Test Review: Beck Depression Inventory - II

Catherine Smith & Bradley T. Erford Loyola College in Maryland 1. Title: Beck Depression n!entory" #BD " $

%. &'thors: &aron T. Beck( )regory *. Bro+n( and ,o-ert &. Steer .. /'-lisher: The /sychological Corporation( San &ntonio( T0 1. 2orms( gro'ps to +hich applica-le: There ha!e -een t+o re!isions of the Seek Depression n!entory. There e3ists the BD ( the BD " &( and the latest !ersion( the BD " . Each in!entory is an instr'ment for meas'ring the se!erity of depression in adolescents 1. years of age and 'p( as +ell as ad'lts. The BD " contains DSM" 4 criteria for depression not incl'ded in the t+o pre!io's !ersions #Conoley( 1567$. 8. /ractical feat'res: The BD contains a fo'r point scale for each item. The s'm of the ratings on the %1 items is then simply compared to the c't score g'idelines in order to identify the interpreti!e range #Beck( Bro+n( & Steer( 1559$. 9. )eneral type: The BD " symptoms of depression. 7. Date of p'-lication: 1559. 6. Cost: -ooklets( ans+er sheets: The complete BD " kit consists of the man'al and %8 record forms. The complete kit is priced at :8..;;. The man'al can -e ordered for :%8.8;( record forms #<'antity of %8$ for :%7.8;( or =<'antity of 1;;$ for :1;1.8;. Spanish record forms are also a!aila-le for the same price. 5. Scoring ser!ices a!aila-le and cost: There are no electronic scoring ser!ices a!aila-le for the BD " . The BD " is scored -y hand only. 1;. Time re<'ired: &ppro3imately 8"1; min'tes is re<'ired for clients to complete the BD " . 11. /'rpose for +hich e!al'ated: 2or 'se +ith adolescents and ad'lts in assessing depression. 1%. Description of test. tems and scoring: The BD " is a self" report analysis of depressi!e symptoms. t is not designed to -e 'sed for the act'al diagnosis of depression #S'nd-erg( 1567$. The +ording of the BD " is clear and concise. The test contains %1 items( most of +hich assess depressi!e symptoms on a Likert scale of ;".. The t+o e3ceptions to this are <'estions 19 and 16. >'estion 19 addresses changes in sleeping pattern( +hile <'estion 16 addresses changes in appetite. The scale in these t+o items consist of ;( a( l-( %a( %-( .a( & .c. /eople are asked to report feelings consistent +ith their o+n o!er the past % +eeks instead of +eek( as in the BD and BD " &. The reason for this is to -e consistent +ith the DSM" 4 criteria for depression. There +ere also t+o items added to indicate any directional changes in eating and sleeping patterns. &ll forms of the in!entory are +ritten at the 8th grade reading le!el #Conoley( 1567$. Clinical interpretation of scores is accomplished thro'gh criterion"referenced proced'res ser!es as an indicator of the occ'rrence and se!erity of the

'tili?ing the follo+ing interpreti!e ranges: ;"1. " minimal depression@ 11"15 " mild depression@ %;"%6 "moderate depression@ and %5"9. " se!ere depression #Beck et al.( 1559$. 1.. &'thorsA p'rpose and -asis for selecting item: The items in the BD " are designed to assess the se!erity of depression in adolescents and ad'lts. This !ersion of the testis specifically designed to address DSM" 4 criteria for depression. The +ording of all -'t three items has -een changed from that of the BD " & for clarity. & series of factor and item analyses +ere performed in order to red'ce the total n'm-er of items on the test from %7 to %1 #Beck et & .( 1559$. 11. &de<'acy of directions( training re<'ired to administer: The instr'ctions of the BD " are straightfor+ard and clearly stated. Little training is re<'ired to administer or score the test. These t+o f'nctions may -e carried o't -y paraprofessionals. The interpretation of the final score re<'ires a professional +ith clinical training and e3perience. 18. Mental f'nctions or traits represented in each score: Bnly the total scale score( meas'ring clinical depression( is interpreta-le as s'-scale scores deri!ed thro'gh factor analysis tend to -e 'nrelia-le. 19. Comments regarding design of test: The simple %1" item rating scale format allo+s indi!id'als to easily comprehend the <'estions and respond appropriately. The test is hand scored +ith little time and effort. S'-totals from pages one and t+o make 'p the Total Score. 17. 4alidation against criteria: BD " total scores ha!e -een correlated +ith scores on other psychological tests. The BD " is positi!ely related to the Scale for S'icide deation #r C..7( n C 186$ as +ell as the Beck Dopelessness Scale #r C .96( n C 186$. The BD " +as also positi!ely correlated +ith the Damilton /sychiatric ,ating Scale for Depression #r C.71( n C 67$ and the Damilton ,ating Scale for &n3iety #r C.17( n C 67@ Beck et al.( 1559$. & diagnostic efficiency st'dy 'sing a clinical college sample of 1%7 st'dents yielded a 5.E tr'e positi!e rate and 16E false positi!e rate #Beck et al.( 1559$. 16. E!idence of constr'ct !alidity: The responses of 8;; psychiatric o'tpatients +ere s'-Fected to an 'nrotated principal components analysis and s'-se<'ent /roma3" rotated iterated principal factor analysis yielding a t+o"factor sol'tion: Somatic"&ffecti!e and Cogniti!e. Confirmation of this factor sol'tion +as attempted -y analy?ing responses of 1%; typical college st'dents. Gsing the same factor analytic proced'res( t+o factors again emerged. Do+e!er the t+o res'ltant factors represented the dimensions Cogniti!e" &ffecti!e and Somatic. t sho'ld -e noted that +hile factor analysis of a %1 item scale 'sing a sample of 8;; participants meets c'rrently accepted minimal re<'irements of at least a 1;:1 ratio of participants: items #act'al ratio of %..6:1$( the st'dy 'sing 1%; college st'dents fall +ell short #act'al ratio of 8.7:1$. S'ch a lo+ ratio of participants to item +ill likely res'lt in an 'nrelia-le factor sol'tion. Th's( f't're research sho'ld address factor sta-ility( partic'larly thro'gh confirmatory factor analytic proced'res. &lso( as mentioned a-o!e( the BD " total score has -een sho+n to correlate significantly +ith the scores of tests p'rporting to meas're depression. 15. 2airness: &s Beck( Bro+n( & Steer #1565$ point o't( differences among men and +omen may e3ist regarding fre<'ency and se!erity of e3pression of depressi!e symptoms. Do+e!er only one set of criterion"referenced interpreti!e g'idelines +as offered in the man'al( and this set is not -roken o't -y se3. 2't're st'dies m'st e3plore this potential se3 difference as c'rrent interpretation g'idelines co'ld Feopardi?e the BD " As diagnostic efficiency( potentially leading to an o!eridentification of +omen and 'nderidentification of men. n addition( no e!idence +as reported regarding fairness of items and total score across racialHc'lt'ral categories.

%;. Comments regarding !alidity for partic'lar p'rposes: The BD " is a fle3i-le instr'ment +hich can -e 'sed in clinical or non"clinical settings. The hit rates reported in the diagnostic efficiency st'dy a-o!e demonstrate the clinical 'tility of the BD " . %1. )enerali?a-ility: The a'thorsA s'ggest the res'lts of pre!io's !ersions of the BD +ere generali?a-le across gender and c'lt'res #Beck( et al.( 1565$. Do+e!er( the a'thorsA also recommend de!eloping local norms +hen 'sing the test +ith ne+ pop'lations. %%. ,elia-ility: The BD " yields a coefficient alpha of .5% for the o'tpatient pop'lation #n C 8;;$ in the sample referred to in the man'al. The coefficient alpha for the college st'dents #n C 1%;$ in the sample +as .5.. Both s'rpass the coefficient alphas for the preceding t+o !ersions of the BD . n addition( a one"+eek test"retest correlation of .5. res'lted from a st'dy of %9 o'tpatients +ho had -een referred for depression and took the BD " d'ring their first and second therapy sessions #Beck et al.( 1559$. n a st'dy +ith -oth +hite and Me3ican" &merican s'-Fects( an internal consistency coefficient of .6; +as comp'ted for the BD " &. Io significant differences +ere fo'nd -et+een participants from the t+o c'lt'ral -ackgro'nds( therefore s'pporting the testAs relia-ility across ethnic gro'ps and aging pop'lations #&mes( )ate+ood" Col+ell( & *ac?marek( 1565$. %.. Iorms: nterpretation of BD " responses is criterion" referenced. The standardi?ation sample +as comprised of .17 +omen and 16. men. Gr-an -ased pop'lations make 'p t+o s'-samples and r'ral -ased pop'lations make 'p another t+o s'-samples. T+o h'ndred and se!enty"se!en o'tpatients +ere from Cherry Dill( Ie+ Jersey( 8; o'tpatients +ere from Bala Cyn+yd( /ennsyl!ania( 1%7 o'tpatients +ere from /hiladelphia( /ennsyl!ania( and 19 +ere from Lo'is!ille( *ent'cky. The a!erage age of the o'tpatients in the sample +as .7.%; years( ho+e!er( the ages ranged from 1."69years. Ca'casians made 'p ninety"one percent of the sample( +hile &frican"&mericans and &sian"&mericans made 'p only fo'r and one percent( respecti!ely #Beck et al.( 1559$. %1. Comments regarding ade<'acy of norms: n the standardi?ation sample( minority pop'lations +ere e3tremely 'nder"represented. Bnly % gro'ps( &frican"&merican and &sian" &merican( +ere incl'ded at all. Together( they comprise only fi!e percent of the total sample. Containing only 8;; indi!id'als( the standardi?ation sample is !ery small. There is no information regarding socioeconomic stat's or residential location #'r-an( s'-'r-an( r'ral$ compared to the GS cens's data. &lso( the BD " As interpretation is criterion"referenced +ith c't score g'idelines to differentiate among minimal( mild( moderate and se!ere categories of depression. Do+e!er( a -rief scan of the reported means and standard de!iation raise some concern a-o't the !ariation of a clientAs scores on the BD " and clinical se!erity estimates. 2or e3ample( the man'al reports that clients clinically diagnosed as se!erely depressed o-tained a mean of .%.59 #SD C 1%.;$ on the BD " . The man'al states the c'toff for the se!erely depressed range is %5"9.. Khile some clinicians may find the offered c'toff g'idelines helpf'l( ca'tion is +arranted. These inferences really only lead the clinician to concl'de that higher scores on the BD " ser!e to indicate that a significant le!el of depressi!e symptoms is -eing reported -y the client. 2'rther st'dy +ith samples di!erse in se3 and race are needed to enhance confidence in these recommended se!erity categories. %8. &ids to 'ser: The BD " man'al is concise and 'ser" friendly. t clearly delineates the de!elopment of the in!entory. &dministration and scoring are disc'ssed in s'fficient detail. Gnder the administration proced're section of the man'al( the choice of self"administration or oral administration is o'tlined. & -i-liography of .9 research"-ased so'rces is incl'ded. tem

option characteristic c'r!es +ere presented in the man'al as an interpreti!e aid for the sophisticated 'ser interested in ma3imi?ing sensiti!ity or specificity. %9. Comments of re!ie+ers: The BD " is a relati!ely ne+ test( therefore little is a!aila-le in the +ay of re!ie+s. BeckAs pre!io's in!entories( incl'ding the BD and the BD " &( ha!e -een accepted as +ell"de!eloped and 'sef'l tools. &s Conoley #1567$ reports( AThe BD #re!ised$ is a +ell"researched assessment tool +ith s'-stantial s'pport for its relia-ility and !alidity. Khen 'sed clinically( care sho'ld -e taken to 'se it as an indicator of the e3tent of depression not as a diagnostic tool. &dditionally( if 'sed as a s'icide screening tool its high faka-ility sho'ld -e remem-ered #p. 75$. S'nd-erg #1567$ goes on to say( Ait #BD " &$ is a simple( short( and specific meas're for depression. 2or clinical p'rposes( of co'rse( diagnosis m'st in!ol!e m'ch more than this test aloneL#p. 6;$. %7. )eneral e!al'ation of the test: B!erall( the BD " is a 'sef'l instr'ment. t pro!ides a fast( efficient +ay to assess depression in either a clinical or non"clinical en!ironment. Bne concern is that the standardi?ation sample is not demographically representati!e of the G.S. pop'lation and little e!idence has -een pro!ided regarding the se3 and c'lt're fairness of the items and total score. /redominantly +hite females from the east coast are 'sed in the sample. &lso( the standardi?ation sample is some+hat small( containing only 8;; indi!id'als and the socioeconomic stat's of the participants is not reported. The faka-ility of the in!entory has -een an iss'e +ith all three !ersions of the Beck Depression n!entory. This sho'ld al+ays -e kept in mind d'ring the administration and interpretation of the test. &dditionally( ca'tion is +arranted +hen 'sing the c'toff g'idelines presented for criterion"referenced interpretation. /sychometrically( st'dies of the BD " indicate e3cellent internal consistency and one"+eek test"retest relia-ility on clinical samples( as +ell as s'-stantial diagnostic efficiency and correlations +ith other tests p'rporting to meas're the constr'ct of depression. Do+e!er( f'rther e3ploratory and confirmatory factor analytic +ork m'st -e 'ndertaken to f'rther 'nderstand the dimensionality 'nderlying the BD " . References &mes( M. D.( )ate+ood"Col+ell( ).( & *ac?marek( M. #1565$. ,elia-ility and !alidity of the Beck Depression n!entory for Khite and Me3ican"&merican gerontic pop'lation. /sychological ,eports( 98( 119."1198. Beck( &. T.( Bro+n( ).( & Steer( ,. &. #1565$. Se3 differences on the re!ised Beck Depression n!entory for o'tpatients +ith affecti!e disorders. Jo'rnal of /ersonality &ssessment( 8.( 95." 7;%. Beck( &. T.( Bro+n( ).( & Steer( ,. &. #1559$. Beck Depression n!entory T0: The /sychological Corporation. man'al. San &ntonio(

Conoley( C. K. #1567$. ,e!ie+ of the Beck Depression n!entory #re!ised edition$. n J. J. *ramer & J. C. Conoley #eds.$( Mental meas'rements year-ook( 11th edition #pp. 76" 75$. Lincoln( IE: Gni!ersity of Ie-raska /ress. S'nd-erg( I. D. #1567$. ,e!ie+ of the Beck Depression n!entory #re!ised edition$. n J. J. *ramer& J. C. Conoley #eds.$( Mental meas'rements year-ook( 11th edition #pp. 75"61$. Lincoln( IE: Gni!ersity of Ie-raska /ress.