The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.
In its current version, the BDI-II is designed for individuals aged 13 and over, and is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex.[1]
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According to Beck's publisher, 'When Beck began studying depression in the 1950s, the prevailing psychoanalytic theory attributed the syndrome to inverted hostility against the self.'[3] By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim descriptions of their symptoms and then using these to structure a scale which could reflect the intensity or severity of a given symptom.[1]
Beck drew attention to the importance of "negative cognitions" described as sustained, inaccurate, and often intrusive negative thoughts about the self.[4] In his view, it was the case that these cognitions caused depression, rather than being generated by depression.
Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression.An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results:
The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring.
When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-off scores were as follows:[7]
The BDI-IA was a revision of the original instrument developed by Beck during the 1970s, and copyrighted in 1978. To improve ease of use, the "a and b statements" described above were removed, and respondents were instructed to endorse how they had been feeling during the preceding two weeks.[8][9] The internal consistency for the BDI-IA was good, with a Cronbach's alpha coefficient of around 0.85, meaning that the items on the inventory are highly correlated with each other.[10]
The development of the BDI was an important event in psychiatry and psychology; it represented a shift in health care professionals' view of depression from a Freudian, psychodynamic perspective, to one guided by the patient's own thoughts or "cognitions".[3] It also established the principle that instead of attempting to develop a psychometric tool based on a possibly invalid theory, self-report questionnaires when analysed using techniques such as factor analysis can suggest theoretical constructs.
The BDI was originally developed to provide a quantitative assessment of the intensity of depression. Because it is designed to reflect the depth of depression, it can monitor changes over time and provide an objective measure for judging improvement and the effectiveness or otherwise of treatment methods.[13] The instrument remains widely used in research; in 1998, it had been used in over 2000 empirical studies.[14] It has been translated into multiple European languages as well as Arabic, Chinese, Japanese, Persian,[15] and Xhosa.[16]
In participants with concomitant physical illness the BDI's reliance on physical symptoms such as fatigue may artificially inflate scores due to symptoms of the illness, rather than of depression.[18] In an effort to deal with this concern Beck and his colleagues developed the "Beck Depression Inventory for Primary Care" (BDI-PC), a short screening scale consisting of seven items from the BDI-II considered to be independent of physical function. Unlike the standard BDI, the BDI-PC produces only a binary outcome of "not depressed" or "depressed" for patients above a cutoff score of 4.[19]
Objective: This study was designed to assess whether vitamin D supplementation can reduce symptoms of depression, metabolic profiles, serum high-sensitivity C-reactive protein (hs-CRP), and biomarkers of oxidative stress in patients with major depressive disorder (MDD).
Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
Introduction: The Beck Depression Inventory-Fast Screen (BDI-FS) is a brief self-report inventory designed to evaluate depression in patients with medical illness. As depressive disorder is especially prominent in multiple sclerosis (MS), a cost-effective procedure for identifying depressive disorder in MS is sorely needed. The BDI-FS may be useful in this regard although, to date, its validity in MS patients has not been assessed.
Methods: Fifty-four consecutive MS patients were studied. All underwent psychological assessment, which included the BDI-FS and other self-report measures of depression. Forty-eight caregiver/informants were interviewed using the Neuorpsychiatric Inventory (NPI). Retrospective chart reviews were conducted by a single trained research assistant, blind to the results of psychological testing and interviews, to determine if antidepressant medications had been prescribed.
Results: The BDI-FS was significantly correlated with other self-report measures of depression (P < 0.001) and with informant reported dysphoria (P < 0.01), In addition, BDI-FS scores discriminated MS patients undergoing treatment for depressive disorder from untreated MS patients (P = 0.01).
Conclusion: These data support the concurrent and discriminative validity of the BDI-FS in MS. As the test is brief and not confounded with neurological symptoms, it is recommended for depression screening in this population.
It is important to note that the official BDI is copyrighted and available on Pearson's website. There are several other depression screens that are not proprietary and are in the public domain for use. If you are concerned about your level of depression, it is important to discuss your symptoms with a mental health professional.
Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S454-S466. doi:10.1002/acr.20556
Demyttenaere K, Jaspers L. Trends in (not) using scales in major depression: A categorization and clinical orientation. Eur Psychiatry. 2020 Sep 23;63(1):e91. doi: 10.1192/j.eurpsy.2020.87. PMID: 32962793; PMCID: PMC7681155.
Eaton WW, Neufeld K, Chen LS, Cai G. A comparison of self-report and clinical diagnostic interviews for depression: diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore epidemiologic catchment area follow-up. Arch Gen Psychiatry. 2000;57(3):217-222. doi:10.1001/archpsyc.57.3.217
Wang FM, Davis MF, Briggs FB. Predicting self-reported depression after the onset of multiple sclerosis using genetic and non-genetic factors. Mult Scler. 2021;27(4):603-612. doi:10.1177/1352458520921073
Fried EI, van Borkulo CD, Epskamp S, Schoevers RA, Tuerlinckx F, Borsboom D. Measuring depression over time . . . Or not? Lack of unidimensionality and longitudinal measurement invariance in four common rating scales of depression. Psychol Assess. 2016;28(11):1354-1367. doi:10.1037/pas0000275
Phan T, Carter O, Adams C, et al. Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2016;13(3):220-228. doi:10.1177/1479972316634604
According to the World Health Organization [3] depression is the leading cause of years lived with disability (YLD), and the most prevalent disorder among serious psychiatric disorders in primary care setting. This disorder is characterized by changes in sleep, appetite and psychomotricity, decreased concentration and decision-making ability, loss of self-confidence, feelings of inferiority or worthlessness and guilt, as well as despair and recurrent thoughts of death with ideation, planning and/or suicidal acts.
So far, the Beck Depression Inventory-II (BDI-II) has become one of the most widely used measures to assess depressive symptoms and their severity in adolescents and adults [4]. The BDI-II [5] is a 21-item self-report measure that taps major depression symptoms according to diagnostic criteria listed in the Diagnostic and Statistical Manual for Mental Disorders [6]. Items are summed to create a total score, with higher scores indicating higher levels of depression. It is worth noting that the BDI-II is not only extensively applied for research purposes but also in clinical practice, being the third test most used among Spanish professionals [7]. 006ab0faaa