Out-patients: (Beck et al, 1996)

  • Excellent correlation between the BDI-II and BDI-IA (r = 0.93; n = 191)

Psychiatric Out-patients: (Beck et al, 1988)

  • Adequate correlation between the BDI and Beck's Hopelessness Scale (r = 0.59; n = 160)
  • Adequate correlation between the DBI and the Beck Anxiety Inventory (r = 0.48; n = 160)

Content Validity

  • Originally constructed from a clinical consensus about depressive symptoms displayed by psychiatric patients (Beck et al, 1961)
  • Created to mirror the criteria for clinical depression as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Wiebe & Penley, 2005)
  • The BDI reflects six of the nine criteria used in the DSM-III for a diagnosis of depression well (Richter et al, 1998)

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Acute Stroke: (House et al, 1991; n = 128; assessed over 12 months after first ever stroke)

  • Strong agreement between BDI and DSM-III criteria evaluated over a one year period. 
  • BDI was sensitive to change in stroke patients
  • Somatic symptoms appeared to decline, while no change was reported for cognitive affective symptoms

Professional Association Recommendations

Considerations

  • BDI is a self-report measure and as such may be susceptible to contextual demands
  • Administrators should be aware of any physical limitations that might impair a patient ability to respond to items or that may influence resultant scores (Moore et al, 1998) 
  • May yield a high rate of false positives in stroke population (approximately 31%), particularly among female patients (Aben et al. 2002)
  • Not been tested for use with proxy respondents (e.g. caregivers, family members)
  • Described as having shortcomings such as high item difficulty, lack of representative norms, controversial factorial validity, instability of scores over short time intervals, and poor discriminant validity against anxiety (Richter, et al., 1998)
  • Described as having advantages such as high internal consistency, high content validity, validity in differentiating between depressed and nondepressed patients, sensitivity to change, and international propagation (Richter, et al., 1998)

Beck Depression Inventory translations:

Chinese (simplified):
http://baike.baidu.com/view/9292518.htm

Danish:
http://www.cure4you.dk/960/BDI%20Beck%20Depression%20Inventory%20-%20dansk.pdf

French:
http://www.deploie-tes-ailes.org/test/depression.php

German (slides 21-22):
http://www1.uni-hamburg.de/psych-3/seminar/schwab/Selbstbeurteilungsverfahren.pdf

Italian (p4-5):
http://www.stateofmind.it/wp-content/uploads/2012/05/BDI-13.pdf

Japanese:
http://www.sannoclinic.jp/bdi.html

Spanish:
http://telemedicinadetampico.files.wordpress.com/2011/12/inventariodedepresiondebeck.pdf

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Aben, I., Verhey, F., et al. (2002). "Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients." Psychosomatics 43(5): 386. Find it on PubMed

Beck, A., Steer, R., et al. (1988). "Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation." Clinical Psychology Review 8(1): 77-100.

Beck, A., Ward, C., et al. (1961). "An inventory for measuring depression." Archives of general psychiatry 4(6): 561.

Beck, A. T., Epstein, N., et al. (1988). "An inventory for measuring clinical anxiety: psychometric properties." J Consult Clin Psychol 56(6): 893-897. Find it on PubMed

Beck, A. T., Steer, R. A., et al. (1996). "Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients." J Pers Assess 67(3): 588-597. Find it on PubMed

Chan, R. C., Lee, P. W., et al. (2000). "Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting." Spinal Cord 38(11): 687-696. Find it on PubMed

Desrosiers, J., Noreau, L., et al. (2002). "Predictors of handicap situations following post-stroke rehabilitation." Disabil Rehabil 24(15): 774-785. Find it on PubMed

House, A., Dennis, M., et al. (1991). "Mood disorders in the year after first stroke." Br J Psychiatry 158: 83-92. Find it on PubMed

Kotila, M., Numminen, H., et al. (1998). "Depression after stroke: results of the FINNSTROKE Study." Stroke 29: 368-372. Find it on PubMed

Moore, M. J., Moore, P. B., et al. (1998). "Mood disturbances in motor neurone disease." J Neurol Sci 160 Suppl 1: 53-56. Find it on PubMed

Pohjasvaara, T., Leppavuori, A., et al. (1998). "Frequency and clinical determinants of poststroke depression." Stroke 29(11): 2311-2317. Find it on PubMed

Poole, H., Bramwell, R., et al. (2006). "Factor Structure of the Beck Depression Inventory-II in patients With chronic pain." Clinical Journal of Pain 22(9): 790-798. Find it on PubMed

Richter, P., Werner, J., et al. (1998). "On the validity of the Beck Depression Inventory. A review." Psychopathology 31(3): 160-168. Find it on PubMed

Riskind, J., Beck, A., et al. (1987). "Taking the Measure of Anxiety and Depression Validity of the Reconstructed Hamilton Scales." The Journal of nervous and mental disease 175(8): 474. Find it on PubMed

Snyder, A. G., Stanley, M. A., et al. (2000). "Measures of depression in older adults with generalized anxiety disorder: a psychometric evaluation." Depress Anxiety 11(3): 114-120. Find it on PubMed

Visser, M., Leentjens, A. F., et al. (2006). "Reliability and validity of the Beck depression inventory in patients with Parkinson's disease." Mov Disord 21(5): 668-672. Find it on PubMed

Wiebe, J. S. and Penley, J. A. (2005). "A psychometric comparison of the Beck Depression Inventory-II in English and Spanish." Psychol Assess 17(4): 481-485. Find it on PubMed

Year published

1961, Revised 1996 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 10/24/2014 1:32 PM  by Jason Raad