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Occupational Medicine 2016;66:174–175 doi:10.1093/occmed/kqv087

QUESTIONNAIRE REVIEW

Beck Depression Inventory

A brief history

The Beck Depression Inventory (BDI) is a 21-item self-reporting questionnaire for evaluating the severity of depression in normal and psychiatric populations [1,2]. Developed by Beck et al. in 1961, it relied on the theory of negative cognitive distortions as central to depression [3]. It underwent revisions in 1978: the BDI-IA and 1996 and the BDI-II, both copyrighted [4]. The BDI-II does not rely on any particular the- ory of depression and the questionnaire has been translated into several languages. A shorter version of the questionnaire, the BDI Fast Screen for Medical Patients (BDI-FS), is available for primary care use. That version contains seven self-reported items each corresponding to a major depressive symptom in the preceding 2 weeks.

Description

The questionnaire was developed from clinical obser- vations of attitudes and symptoms occurring frequently in depressed psychiatric patients and infrequently in non-depressed psychiatric patients [5]. Twenty-one items were consolidated from those observations and ranked 0–3 for severity. The questionnaire is com- monly self-administered although initially designed to be administered by trained interviewers [3]. Self- administration takes 5–10 min. The recall period for the BDI-II is 2 weeks for (major depressive symptoms) as operationalized in the fourth edition of Diagnostic and Statistical Manual (DSM-IV).

Items

The BDI-II contains 21 items on a 4-point scale from 0 (symptom absent) to 3 (severe symptoms). Anxiety symptoms are not assessed but affective, cognitive, somatic and vegetative symptoms are covered, reflect- ing the DSM-IV criteria for major depression. Scoring is achieved by adding the highest ratings for all 21 items. The minimum score is 0 and maximum score is 63. Higher scores indicate greater symptom severity. In non-clinical populations, scores above 20 indicate depression [6]. In those diagnosed with depression, scores of 0–13 indicate minimal depression, 14–19 (mild depression), 20–28 (moderate depression) and 29–63 (severe depression) [4].

Validity

Content validity of the BDI-II has improved following item replacements and rewording to reflect DSM-IV criteria for major depressive disorders. Mean correlation coefficients of 0.72 and 0.60 have been found between clinical ratings of depression and the BDI for psychiatric and non-psychiatric populations [3]. Construct validity is high for the medical symptoms measured by the questionnaire, α = 0.92 for psy- chiatric outpatients and 0.93 for college students [7]. High concurrent validities have been demonstrated between the questionnaire and other measures of depression such as the Minnesota Multiphasic Personality Inventory-D, r = 0.77 [3]. Criterion validity of the BDI-II is positively correlated with the Hamilton Depression Rating Scale (r = 0.71) with a high 1 week test-retest reliability r = 0.93 (suggesting robustness against daily variations in mood) and an internal consistency of α = 91 [4].

Key research

A Brazilian study (n = 1555) measured specific aspects of depression and found that the BDI discriminated highly for depressive symptomatology [8]. A chronic pain study (n = 1227) reported strong agreement between the BDI-FS and BDI-II with equal ability at detecting clini- cal change [9]. A coronary artery disease study (n = 804) found the BDI-II to be a better screening tool in predict- ing major mood disorders [10].

Availability and clinical use

The BDI-II is copyrighted. The rights are held by Harcourt Assessment Incorporated (Pearson Education plc), under contract from the author. A fee is required for the manual and record forms. This lim- its availability. In occupational health, the BDI-II can be used as a screening tool to detect depression in nor- mal populations or as a tool to assess symptom sever- ity in clinical populations.

Gordon Jackson-Koku e-mail: [email protected]

References

1. Piotrowski C, Sherry D, Keller JW. Psychodiagnostic test usage: a survey of the society for personality assessment. J Pers Assess 1985;49:115–119.

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2. Steer RA, Beck AT, Garrison B. Applications of the Beck Depression Inventory. In: Sartorius n, Ban TA, eds. Assessment of Depression. Geneva, Switzerland: World Health Organization, 1986; 121–142.

3. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of eval- uation. Clin Psychol Rev 1988;8:77–100.

4. Beck AT, Steer RA, Brown GK. BDI-II: Beck Depression Inventory Manual. 2nd edn. San Antonio, TX: Psychological Corporation, 1996.

5. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.

6. Kendall PC, Hollon SD, Beck AT, Hammen CL, Ingram RE. Issues and recommendations regarding use of

the Beck Depression Inventory. Cognitive Ther Res 1987;11:289–299.

7. Beck AT, Steer RA. Manual for the Beck Depression Inventor y. San Antonio, TX: The Psychological Corporation, 1987.

8. Gorenstein C, Andrade L, Zanolo E, Artes R. Expression of depressive symptoms in a nonclinical Brazilian adolescent sample. Can J Psychiatry 2005;50:129–136.

9. Poole H, Bramwell R, Murphy P. The utility of the Beck Depression Inventory Fast Screen (BDI-FS) in a pain clinic population. Eur J Pain 2009;13:865–869.

10. Frasure-Smith n, Lespérance F. Depression and anxi- ety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008;65:62–71.