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Beck Depression Inventory-II (BDI-II)

The Beck Depression Inventory-II (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 2 weeks.
 
Description: The Beck Depression Inventory-II (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 2 weeks.
 
Disease States: Bipolar disorder, Major depressive disorder
Validated Uses: Screening, Treatment Monitoring & Evaluation, Symptom Severity
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, Fourth Edition (DSM-4), 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 from 0 to 3, with the exception of 2 items rated from 0 to 6.4,5 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-4 criteria, the scale is also compatible with the DSM-5. The core criteria for MDD are consistent across these editions.10
Scale Validity: The sensitivity and specificity of the BDI-II depend on the population examined.4,11 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.11 In a separate study of 1904 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 2 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.5,12,*
Cited Limitations: While the BDI-II covers most of the criteria for depression listed in the DSM-4, 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
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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 disorder,1,2 Major depressive disorder1,3,4; Validated Uses: Screening,3,5 Treatment Monitoring & Evaluation,5,6 Symptom Severity5,6; Administration Method: Self-report1,3-5,7; Time to Administer: 5–15 minutes5,7; Commonly used in: Clinical Trials & Research2,3,8, Clinical Practice3,4,9
 

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient. 

 

ABBV-US-01584-MC, Version 1.0 
Approved 04/2024 
AbbVie Medical Affairs 

References:

  1. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588-597. doi:10.1207/s15327752jpa6703_13 
  2. Tohen M, Bowden CL, Nierenberg AA, Geddes JR. Clinical Trial Design Challenges in Mood Disorders. Elsevier; 2015. doi:10.1016/C2012-0-00773-9 
  3. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry. 2013;35(4):416-431. doi:10.1590/1516-4446-2012-1048 
  4. Subica AM, Fowler JC, Elhai JD, et al. Factor structure and diagnostic validity of the Beck Depression Inventory-II with adult clinical inpatients: comparison to a gold-standard diagnostic interview. Psychol Assess. 2014;26(4):1106-1115. doi:10.1037/a0036998 
  5. Rush AJ, First MB, Blacker D. Handbook of Psychiatric Measures. 2nd ed. American Psychiatric Publishing; 2008. 
  6. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571. doi:10.1001/archpsyc.1961.01710120031004 
  7. Lam RW, Michalak EE, Swinson RP, Anderson I. Assessment Scales in Depression, Mania and Anxiety. Taylor & Francis Group; 2005. doi:10.1192/pb.30.10.398 
  8. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. A review. Psychopathology. 1998;31(3):160-168. doi:10.1159/000066239 
  9. Jakšić N, Ivezić E, Jokić-Begić N, Surányi Z, Stojanović-Špehar S. Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care. J Clin Psychol Med Settings. 2013;20(3):311-322. doi:10.1007/s10880-013-9363-2 
  10. Center for Behavioral Health Statistics and Quality. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Substance Abuse and Mental Health Services Administration; 2016. 
  1. Arnau RC, Meagher MW, Norris MP, Bramson R. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol. 2001;20(2):112-119. doi:10.1037//0278-6133.20.2.112 
  2. Guy W. ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education, and Welfare; 1976. 

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