BECK DEPRESSION INVENTORY (BDI)
To measure depression symptoms and severity in persons age 13 and older.
Based on clinical observations and patient description, the BDI contains items that reflect the cognitive, affective, somatic, and vegetative symptoms of depression (1,2).
Aaron T. Beck, PhD, Center for Cognitive Therapy, Philadelphia, PA.
The revised BDI (BDI-IA) (3), replaced the original version (2). The BDI-IA is similar to the original, except timeframe extends “over the past week, including today” and some items were reworded to avoid double negative statements. The BDI-II contains substantial revision of the original and revised BDI so that the assessment of symptoms corresponds to the DSM-IV criteria (4). BDI-II timeframe extends for 2 weeks to correspond with the DSM-IV criteria for major depressive disorder.
BDI FastScreen for Medical Patients (formerly known as BDI-Primary Care [BDI-PC]) contains 7 cognitive and affective items from the BDI-II to assess depression in individuals with biomedical or substance abuse problems (5). The BDI FastScreen excludes the somatic items from BDI-II. The timeframe on the BDI FastScreen is the same as BDI-II.
The BDI has been translated into several languages, including Spanish, Chinese, Dutch, Finnish, French (Canadian), German, Korean, Polish, Swedish, and Turkish (6).
Number of items in scale
There are 21 items in the BDI-IA and BDI-II; and 7-items in the BDI FastScreen.
None typically reported. The BDI-IA manual discusses the cognitive-affective (Items 1–13) and the somatic-performance (Items 14–21) subscales that discriminate between psychiatric, medical, and normal samples (2). Factors analysis of the BDI-II revealed two intercorrelated factors, somatic-affective and cognitive dimensions (3).
BDI-IA: developed and validated using psychiatric and normal populations. Beck and colleagues (3) studied outpatient samples that included persons with severe psychiatric diagnoses, depressive disorders, substance abuse, and college students. BDI-II validated using college students, adult psychiatric outpatients, and adolescent psychiatric outpatients (4).
BDI-FastScreen validated using general medical inpatients referred for psychiatric consultation and outpatients seen by family practice, pediatrics, and internal medicine (5).
Since being revised in 1972, the BDI has been widely accepted and used in psychology and psychiatry for assessing the intensity of depression in psychiatric and normal populations. Studies have been conducted in a variety of settings using medical populations (e.g., Parkinson's disease, human immunodeficiency virus, oncology), persons with disabilities, (e.g., arthritis, spinal cord injury, amputation), veterans, students, older adults, adolescents, and many populations with psychiatric diagnoses (e.g., eating disorders, addictions, anxiety disorders).
WHO ICF Components
Paper and pencil self-report in group or individual format; self or oral administration.
Minimal training required for paraprofessionals or professionals to administer. A clinician needs to interpret the revised BDI score by paying particular attention to items endorsing self harm or feelings of helplessness, such as suicide ideation (item 9) and pessimism/hopelessness (item 2).
Time to administer/complete
Self-administration: 5-10 minutes; Oral administration: 15 minutes.
Pencil or pen to indicate response.
Contact The Psychological Corporation to purchase the BDI, BDI-II, or the BDI FastScreen for Medical Patients manuals and instrument. Computer software is available from Psychological Corporation for on-screen administration, for use with paper and pencil administration, or for input of data from a desktop scanner. The computer program may be used to administer a single questionnaire or to integrate the results of sequential administrations. The Psychological Corporation, 555 Academic Court, San Antonio, TX 78204; Website: www.psychcorp.com. Items may be seen in McDowell and Newell (7).
4-point scale indicates degree of severity; items are rated from 0 (not at all) to 3 (extreme form of each symptom).
BDI: 0–63; BDI-II: 0–63; BDI FastScreen: 0–21.
Interpretation of scores
No arbitrary cut-off score for all purposes to classify different degrees of depression.The following guidelines have been suggested to interpret the revised BDI (the BDI-IA) (3). With the normal population, a BDI-IA score of ≥15 may indicate possible depression and warrants an additional clinical evaluation as confirmation. Minimal range 0–9; Mild depression 10–16; Moderate depression 17–29; Severe depression 30–63.
The following guidelines have been suggested to interpret the BDI-II (4), Minimal range 0–13; Mild depression 14–19; Moderate depression 20–28; Severe depression 29–63.
The following guidelines have been suggested to interpret the BDI FastScreen for Medical Patients (5). Minimal 0–3; Mild depression 4–8; Moderate depression 9–12; Severe depression 13–21.
Method of scoring
Sum the severity ratings of each depression item. Use the highest response when an item has more than one severity rating. Special instructions: BDI-IA: If examinee is consciously trying to lose weight, then Item 19 is not added to total score. BDI-II: For diagnostic purposes, Item 16 (sleep patterns changes) and Item 18 (appetite changes) contain 7-point ratings to note increases or decreases in behavior.
Time to score
Training to score
Minimal training, 5–10 minutes.
Training to interpret
Minimal training to interpret, yet due to the suicide risk with depression, a health professional should interpret the BDI-IA to provide appropriate referrals and possibly psychotherapeutic interventions for at-risk individuals.
Means and standard deviations appear in the manuals for samples used to validate the instrument.
Beck and Steer (3) report that Cronbach's coefficient alphas for the revised BDI's normative-psychiatric samples range from 0.79 to 0.90. These coefficients are consistent with estimates of coefficient alpha reported in a psychiatric sample (0.86) and in a non-psychiatric sample (0.81; 8). The BDI-II has higher internal consistency than the BDI-IA: Cronbach's alpha reported as 0.92 for outpatients and 0.93 for college students. Coefficient alphas for BDI FastSceen ranged from 0.85 to 0.89.
Beck et al's (8) review of BDI-IA studies reported correlations between pre- and posttests, for varying time intervals, that ranged from 0.48 to 0.86 for psychiatric patients and from 0.60 to 0.90 for non-psychiatric patients. For college students, test-retest correlations ranged from 0.64 to 0.90; BDI-II test-retest (administered 1-week apart) correlation was 0.93.
According to the manual (3), BDI-IA items reflect 6 of 9 DSM-II criteria well. The BDI-II revision improved content validity by rewording and adding items to assess DSM-IV criteria for depression.
As theorized, the BDI-IA and BDI-II are positively correlated with hopelessness construct in normative samples. In a factor analysis of the BDI responses of patients and non-patients, Beck and colleagues (8) found that 3 factors (cognitive-affective, performance, and somatic) were consistently identified across diagnostic groups. Factor analysis of the BDI-II yielded 2 factors (somatic-affective and cognitive factors) (4).
Beck and colleagues (8) reported a mean correlation of 0.72 between BDI-IA and clinical depression ratings in psychiatric patients and 0.60 in a nonpsychiatric sample. In normative samples, correlations between BDI-IA and Hamilton Rating Scale for Depression (HRSD) ranged from 0.40 in single episode major depression to 0.87 in alcoholics. The BDI-IA was significantly related to the depression subscale of the Symptom Checklist-90-Revised (0.76); BDI-II and HRSD were positively correlated (0.71) (4).
Sensitivity/responsiveness to change
The BDI is less likely to overestimate changes due to psychotherapy or pharmacologic interventions than the HRSD.
Comments and Critique
The BDI has been criticized for having items that are confounded by the physical sequelae associated with physical disability, such as arthritis; items related to physical appearance, fatigue, ability to work, weight loss, and physical complaints (9). The cost of the test materials may be prohibitive since less expensive public domain assessments are readily available. The manual suggests using the BDI cautiously as a screening tool for clinical depression.
1. (Original) Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.
2. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
3. Beck AT, Steer RA. Manual for the Beck Depression Inventory, 1993 edition. San Antonio (TX): The Psychological Corporation; 1987.
4. Beck AT, Steer RA, Brown GK. Beck Depression Inventory-Second Edition Manual. San Antonio (TX): The Psychological Corporation; 1996.
5. Beck AT, Steer RA, Brown GK. BDI-FastScreen for Medical Patients Manual. San Antonio (TX): The Psychological Corporation; 2000.
6. Naughton MJ, Wiklund I. A critical review of dimension-specific measures of health-related quality of life in cross-cultural research. Qual Life Res 1993;2:397–432.
7. McDowell I, Newell CI. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press; 1996.
8. Beck AT, Steer RA, Garbin M. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988;8:77–100.
9. Callahan LF, Kaplan MR, Pincus T. The Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D), and General Well-Being Schedule Depression subscale in rheumatoid arthritis. Arthritis Care Res 1991;4:3–11.
Beck AT, Guth D, Steer RA, Ball R. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for primary care. Behav Res Ther 1997;35:785–91.
Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of the Beck Depression Inventories-1A and -II in psychiatric outpatients. J Pers Assess 1996;67:588–97.
Steer RA, Cavalieri TA, Leonard DM, Beck AT. Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders. Gen Hosp Psychiatry 1999;21:106–11.
Steer RA, Rissmiller DJ, Beck AT. Use of the Beck Depression Inventory-II with depressed geriatric inpatients. Behav Res Ther 2000;38:311–8.
Tanaka-Matsumi J, Kameoka VA. Reliabilities and concurrent validities of popular self-report measures of depression, anxiety, and social desirability. J Consult Clin Psychol 1986;54:328–33.