ISSN: 2277- 7695

CODEN Code: PIHNBQ

ZDB-Number: 2663038-2
Received: 01-12-2012 IC Journal No: 7725
Accepted: 03-02-2013
Vol. 2 No. 1 2013
Online Available at www.thepharmajournal.com

THE PHARMA INNOVATION - JOURNAL

The Beck Depression Inventory

Abimbola Farinde 1*

1. Clear Lake Regional Medical Center, Webster, Texas, USA

[E-mail: [email protected]]

I. Introduction to the Beck Depression Inventory

II. Description of the Test and History
III. Content and Use of the Beck Depression Inventory
A. Benefits of the Beck Depression Inventory
IV. Psychometric Qualities of Beck Depression Inventory
V. Reliability, Validity, and Factor Analysis
VI. Critique of the Beck Depression Inventory
VII. Internal Consistency and Test-Retest Reliability
VIII. Ethical Implications
IX. Legal Implications
X. Disadvantage (Challenges) of the Beck Depression Inventory
XI. Summarization of the Beck Depression Inventory
XII. Future Endeavors of the Beck Depression Inventory
Keyword: Beck Depression Inventory, Self-Report, Depression Rating, Psychometric Properties,
Validity, Reliability

1. Introduction numerous diagnoses of depression due to its most

There are many assessment and diagnostic tools recent revisions that more closely resemble the
that either measure intelligence, aptitudes, diagnostic criteria for depression (Gregory,2007).
achievements, and behaviors so it is was no Over the year many studies have questioned the
surprise when the Beck Depression Inventory credibility of the BDI but its soundness have been
(BDI) was created in 1961 by Aaron T. Beck, a established through documentations of the
pioneer in cognitive therapy, with the sole internal consistency of the scale, its test-retest
purpose of determining the severity and intensity reliability, and its extensive validation against
level of the symptoms of depression. The Beck other measures of depression and independent
Depression Inventory is defined as a validated criteria for depression (Gregory, 2007). The
measure that has been instrumental in leading to utilization of the Beck Depression Inventory still

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continues to expand into a variety of clinical and that correspond to the criteria for diagnosing
non-clinical practice sites to identify depressive depressive disorders listed in the American
symptoms that might have otherwise Psychiatric Association’s publication of the
unrecognized and undiagnosed. Similar to many Diagnostic and Statistical Manual for Mental
other assessment tools it credibility and usability Disorders-Fourth Edition- Text
have come into question but research studies have Revision(American Psychiatric Association,
shown that the Beck Depression Inventory is 2000). In its attempt to further reflect the current
successful when it comes to producing the DSM-IV diagnostic criteria for depression not
outcome that it is intended to measure. only were new items such as agitation,
worthlessness, loss of energy and concentration
A. Description of the test and its History difficulty included but both increases and
The Beck Depression Inventory is a widely decreases in appetite were added in the same item
utilized 21-item self-report scale in both clinical with hypersomnia and hyposomnia in another
and research studies (Beck et al.,1996). The scale item. Items related to changes in body image,
was originally developed in 1961 as an hypochondria, and difficulty working were
interviewer-assisted format but has undergone replaced but item dealing with thoughts of
several revisions over the last 35 years from the suicide, interest in sex, and feelings of being
BDI-1A(1978), to the most recent version The punished remained the same. When it comes to
Beck Depression Inventory-II (1996) which is a analyzing the content of the revised version of the
completely self-administered format. The Beck questionnaire, items generally cover the cognitive
Depression Inventory-II is a depression rating and affective components of depression. The
scale that can be used in individuals that are ages addition of these components into the assessment
13 years and older, and rates symptoms of process only allow for a more definitive
depression in terms of severity on a scale from 0 conclusion to be reached when there is the
to 3 based on the 21 specific items. Patients that question as to the presence or absence of
endorse multiple items on the questionnaire(i.e. depression.
sadness, pessimism, past failure, loss of pleasure,
guilty feelings, punishment fears, self-dislike, and B. Benefits of the Beck Depression Inventory
so forth) typically have higher scores with a The rating duration for the BDI was changed
maximum score of 63 compared to others. The from a 1-week period to over the past 2 weeks
sum of the BDI generally represents the severity with the revised BDI-II. The revised version
of the depression with the test being scored represents a significant milestone because of
differently for the general population compared to improvements having been made over the
those individuals with an established clinical original structure which includes revisions to the
diagnosis of depression. For the general content, psychometric validity, external validity,
population, a score of 21 or greater is associated and its ability to be utilized in widespread clinical
with depression but for individuals who have practice sites(Beck et al., 1996). One of the
been clinically diagnosed, scores from 0 to 9 primary characteristics that has lead to the
represent minimal depressive symptoms, scores increased popularity of the use of the BDI-II is
of 10 to 16 indicate mild depression, scores of 17 that the majority of people are able to complete
to 29 indicate moderate depression, and scores of the 21 items of the self-report within a 5-10
30 to 63 indicate severe depression. minutes time span but in order for this occur the
Content and use of Beck Depression Inventory administrator must make it a point to preserve the
The self-report consists of questionnaires that integrity of the test results such as the testing
primarily focus on the cognitive distortions that environment possessing sufficient illumination
underlie depression (Beck & Steer,1987). The for reading and being quiet enough to facilitate
current version of the inventory was specifically adequate concentration for the test taker.
developed to serve as an assessment of symptoms

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C. Description of the test and its history questioning is representative of the format for all
The conception and ultimate development of the of the 21 items with a total raw score serving as
Beck Depression Inventory came from its novel the sum of the endorsements of symptoms of
approach towards describing the symptoms of depression.
depression which proved to be revolutionary
during that time period. The inventory relied on D. Reliability, Validity, and Factor Analysis
using the combination of patient’s subjective The reliability of the Beck Depression Inventory
depiction of their symptoms along with the has been based off its use in clinical studies as
structured format of the scale in order to arrive at well as being shown to be exemplary for use in
the intensity or the severity of a given symptom. both depressed and nondepressed samples of
The inventory has managed to maintain many of older individuals as established in other age
the foundations that were vital component of the groups as well(Gallagher et al.,1982). A study
development of the inventory structure such as that examines that psychometric properties of the
the 4-point rating scale format ranging from 0 to Beck Depression Inventory was conducted by
3 with only a few medications being made in the Wiebe et al(2005) that focused on a comparison
wording of the original response options (Osman of the psychometric properties of English and
et al.,2004). The BDI-II still manages to retain Spanish language versions of the Beck
the simplicity and ease of administration (only Depression Inventory in substantial samples of
taking about 10 minutes to complete) which was undergraduate students yielded results that
associated with original BDI, and the direct provided evidence of the strong internal
guidelines that are both understandable and user- consistency of the BDI-II across both languages,
friendly. and the test-retest reliability of the BDI –II being
acceptable for both languages (Wiebe,2005). The
E. Psychometric Qualities of Beck Depression reliability of the Spanish translation slightly
Inventory exceeded the original English version with
It is widely known from various studies that the Spanish translation producing a coefficient of
psychometric qualities of the BDI are believed to 0.91 and the English version yielding a
be quite sound (Beck et al., 1996). The self-report coefficient of 0.89 leaving little or no variability
manual is well written, and succeeds in providing that could be attributed to language
the reader with information regarding norms, (Wiebe,2005).
factor analysis, and nonparametic item-option An analysis of factor validity using confirmatory
characteristic curves for each item. The BDI factor analysis (CFAs) to find the best fit for the
manages to retain a high level of standardization two factor model demonstrated that the English
by maintaining a consistent practice of uniformity language factor structure showed a good fit with
for test administrators and advising examiners the data from the Spanish instrument. The results
about scenarios for potential distortions of test of analysis demonstrated that the translation is
results by keeping in mind that self-reports appropriate for use in both medical and student
inventories are subject to a response bias, and samples. With the ever increasing need to provide
ultimately factoring this into the overall mental health service that are sensitive to any
interpretation of the test results (Dozois et al., given culture it is recognized that continued
1998). Additionally, the formulation of the research is required to document the validity and
directions allows for a consistent administration reliability of commonly used clinical and research
process, for example, the statements for each of instruments.
the 21 items attempt to maintain the same format
such as (0= I am upbeat about the future), (1= I F. Psychometric Qualities of Beck Depression
feel slightly discourages about the future), (2= I Inventory-Youth
feel the future has little to offer for me), (3=I feel Another notable research study conducted by
that the future is utterly hopeless). This format of Stapleton et al (2007) sought to identify the

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psychometric properties of the Beck Depression completely address how such an issue can be
Inventory for Youth (BDI-Y) in a sample of appropriately handled so as to not interfere with
859 girls that were ages 9-13 years by age level the test results, but rather provides an ambiguous
and for selected races or ethnic groups. While answer for a possible resolution. For the most
research on the psychometric properties of the part, The Beck Depression Inventory reports
BDI-Y has been scarce the suggestion of its “correlations of 0.93 and 0.84” between the BDI-
soundness has been made. In term of II and its predecessors in two samples of 191 and
standardization, the manual provides separate 84 outpatients and the correlations between of
normative information for 7 to 10 year old and 11 0.68 and 71, respectively, between the BDI-II and
to 14 year old girls (Beck et al., 2001). The two other depression instruments(The Revised
standardization sample consists of a mean BDI-Y Hamilton Psychiatric Rating Scale for Depression
score of 19(SD=9.4) and 16.5(SD=11.0) The and the Beck Hopelessness Scale (Sprinkle et al.,
BDI-Y demonstrates high internal consistency 2002,pp.381).
measured by Cronbach’s alpha and reliability was
slightly lower for the 9-year old girls as compared H. Internal Consistency and Test-Retest
to the 10 and 11 year old girls (Stapleton et al., Reliability
2007). In terms of the convergent validity, “high The internal consistency of the Beck Depression
correlation of a test with other variables or tests Inventory has been validated with substantial
with which it shares an overlap of constructs”, the evidence reporting coefficient alphas of 0.91 and
BDI-Y correlation highly with Children’s higher, only about two published reports have
Depression Inventory(CDI) scores for the sample consistently validated its test-retest reliability. For
overall, 0.83( Gregory, 2007, pp.134). The instance, Leigh and Anthony Tolbert(2001)
correlation was noticeably lower for the 9 year reported a non-clinical sample of 53 hearing
old group, 0.73 as compared with the estimates impaired university students that produced a test-
between 0.84 and 0.86 for the other age groups(z- retest correlation of 0.74 when given the BDI-II
statistic ranged from -2.4 to -3.8) for the four one week apart. Also, Beck, Steer, and
pairwise comparisons (Stapleton et al., 2007). Brown(1996) discovered that on 26 outpatient
Overall the study was able to demonstrate the who were administered the BDI-II during their
reliability and validity estimates of the BDI-Y first and second therapy sessions about 1 week
across different races and ethnic groups which apart, there was a test-retest reliability of 0.93
other prior studies were unable to accomplish this indicating the test is sensitive to daily changes in
task. mood. In terms of the criterion validity of the test
there was some weaknesses in the design such as
G. Critique of the Beck Depression Inventory the majority of the study participants being White
A critique of the strength and weaknesses of the to the extent that the applicability of the finding
Beck Depression Inventory can produce findings to non-White students was unclear. Only one
about its psychometric qualities such as the criterion was utilized in order to determine the
advantage of its uniform standardization presence of absence of depression which was an
procedure which consists of easy and formalized intake interview a counselor which does not
directions for test administration as well as the provide enough evidence as to the validity of the
ability of reader to comprehend the guidelines study.
provided in the instructional manual. On the other
hand, there are disadvantages to that the manual I. Ethical Implications
does not adequately address such as the potential An ethical issue that can potentially arise with the
for clients to alter their presentations based on an Beck Depression Inventory is whether or not the
incentive or personal agenda associated with psychometric properties of the inventory
being diagnosed with depression. The Beck including the content validity, factor structure,
Depression Inventory manual does not reliability estimates, and content validity is

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sufficient enough to be used in the adolescent that a decision that affects the well-being of the
population and if so does this give the clinician patient was made without the patient’s input. It
the authority to make this information available would be understandable if the patient exhibited
to the adult guardians of the adolescents (Osman some cognitive impairments but since this is not a
et al., 2004). In most cases, the Beck Inventory factor the clinician can be held liable for choosing
class has been synonymous with its utilization in not to share pertinent information with their
the adult population in the adult population and patient based off their biases about individuals
the study embarked upon by Osman et al was with mental diagnoses. According to the APA
designed to provide the same level of assessment Ethics Code(2002), psychologists are prohibited
of depression and relevancy when it comes to from practicing unfair discrimination that would
identifying the distinctive symptoms of major deny any individual of their right based on a
depressive episode. While adolescents may still disability or a bias they might have about that
be viewed minors they are to be viewed as having individual.
the same right as adults when it comes to the
confidentiality and the protection of their health K. Use of Beck Depression Inventory in
information. According to the American clinical practice
Psychological Association (APA) Ethics Code As a clinical psychologist, the Beck Depression
(2002) psychologists must “respect the dignity Inventory can be used during a patient encounter
and worth of all people and the rights of to gauge whether or not a patient endorses feeling
individuals, confidentiality, and self- of depression. If after multiple encounter the
determination” (APA, 2002, pp.4). In order to patient exhibits classical symptoms of depression,
actively protect patient health information, the inventory could be utilized to confirm or deny
regardless of the patient’s age, a psychologist this suspicion through self-report. The Beck
must be fully aware of the safeguards in place Depression Inventory can serve as the first tier for
that are necessary to protect the right and security the assessment of depression with the DSM-IV-
of those individuals whose vulnerabilities may TR coming behind to provide an official
impair autonomous decision-making. While a diagnosis (American Psychiatric
psychologist may assume that it is in the best Association,2000). The benefits that can be
interest of the adolescent to make their reaped from using the Beck Depression Inventory
information available to outside parties including come from its ease of administration and
guardians it could be a violation if the consent of understandable questions that allow the user to
the adolescent was not given or under law the maneuver through the 21 items of the
adolescent does not pose any harm to him or questionnaire. The simplicity of the questionnaire
herself and others but the information is released allows for its use with a wide variety of patients
to the public. from adolescents to adults which can then lead to
an increase of undiagnosed of unrecognized
J. Legal Implications depressive symptoms. Along with the ability to
Secondly, a legal issue that can arise with the use identify those patients that might be exhibiting
of the Beck Depression Inventory is a clinician depressive symptoms, the inventory can produce
breaching the agreements that were established problems with more patients stating that they are
within an informed consent contract and deciding depressed in order to benefit from the receiving
to not provide any information about the outcome the diagnosis, or having a personal agenda the
of the inventory since they are in an inpatient comes with having the label of depression.
psychiatric facility but instead only provide the
information to other members of the health care L. Disadvantage (Challenges) of the Beck
team and family members of the patients. First Depression Inventory
and foremost, the rights of the patient receiving As a clinical psychologist, the challenge will
the treatment have been violated due to the fact come when determining which patients are

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exhibiting legitimate signs and symptoms of age gap. The transition from an interview-based
depression or which patients are pretending in the to self-report has brought both advantages and
hopes of reaping some type of benefit. Patients disadvantages for the assessment process. For
are either capable of hiding their despair or can example, an advantage is the fact that patients are
exaggerate their depression with the Beck more likely to verbalize their inner feelings if
Depression Inventory but for those patients who they are in control of the process but a
are motivated to accurately display their inner disadvantage is the ability for non-motivated
emotions, the inventory represents one of the best patients to manipulate the process and state what
instruments for identifying the presence and/or they feel will lead to them receiving a diagnosis
severity of depressive symptoms (Stehouwer, of depression and having some type of personal
1987). Also, the results of the Beck Depression gain.
Inventory can be used to not only assess and
monitor changes in depressive symptoms among M. Future Endeavors of the Beck Depression
people in a mental health care setting but it can be Inventory
translated to other practice settings whether In my opinion, the future of the Beck Depression
inpatient and outpatient (Beck et al. 1988). The Inventory will focus on moving towards the
ubiquitous use of the inventory can potentially assessment of other mood disorder such as
allow for a confirmed diagnosis of depression anxiety and bipolar disorder. The inventory has
based off aspects of the DSM-IV-TR or assist already branched into assessing the presence of
with producing a list of other mood disorders that depression in youth to serve as useful screening
might be the culprit if it is not depression. tool for depression in youths (Stapleton et
Summarization of the Beck Depression Inventory al.,2007). Additionally, there is the Beck
The current status of the Beck Depression Hopelessness Scale so the ability to translate this
Inventory signifies a test that has reached a into an assessment that can target other mood
pinnacle in terms of its level of merit and disorders can only serve to expand the utilization
credibility. Over many years, it has undergone of the inventory within all facets of psychology
two significant revisions with the most recent and possibility beyond the scope of psychology.
(2nd edition revision) displaying the greatest As the Beck Depression Inventory represented a
improvements that have ever been made to the breakdown in terms of how assessment of
instrument. In order for it to become a better depressive symptoms should be performed the
representation of the diagnostic criteria that was same can translate into the assessment process for
been established by the American Psychiatric other disorders such as post-traumatic stress
Association for depression it has incorporated key disorder, generalized anxiety disorder, social
components of the DSM-IV-TR criteria for phobias, specific phobias, and bipolar I disorder
depression into the 21 items of the inventory. The and bipolar II disorder in the long run. When it
revised version of the Beck Inventory brings the comes to the development of psychological tests,
scale into a better accord with current psychiatric test developers must consider whether the test
diagnostic criteria (Ward, 2006). An emphasis that is used in one population can apply to
has been placed on observing cognitive and another (Sprinkle et al.,2002). It is sometimes
affects components of depression such as difficult to generalize a test used in a sample to an
pessimism, guilt, crying, indecision, and self- entire population so this is where the Beck
accusations and eight items focusing on somatic Depression Inventory can provide assist by
and performance variables such as sleep making revisions that include the particular
problems, body image, and work difficulties features and characteristics of one group to the
(Gregory, 2007). The Beck Depression Inventory next so its use can grow with time.
has established itself to be a reliable instrument
for providing a comprehensive assessment of
depressive symptoms across genders and a wide

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2. References 15. Stapleton, L.M., Sanders, J.B., & Stark,

1. American Psychiatric Association. (2000). K.D.(2007). Psychometric Properties of the
Diagnostic and statistical manual of mental Beck
disorders (Revised 4th ed.). Washington, DC: 16. Depression Inventory for Youth in a Sample of
Author. Girls. Psychological Assessment,19,230-235.
2. American Psychological Association(2002). 17. Stehouwer, R.S.(1987), Beck Depression
Ethical Principles of Psychologists and Code Of Inventory. In D.J.Keyser &R..S. Sweetland(Eds.).
Conduct. Washington, DC: Author. Test critiques compendium, Kansas City, MO:
3. Beck, A.T., Steer R.A., Brown G.K. (1996). Beck Test Corporation of America.
Depression Inventory Manual, 2nd Edition. San
Antonio, TX, Psychological Corporation.
4. Beck, A. T.,Steer, R.A., & Garbin, G.M. (1988).
Psychometric properties of the Beck
Depression Inventory: Twenty-five years of
evaluation." Clinical Psychology Review, 8, 77-
100.
5. Beck A.T., Beamesderfer, A.(1974). Assessment
of depression: the depression inventory. Mod
6. Probl, 7,151–169.
7. Beck, J.S., Beck, A.T., & Jolly, J.B.(2001). Beck
Youth Inventories, San Antonio, TX:
Psychological Association.
8. Dozois, D.J.A.,Dobsson, K.S., & Ahnberg,
J.L.(1998). A psychometric evaluation of the
Beck Depression Inventory-II. Psychological
Assessment, 10, 83-89.
9. Gallagher D, Breckenridge J, Steinmetz J, et
al(1982). The Beck Depression Inventory and
Research Diagnostic Criteria: congruence in an
older population. J Consult Clin Psychol,
51,945–946.
10. Gregory, R. J. (2007). Psychological testing:
History, principles, and applications (5th ed.).
Boston: Pearson Education, Inc.
11. Leigh, I.W., & Anthony-Tolbert,
S.(2001).Reliability of the BDI-II with deaf
persons. Rehabilitation Psychology, 46,195-
202.

12. Osman, A.Kopper, B.A, Barrios, F. et al., (2007).

Reliability and Validity of the Beck Depression
Inventory-II with Adolescent Psychiatric
Inpatients. Psychological Assessment,16,120-
132.
13. Ward, L.C.(2006). Comparison of Factor
Structure Models for the Beck Depression
Inventory-II. Psychological Assessment, 28, 81-
88.
14. Sprinkle, S.D., Lurie, D., Insko, S.L. et al(2002).
Criterion Validity, Severity Cut Scores, and Test-
Retest Reliability of the Beck Depression
Inventory-II in a University Counseling Center
Sample. Journal of Counseling Psychology, 49,
381-385.

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