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BECK DEPRESSION INVENTORY (BDI).
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Discusses the general nature of the self-report, self-administered test.... More...
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Paper Abstract:
Discusses the general nature of the self-report, self-administered test. Purpose of measuring of attitudes and wide range of symptoms of depression. Method of scoring. Applicability. Theoretical foundation in cognitive theoty. Technical description. Components of the revised BDI. Critique of the test regarding reliability and validity. Usefulness as a diagnostic indicator.
Paper Introduction:
CRITIQUE OF THE BECK DEPRESSION INVENTORY
Identifying Information
The original version of the Beck Depression Inventory (BDI) was introduced by Beck, Ward, Mendelson, Mock & Erbaugh in 1961. The BDI was revised in 1971 and made copyright in 1978 following additional pilot testing (Groth-Marnat, 1996). Both the original and revised versions of the instrument have been found to be highly correlated with the average correlation coefficient set at .84 (Groth-Marnat, 1996). An amended version of the Beck Depression Inventory was published in 1993 (BDI-IA; Beck & Steer, 1993).
General Nature of the Test
The Beck Depression Inventory (BDI) is a self-report, self-administered instrument consisting of 21 items designed to measure char
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The BDI wasrevised in 1971 and made copyright in 1978 following additional pilottesting (Groth-Marnat, 1996). (1996). J.& Beck, A.T., (2 ) Use of the BeckDepression Inventory with depressed geriatric patients. Alternate test-retest reliability methodsdid show that regardless of whether the two tests were reissued at two orsix week intervals, scores reflected changes in the severity of depression.Beck et al. Split-half reliabilities are also high with a split-half coefficientof .93. It is,however, probably best employed as a research tool and/or as one of manyassessments of depression collected for diagnostic purposes. The BDI takes approximately 1 minutes to complete; typically, a fifth to sixth grade reading age isrequired to adequately understand the test items (Groth-Marnat, 1996). Journal ofPersonality Assessment, 7 (2), 222-231. (1998). Based on descriptionsprovided by depressed patients, 21 basic items of symptoms and attitudeswere derived and a four point rating scale was used to rate each item interms of severity. In most every psychological test, items must berewritten to improve reliability and/or validity. & Cox, B.J. Beck, A. For example, Enns, Larsen and Cox (2 ) noted that thetwo most frequently used instruments for measuring depression are theobserver-rated Hamilton Depression Scale and the self-rated Beck DepressionInventory (both with demonstrated reliability and validity) and yet the twoassessment methods provide discrepant scores for many depressed subjects. Behaviour Researchand Therapy, 38(3), 311-318. It was concluded that the change represents measurementerror with this instrument rather than any "real" change in depression. (1996). (2 ). Washington, DC: Author. Richter, P., Werner, J., Heerlien, A., Kraus, A., Sauer, H., (1998).On the validity of the Beck Depression Inventory; A review.Psychopathology, 31(3), 16 -168. Further, Ahava, Iannone, Grebstein and Schirling (1998) havequestioned the reliability of the measure over time as a function ofpsychometric soundness rather than as a function of decreases indepression. It is short and easy to use, taking very littletime to fill out. Thus, it is only to be expected that the BDI needs,and will continue to need, improvements. Analyses were said to show that a good deal of thediscrepancies in the scores of both instruments could be explained bydifferences on several of the socio-demographic factors. Steer, R. However, Beck did not collect test-retest reliability data statingthat if the BDI was re-administered within a short interval then scorescould be spuriously inflated due to memory factors, while if the test wasre-administered after a long interval then consistency would be lower dueto the intensity of depression. Discrepancies betweenself and observer ratings of depression. T., & Steer, R. McKenzie, N., & Marks, I. (1994). Manual for the BeckDepression Inventory (2nd ed.) San Antonio, TX: The PsychologicalCorporation. (1999).Quick rating of depressed mood inpatients with anxiety disorders. Also, evidencing strong internalconsistency are the alpha coefficients of .86 and .81 observed for the testwhen given to psychiatric and non-psychiatric populations respectively(Beck, Steer & Garbin, 1988). Responses to the 21 items of the BDIare made on a 4-point scale, ranging from to 3 (total scores can rangefrom to 63). However, some concernshave been raised. (1974). A. San Antonio, TX: The Psychological Corporation. American Psychiatric Association. Moreover, the majority of the itemsthat were retained were re-written for clarity. Findings were said to show a 4 percent decline in BDI scores over atime interval of 8 weeks, a main effect that was said to account forapproximately 1 percent of the variance. & Schirling, J. CRITIQUE OF THE BECK DEPRESSION INVENTORY Identifying Information The original version of the Beck Depression Inventory (BDI) wasintroduced by Beck, Ward, Mendelson, Mock & Erbaugh in 1961. Y., Rickets, K. Technical Description In terms of test development, the intent of the authors developingthe original instrument was to design a questionnaire that reflecteddepressed patients' own idiosyncratic description of their condition (see:Beck, Ward, Mendelson, Mock & Erbaugh, 1961). Journal of Affective Disorders, 6 (1),33-41. However, the BDI has much to recommend it despite the few ongoingpsychometric concerns. T., Steer, R..A., Garbin, M.. Employing asa sole diagnostic indicator is most likely a mistake. Beck, A.T., Rial, W. General Nature of the Test The Beck Depression Inventory (BDI) is a self-report, self-administered instrument consisting of 21 items designed to measurecharacteristic attitudes and symptoms of depression that can be used toassess degree of depression in both clinical and non-clinical populations(Steer, Rissmiller & Beck, 2 ). Beck, A.T., Ward, C. Further, BDI symptoms associated with WeightLoss, Body Image Change, and Somatic Preoccupation were dropped from thetest following psychometric analyses demonstrating that these symptoms wereless reflective of depression severity than these same items had been whenthe test was originally developed. These findingsled the authors to conclude that the most accurate assessment of depressioncannot be obtained by either instrument alone and that what is needed ismulti-modal assessment in which the BDI is but one assessment factor. G., (1988) Psychometricproperties of the Beck Depression Inventory: Twenty-five years ofevaluation. The items developed on the original test were strictly used to assessdepression severity and were not derived from any theory of depression.After the elimination of alternative wordings for the same symptoms andword changes for 15 of the test items based on pilot testing, the finalversion was copyrighted in 1978 (Beck & Steer, 1993). Discriminant analysis has shown that the revisedBDI discriminates psychiatric patients from non- psychiatric patients aswell as relatively higher scores for patients with major depressivedisorder compared to patients withdysthymic disorders; and, further, the revised BDI has also been used todiscriminate loneliness, stress and self reported anxiety (Groth-Marnat,1996). NY:Mayfield Publishing. Critiques of Test by Others Most critiques of the BDI find the instrument psychometrically sound(Richter, Werner, Heerlien, Kraus, Sauer, 1998). Also, clinical ratings for Psychiatric patients havebeen found to be high to moderate ranging from .55 to .96 Man r =.72 (Beck,Steer & Garbin, 1988). In an effort to determine the factors possibly responsible for thesedifferences, Enns et al. Washington, DC: Author. In short, there is no "final edition" of the BDI or any otherpsychological test; rather, any test can and does usually improve withsubsequent revisions. Indeed, for more than 3 years, he has led weeklyseminars in which clinicians are still asked to contribute patientdescriptions of depression and other elements of how they seem toexperience various aspects of depression. Personal Critique The BDI is one of the most frequently used assessments fordepression. Isthe Beck Depression Inventory reliable over time? Manual for the Beck DepressionInventory. Overall, its psychometric soundness appears to be established,although studies show that there is clear room for improvement, which isvery reasonable given that, in general, psychological tests need to becontinually refined. In terms of scoring, the overall score is tallied for allitems. Its validity and reliability,especially of the revised editions, are fairly well established and it hasbeen used in literally hundreds and hundreds of clinical studies. British Journal of Psychiatry, 174, 266-269. However, other authors have found the reliabilityand validity of short forms to be far lower than reported in earlierresearch (Smith, McCarthy & Anderson, 2 ). Psychological testing andassessment: An introduction to tests and measurement. Psychological Assessment, 12(1), 1 2-111. The BDI is applicable for use with individuals 13 years of age orolder (Steer, Rissmiller & Beck, 2 ). Clinical Psychology Review, 8(1), 77-1 . (1987). Another concern with respect to the Beck Depression Inventory hasbeen associated with the psychometric soundness of its alternative forms.There has been research supporting alternative form reliability. If the score is over 4 , a level significantlyabove even severely depressed persons, it is considered to be anexaggeration of depression, possibly characteristic of histrionic orborderline personality disorders (Groth-Marnat, 1996). (2 ) used the two instruments to assessdepression in a sample of 94 patients diagnosed with major depressivedisorder; they also collected a substantial amount of socio-demographicdata on patients. T., Steer, R. A., & Brown, G. Groth-Marnat G. Smith, G.T., McCarthy, D.M., & Anderson, K.G. The theoretical foundation of the BDI is cognitive theory. A., Rissmiller, D. (2 ). An amended versionof the Beck Depression Inventory was published in 1993 (BDI-IA; Beck &Steer, 1993). Forexample, Beck, Rial and Rickels (1974) found correlations (between the 21items and 13 items short form)ranging from .89 to .97. Beck, A. Moreover, a substantial body of research now shows thatthe instrument can be used successfully with a large variety of bothclinical and non-clinical populations. In terms of reliability, internal consistency for the BDI has beenfound to range from .73 to .92 with a mean consistency coefficient of .86(Beck, Steer & Garbin, 1988). Psychological Reports, 34 (3), 1184-1186. Score values are categorized as follows: 5 - 9 These ups and downs are considered normal 1 - 18 Mild to moderate depression 19 - 29 Moderate to severe depression 3 - 63 Severe depressionA score that is below 4 is considered to be possible denial of depressionor simply good faking. Reliabilities for the short forms of the testare similar (Groth-Marnat, 1996). Both the original and revised versions of theinstrument have been found to be highly correlated with the averagecorrelation coefficient set at .84 (Groth-Marnat, 1996). (4th ed). In other words, depression was as much athought disorder as a mood disorder. The handbook of psychological assessment (3rded.), John Wiley & Sons, New York. & Swerdlik, M.E. Diagnostic and statisticalmanual of mental disorders (3rd ed., rev.). (1998). This decrease in self-reportedsymptoms of depression was due to repeated measurement alone, not due toany intervention. H., Mendelson, M., Mock, J., & Erbaugh, J.(1961) An inventory for measuring depression. American Psychiatric Association. References Ahava, G.W., Iannone, C., Grebstein, L, . The revised Beck Depression Inventory assesses a wide range ofsymptoms associated with depression. Noting that determining the stability of any instrument overmultiple administrations is a common element of clinical trials research,the authors examined the multiple test-retest reliability of the BDI in anon-clinical sample. (1993). Beck, A. K. Diagnostic and statisticalmanual of mental disorders (4th ed.). Although refined over the years,Beck's basic theoretical position on depression remains cognitive innature. Numerous pilot testshave to be conducted, and so forth. (1961) reported that inter-rater reliability was notappropriate for the BDI Regarding content validity, revised BDI items have been found to beconsistent with six of the nine DSM categories for diagnosis of depression(Groth-Marnat, 1996). As notedby Cohen & Swerdlik (1998), when Beck first began studying depression inthe 195 s, the prevailing theory of depression was psychoanalytic innature; this theory postulated that depression involved inverted hostilityagainst the self. Short form of DepressionInventory: Cross-validation. Archives of GeneralPsychiatry, 4, 561-571 Cohen, R.J. Similarly, McKenzieand Marks (1999) found that use of the short form to assess depression in258 in-patients and 554 out-patients with anxiety disorders were veryaccurate, concluding that the short form of the scale was at least areasonable rough guide to depression severity, saving time for both thepatient and clinician. However, with the release by the American Psychiatric Association ofthe third and fourth versions of the Diagnostic and Statistical Manual ofMental Disorders (APA, 1987, 1994), the test was upgraded by the additionof symptoms addressing DSM criteria for major depression disorders such asthe symptoms of Agitation, Concentration, Difficulty, and Worthlessness(Beck, Steer & Brown, 1996). The instrument was developed in differentforms including computerized versions (Steer, Rissmiller & Beck, 2 ), acard form (Groth-Marnat, 1996), and a 13- and 11-items form (Beck, Steer &Brown, 1996). An evaluation of multipletest-retest reliability in a nonclinical college student sample. On the sins ofshort-form development. Enns, M.W., Larsen, D.K. What this means is that the adequacy ofsuch instruments are, at best, a shifting, dynamic concept due tocontinuous redefining of constructs as psychological knowledge andunderstanding grows. However, Beck observed that depressed patients hadnegative views of themselves, of their present experiences, and of theirfuture and he, therefore, postulated that depression derived from thesethree areas of negative thought. The relationship to demographic,clinical and personality variables. To obtain symptom descriptions, Beck not only collected his ownpatients' descriptions but also encouraged his colleagues and students tosend him their patients.
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