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  2. Beck Depression Inventory

Beck Depression Inventory

Last Updated

Purpose

Quantifies the severity of depression.

Link to Instrument

Instrument Details

Acronym BDI-II (Revised 1996)

Area of Assessment

Mental Functions

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$186.30

Cost Description

$186.30 for complete kit that includes a manual (print) and 25 record forms (print)

CDE Status

NINDS CDE Notice of Copyright, Beck Depression Inventory II (BDI-II) – As of 4/15/2025

  • NeuroRehab Supplemental – Highly Recommended (Recommendation for use: Indicated for studies requiring a measure of emotional impairment.)
  • Supplemental – Highly Recommended: Epilepsy, Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
  • Supplemental: Amyotrophic Lateral Sclerosis (ALS), Epilepsy, Headache, Huntington’s Disease (HD), Multiple Sclerosis (MS), Parkinson’ Disease (PD), Sport-Related Concussion (SRC), Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post-concussion), Stroke, and Traumatic Brain Injury (TBI)
  • Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)

  

Diagnosis/Conditions

  • Stroke Recovery

Populations

Stroke
Spinal Cord Injuries
Mixed Conditions
Neurologic Conditions
Brain Injury
Cancer
Multiple Sclerosis

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

Elderly Adult

65 - 80

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; updated by Mallory Fredricks, OTR/L, Neurologic Occupational Therapy Fellow, Shirley Ryan AbilityLab in August 2025.

ICF Domain

Body Function

Measurement Domain

Emotion

Professional Association Recommendation

None found -- last searched 8/29/2025.

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).
  • Has 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).
  • Available in multiple languages:
    • Arabic – validated (Abdel-Khalek et al., 1998)
    • Cambodian – translated without validation (Savin et al., 1996)
    • Chinese – validated (Zheng et al., 1988)<
    • Dutch – validated (Bosscher et al., 1986)
    • Finnish – validated (Raitasalo, 1995)
    • French – validated (Collet et al., 1986)
    • German – validated (Hautzinger, 1991)
    • Italian – translated without validation (Ranchetti, 1987)
    • Japanese – validated (Kojima et al., 2002)
    • Korean – translated without validation (Sung et al., 1992)
    • Persian – validated (Ghassemzadeh et al., 2005)
    • Polish – validated (Parnowski et al., 1977)
    • Portuguese – validated (Gorenstein et al., 1996; 1999)
    • Spanish – validated (Sanz et al., 2005)
    • Serbo – Croatian (roman script) validated (Grubac, 1989)
    • Swedish – validated (Byrne et al., 1995)
    • Turkish – validated (Hisli, 1988)
    • Xhosa – translated without validation (Drennan et al., 1991)

The above translations are subject to the Terms and Conditions of Use of the Rehab Measures Database. The Shirley Ryan AbilityLab 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@sralab.org.

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

Spinal Cord 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

Stroke: Kotila et al., 1998; n = 594 patients with first-ever stroke, age ≥ 15, BDI performed at 3 and 6 months, Finnish sample)

 

The Frequency and Severity of Depression of Patients and Caregivers at 3 and 12 Months After Stroke in Districts With and Without Active After-Hospital Discharge Programs

 

Patients at 3 months

Severity of Depression (BDI Points)*

 

Active n (%)

 

Control n (%)

0-9

106 (58.6)

64 (45.7)

10-18

51 (28.2)

43 (30.7)

19-29

19 (10.5)

24 (17.2)

30-63

5 (2.7)

9 (6.4)

Total

181 (100)

140 (100)

 

Caregivers at 3 months

Severity of Depression (BDI Points)*

 

Active n (%)

 

Control n (%)

0-9

73 (58.4%)

41 (58.5)

10-18

41 (32.8)

20 (28.6)

19-29

11 (8.8)

7 (10.0)

30-63

0 (0)

2 (2.9)

Total

125 (100)

70 (100)

 

Patients at 12 months

Severity of Depression (BDI Points)*

 

Active n (%)

 

Control n (%)

0-9

107 (58.4)

57 (44.6)

10-18

46 (25.3)

53 (41.4)

19-29

27 (14.7)

15 (11.7)

30-63

3 (1.6)

3 (2.3)

Total

183 (100)

128 (100)

 

Caregivers at 12 months

Severity of Depression (BDI Points)*

 

Active n (%)

 

Control n (%)

0-9

70 (60.9)

40 (58.0)

10-18

35 (30.4)

16 (23.2)

19-29

9 (7.8)

8 (11.6)

30-63

1 (0.9)

5 (7.2)

Total

115 (100)

69 (100)

*Beck Depression Index: 0-9 indicates null to minimal; 10-18, mild to moderate; 19-29, moderate to severe; and 30-63, severe.

 

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

Mixed Conditions

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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)

  • Adequate 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)

Neurologic Conditions

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Standard Error of Measurement (SEM)

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021; n = 62 PSP patients, male = 33 (53%), median age = 70 years; median disease duration = 3 years; BDI-II) 

  • SEM = 3.82

 

Cut-Off Scores

Parkinson’s Disease: (Maggi et al., 2023; n = 50 PD outpatients; mean age = 65.16 (8.65) years, male = 35 (70%); mean disease duration = 11.22 (4.52) years; Italian translation of BDI-II) 

  • ≥ 14.5 is cut-off value for diagnosis of depression (sensitivity 92.3%, specificity 96.7%)

 

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021)

  • ≥ 14.5 is cut-off value for diagnosis of depression (sensitivity 71%, specificity 71%)

 

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

Internal Consistency

Parkinson’s Disease: (Maggi et al., 2023) 

  • Excellent: Cronbach’s α = 0.840

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021)

  • Excellent: Cronbach's alpha = 0.868

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Parkinson’s Disease: (Maggi et al., 2023)

  • Adequate ability of the BDI-II to accurately predict a diagnosis of depression (AUC = 0.859, positive predictive value (PPV) = 0.333, negative predictive value (NPV) = 0.976)

 

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021)

  • Adequate ability of the BDI-II to accurately predict a diagnosis of depression (AUC = 0.739 (95% CI = 0.611-0.867), 71% diagnostic accuracy, positive predictive value (PPV) = 56%, and negative predictive value (NPV) = 83%)

 

Construct Validity

Convergent validity:

Parkinson’s Disease: (Maggi et al., 2023)

  • Excellent correlation between scores on the BDI-II and the Parkinson Anxiety Scale (PAS) (r = 0.675, p < 0.001)
  • Adequate correlation between scores on the BDI-II and the depression/dysphoria domain of the Neuropsychiatric Inventory (NPI-D) (r = 0.401, p = 0.004)

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021)

  • Adequate correlation between the BDI-II total score and item 4 (for depression symptoms) of the Natural History and Neuroprotection in Parkinson Plus Syndromes Parkinson Plus Scale (NNIPPS) (r = 0.343, p = 0.009)

 

Discriminant validity:

Parkinson’s Disease: (Maggi et al., 2023)

  • Excellent correlations between scores on the BDI-II and the Apathy Evaluation Scale (AES) (r = 0.265, p = 0.079) and the BDI-II and the Montreal Cognitive Assessment (MoCA) (r = -0.113, p = 0.435)

Progressive Supranuclear Palsy (PSP): (Cuoco et al., 2021)

  • Excellent correlations between the BDI-II and the MoCA (r = -0.244, p = 0.067), and the BDI-II and the Clock Drawing Test (CDT) (r = -0.116, p = 0.394)

 

Brain Injury

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Cut-Off Scores

Severe Traumatic Brain Injury (TBI): (Schwarzbold et al., 2014; n = 46 severe TBI survivors, mean age at injury = 31.1 (11.5) years, male = 38 (82.6%), median time after injury = 15 months; severe TBI = Glasgow coma score ≤ 8 on admission; Brazilian sample; BDI-II)

  • ≥ 14 is cut-off value for diagnosis of depression (sensitivity 92.3%, specificity 96.7%)

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Severe Traumatic Brain Injury (TBI): (Schwarzbold et al., 2014)

  • Excellent ability of the BDI-II to accurately predict a diagnosis of depression at a median of 15 months post-injury (AUC = 0.946)

 

 

Multiple Sclerosis

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Cut-Off Scores

Multiple Sclerosis (MS): (Sacco et al., 2016; n = 141 MS patients, female = 99 (70.2%), median age = 39.3 (11.2) years; age range = 15-63 years; median disease duration = 11.1 (9.2) years; Italian sample; BDI-II)

  • ≥ 18.5 is cut-off value for diagnosis of depression (sensitivity 78%, specificity 88%)

 

Internal Consistency

Multiple Sclerosis (MS): (Sacco et al., 2016; n = 141)

  • Excellent: Cronbach's alpha = 0.89

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Multiple Sclerosis (MS): (Sacco et al., 2016; n = 141)

  • Excellent ability of the BDI-II to accurately predict a diagnosis of depression (AUC = 0.91)

 

Construct Validity

Convergent validity:

Multiple Sclerosis (MS): (Sacco et al., 2016; n = 141)

  • Excellent correlations between the BDI-II score and the Total and subscale scores on the Chicago Multiscale Depression Inventory (CDMI)(p < 0.001):
    • CMDI Total (r = 0.79)
    • CMDI Mood (r = 0.73)
    • CMDI Evaluative (r = 0.71)
    • CMDI Vegetative (r = 0.73)

Discriminate validity:

Multiple Sclerosis (MS): (Sacco et al., 2016; n = 141)

  • Excellent: index D for all BDI-II items ≥ 0.40

 

Cancer

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Cut-Off Scores

Cancer: (Almeida et al., 2023; n = 586 (210 patients with cancer diagnosis, mean age = 58.0 (11.7) years; and 376 with mental health complaints, but without cancer, mean age =  52.3 (17.1); Portuguese translation of BDI-II)

  • >14 for diagnosis of depressive disorder in unidimensional model for patients with cancer diagnosis (n = 94) (sensitivity = 86.8, sensitivity = 73.2)
  • >18 for diagnosis of depressive disorder in unidimensional model for patients without a cancer diagnosis (n = 202) (sensitivity = 83.5, sensitivity = 72.5)

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Cancer: (Almeida et al., 2023)

  • Adequate predictive validity of the BDI-II total score to predict diagnosis of depressive disorder in unidimensional model for patients with cancer diagnosis (n = 94) (AUC = 0.85 (95% CI: 0.76, 0.91), PPV = 80.7, NPV = 81.1)
  • Adequate predictive validity of the BDI-II total score to predict diagnosis of depressive disorder in unidimensional model for patients without cancer diagnosis (n = 202) (AUC = 0.87 (95% CI: 0.81, 0.91), PPV = 85.4, NPV = 69.4)

 

Construct Validity

Discriminate validity:

Cancer: (Almeida et al., 2023)

  • Significant ability of the BDI-II total score to discriminate between patients with and without a cancer diagnosis (p < 0.001)

 

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

Almeida, S., Camacho, M., Barahona-Corrêa, J. B., Oliveira, J., Lemos, R., Rodrigues da Silva, D., Alves da Silva, J., Baptista, T. M., Grácio, J., & Oliveira-Maia, A. J. (2023). Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items. International Journal of Clinical and Health Psychology, 23(2), Article 100350. https://doi.org/10.1016/j.ijchp.2022.100350

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.

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

Cuoco, S., Cappiello, A., Abate, F., Tepedino, M. F., Erro, R., Volpe, G., Pellecchia, M. T., Barone, P., & Picillo, M. (2021). Psychometric properties of the Beck Depression Inventory-II in progressive supranuclear palsy. Brain and Behavior, 11(10), e2344. https://doi.org/10.1002/brb3.2344

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

Maggi, G., D’Iorio, A., Aiello, E. N., Poletti, B., Ticozzi, N., Silani, V., Amboni, M., Vitale, C., & Santangelo, G. (2023). Psychometrics and diagnostics of the Italian version of the Beck Depression Inventory-II (BDI-II) in Parkinson’s disease. Neurological Sciences, 44(5), 1607–1612. https://doi.org/10.1007/s10072-023-06619-w

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

Sacco, R., Santangelo, G., Stamenova, S., Bisecco, A., Bonavita, S., Lavorgna, L., Trojano, L., D'Ambrosio, A., Tedeschi, G., & Gallo, A. (2016). Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis. European Journal of Neurology, 23(4), 744–750. https://doi.org/10.1111/ene.12932

Schwarzbold, M. L., Diaz, A. P., Nunes, J. C., Sousa, D. S., Hohl, A., Guarnieri, R., Linhares, M. N., & Walz, R. (2014). Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury. Revista Brasileira de Psiquiatria, 36(3), 206–212. https://doi.org/10.1590/1516-4446-2013-1308

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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