AbstractThe present review discusses validity aspects of the Beck Depression Inventory (BDI) on the basis of meta-analyses of studies on the psychometric properties. Shortcomings of the BDI are its high item difficulty, lack of representative norms, and thus doubtful objectivity of interpretation, controversial factorial validity, instability of scores over short time intervals (over the course of 1 day), and poor discriminant validity against anxiety. Advantages of the inventory are its high internal consistency, high content validity, validity in differentiating between depressed and nondepressed subjects, sensitivity to change, and international propagation. The present paper outlines agreements and contradictions between the various studies on the BDI and discusses the potential factors (composition of the subject sample, statistical procedures, point in time of measurement) accounting for the variance in their results.
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The BDI-II is a widely used 21-item self-report inventory measuring the severity of depression in adolescents and adults. The BDI-II was revised in 1996 to be more consistent with DSMIV criteria for depression.
For example, individuals are asked to respond to each question based on a two-week time period rather than the one-week timeframe on the BDI. The BDI-II is widely used as an indicator of the severity of depression, but not as a diagnostic tool, and numerous studies provide evidence for its reliability and validity across different populations and cultural groups. It has also been used in numerous treatment outcome studies and in numerous studies with trauma-exposed individuals. The BDI-II is based on the amended Beck Depression Inventory (BDI-A). Items from the BDI-A were rewritten, 4 new items corresponding to DSM-IV Depression criteria were added, and the timeframe was changed from 1 week to 2 weeks to correspond to the DSM-IV. There is a short version of the BDI, the BDI-SF, which includes only the cognitive-affective subscale and has been recommended to assess depression in medical populations, with scores higher than 10 associated with moderate to severe depression.
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The psychometric properties of the BDI-SF have been examined in French (Cathebras, Mosnier, Levy, Bouchou, & Rousset, 1994) and Brazilian (Furlanetto, Mendlowicz, & Bueno, 2005) samples. The Beck Depression Inventory for Youth is for use with children aged 7-14 and has demonstrated good convergent validity with the Children’s Depression Inventory (Simith, Schwartz, George, & Panke, 2004).
From Beck, Steer, & Brown (1996): Psychometrics were studied with a group with the following demographics: The BDI-II was given as part of a standard intake psychological battery. Five hundred outpatients from various clinics and hospitals located in New Jersey, Pennsylvania, and Kentucky were included. This population consisted of 317 females and 183 males; 91% Caucasian, 4% African American, 4% Asian American, and 1% Latino. The mean age was 37.20 (SD=15.91). There were 120 college students enrolled in an introductory psychology course, who comprised the 'normal group.' This population consisted of 67 females and 53 males with a mean age of 19.58 (SD=1.84) and was predominately Caucasian.Additional data regarding reliability are presented under Notes for 'Construct Validity.' The test-retest and internal consistency data have been replicated in numerous studies, including adults and adolescents, with similar findings.
The items on the BDI-II were developed to assess an individual's depressive symptoms based on DSM-IV criteria for depressive disorders.Osman, Kopper, Guttierez, Barrios, & Bagge (2004) studied the content validity of the BDI-II by having 10 “experts” rate the relevance and specificity of items for DSM-IV Major Depressive Disorders. Thirteen adolescents aged 13-17 rated the degree to which items were understandable, easy to read, and would correspond to what they would say to a mental health professional about how they feel.Items receiving low Relevance ratings included item 3 (Past Failure), item 6 (Punishment Feelings), and item 21 (Loss of Interest in Sex). Items receiving low Specificity ratings included item 11 (Agitation), item 19 (Concentration Difficulty), and item 21 (Loss of Interest in Sex).
Dozois, Dobson, & Ahnberg (1998) indicated sensitivity and specificity rates listed above using cutoffs of 0-12 (nondepressed), 13-19 (dysphoric), and 20-63 (dysphoric or depressed). Kumar, Steer, Teitelman, & Villacis (2001) examined adolescents who had cutoff scores of 21 and above. They found a sensitivity of.85 and specificity of.83, as well as the positive and negative predictive power listed above. Sprinkle et al. (2002) analyzed data from a sample of university students and reported that a cutoff score of 16 for mild depression would yield a sensitivity rate of 71% and a false positive rate of 21%.
Due to the face validity of the BDI-II, underreporting and overreporting may be likely. Individuals with low education and some Spanish speakers have difficulty with the response format. The procedure used to determine the cut scores may increase the likelihood of false positives or overdiagnoses of depression among clients.
The wording in some items asks the respondent to compare their current state to a prior one (e.g., than usual, as ever). Individuals with chronic trauma since childhood sometimes respond by circling a zero because they do not feel worse than 'usual.'
. The normative sample is predominantly White (91%). Although the measure can be used for adolescents, the norms were gathered with adults.
The majority of psychometric studies conducted with adolescents in the United States have involved predominantly Caucasian samples and have not included large numbers of individuals of lower socio-economic status. More research is needed on the use of the BDI-II with diverse groups of adolescents.