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Beck Depression Inventory

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Purpose

Quantifies severity of depression.

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Instrument Details

Acronym BDI-II (Revised 1996)

Area of Assessment

Depression

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$115.00

Cost Description

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

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • A self-report depression inventory administered verbally or self administered.
  • BDI identifies overt behavioral characteristics of depression.
  • Items are 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.

Number of Items

21

Equipment Required

  • Testing form
  • Writing instrument

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Instrument Reviewers

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.

ICF Domain

Body Function

Measurement Domain

Emotion

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's 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!

Spinal Injuries

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Normative Data

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

Stroke

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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%

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) 

Criterion Validity (Predictive/Concurrent)

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)

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

Non-Specific Patient Population

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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

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

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)

Internal Consistency

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)

Construct Validity

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)

Parkinson's Disease

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Test/Retest Reliability

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

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

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