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Beck Depression Inventory-II (BDI-II)

The BDI-II is a 21-item, self-rated scale that assesses the severity of depressive symptoms experienced by a patient with a diagnosed mood disorder over the past two weeks.
 
Description: The BDI-II is a 21-item, self-rated scale that assesses the severity of depressive symptoms experienced by a patient with a diagnosed mood disorder over the past two weeks.
 
Disease States: Bipolar disorder, Major depressive disorder
Validated Uses: Screening, Treatment Monitoring & Evaluation, Symptom Severity
Populations: Adolescent, Adult, Geriatric
Administration Method: Self-report
Time to administer: 5–15 minutes
Commonly used in: Clinical Trials & Research, Clinical Practice
Detailed Description: Originally developed as a clinician-rated scale, the BDI was later adapted into a self-report format.5,6 The updated, self-rated version of the BDI-II is now the most frequently used version of the scale.5 The BDI-II has 21 items that evaluate the symptoms of depression described by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), including sadness, loss of pleasure, guilty feelings, suicidal thoughts, irritability, loss of energy, changes in sleeping, changes in appetite, and more.1,5 Items are rated according to severity on a 0–3 scale, with the exception of two items rated on a 0–6 scale.4,5 The BDI is scored by simple addition and has a maximum total score of 63.4,5 Severity thresholds that are used to classify patients are shown in the table below.4,5
 
Score Clinical Indication
≤ 13 No or minimal depression
14–19 Mild depression
20–28 Moderate depression
> 28 Severe depression

Note: Although the BDI-II was initially developed based on DSM-IV criteria, the scale is also compatible with the DSM-5. The core criteria for MDD are consistent across these editions.12

Scale Validity: Sensitivity and specificity of the BDI-II depends on the population examined.4,13 In a study of 340 adult primary care patients, the BDI-II demonstrated 94% sensitivity and 92% specificity when a cutoff score of 18 was used.13 In a separate study of 1,904 adult inpatients being treated for psychiatric complaints, the BDI-II showed lower sensitivity and specificity.4 In this population, the BDI-II had a sensitivity of 79% and specificity of 54% when a cutoff score of 19 was used.4
Alternative Versions: The original BDI (also referred to as “BDI-I”) consisted of 21 items and was scored similarly to the BDI-II.1,6 Major differences between the two versions include the timeframe for assessment (ie, “the present time” for the original BDI and “the last 2 weeks” for the BDI-II) and the symptoms covered.1,6 The original BDI included items for weight loss, distorted body image, somatic preoccupation, and inability to work.1,5 These were subsequently replaced in the BDI-II with items more sensitive to identifying depression, including agitation, feelings of worthlessness, difficulty concentrating, and energy loss.1,5 An abbreviated 13-item BDI used for screening and symptom evaluation has also been published.5,14
Cited Limitations: While the BDI-II covers most of the criteria for depression listed in DSM-IV, it may not be fully comprehensive, as it does not include any items to evaluate weight gain or loss.5 Other symptoms included in the BDI-II, such as agitation and loss of energy, can also be caused by underlying medical illness and may lead to exaggerated severity scores in patients with a comorbid condition.5 Finally, although the scale is widely used, more research is needed to evaluate the scale in comparison with clinician-rated scales and to evaluate individual items for validity.3

The BDI-II and related scoring materials can be purchased here

Footnotes:

†Although only the BDI-II is discussed here, we include information about alternative versions for your general awareness and convenience. These alternative versions may be used by different practitioners or in clinical trial or other research settings.

Supporting references for the filters are as follows:
Disease States: Bipolar disorder1,2, Major depressive disorder1,3,4; Validated Uses: Screening3,5, Treatment Monitoring & Evaluation5,6, Symptom Severity5,6; Populations: Adolescent3,7, Adult3,4,7,8, Geriatric9; Administration Method: Self-report1,3-5,7; Time to Administer: 5–15 minutes5,7; Commonly used in: Clinical Trials & Research2,3,10, Clinical Practice3,4,11

References:

  1. Beck, AT et al. J Pers Assess. 1996;67(3):588-597.
  2. Tohen, M et al. Clinical trial design challenges in mood disorders. (Elsevier Inc., 2015).
  3. Wang, YP & Gorenstein, C. Braz J Psychiatry. 2013;35(4):416-431.
  4. Subica, AM et al. Psychol Assess. 2014;26(4):1106-1115.
  5. Rush, AJ et al. Handbook of Psychiatric Measures. (American Psychiatric Publishing, Inc., 2008).
  6. Beck, AT et al. Arch Gen Psychiatry. 1961;4:561-571.
  7. Lam, R et al. Assessment Scales in Depression, Mania and Anxiety. (Taylor & Francis Group, 2005).
  8. Dolle, K et al. Psychiatry Res. 2012;200(2-3):843-848.
  9. Steer, RA et al. Behav Res Ther. 2000;38(3):311-318.
  10. Richter, P et al. Psychopathology. 1998;31(3):160-168.
  1. Jaksic, N et al. J Clin Psychol Med Settings. 2013;20(3):311-322.
  2. Center for Behavioral Health Statistics and Quality. 2014 National Survey on Drug Use and Health: DSM-5 Changes: Implications for Child Serious Emotional Disturbance (unpublished internal documentation). 2016. Substance Abuse and Mental Health Services Administration. Rockville, mD.
  3. Arnau, RC et al. Health Psychol. 2001;20(2):112-119.
  4. Guy, W. ECDEU Assessment Manual for Psychopharmacology. 1976. Education U.S. Department of Health, and Welfare. Rockville, MD.

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