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Beck Depression Inventory II (BDI-II)
Please visit this website for more information about the instrument: Beck Depression Inventory
Supplemental – Highly Recommended: Epilepsy, Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
Supplemental: Amyotrophic Lateral Sclerosis (ALS), Epilepsy, Headache, Multiple Sclerosis (MS), Parkinson’s Disease (PD), Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), and Traumatic Brain Injury (TBI)
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Construct measured: This scale measures the existence and severity of symptoms of depression.
Generic vs. disease specific: Generic.
Means of administration: Self-administered.
Intended respondent: Self-Report.
# of items: 21 items.
# of subscales and names of sub-scales:
2 subscales: Affective and Somatic subscales.
# of items per sub-scale: 8 for affective; 13 for somatic.
The Beck Depression Inventory-II (BDI-II) developed in 1996, was derived from the BDI. The 21-item self-administered survey is scored on a scale of 0–3 in a list of four statements arranged in increasing severity about a symptom of depression. BDI-II assesses presence and intensity of mood symptoms. The scale can be divided into 2 subscales, affective symptoms (8 items) and somatic symptoms (13 items). Cut-off scores are available to classify degree of mood intensity. The scale is also available in Spanish.
Each of the 21 items corresponding to a symptom of depression is summed to give a single score for the Beck Depression Inventory-II (BDI-II). There is a four-point scale for each item ranging from 0 to 3. On two items (16 and 18) there are seven options to indicate either an increase or decrease of appetite and sleep. Cut-off score guidelines for the BDI-II are given with the recommendation that thresholds be adjusted based on the characteristics of the sample, and the purpose for use of the BDI-II. Total score of 0–13 is considered minimal range, 14–19 is mild, 20–28 is moderate, and 29–63 is severe. This scale can be scored either manually or using the Pearson proprietary software Q-global.
ALS Specific:
Strengths: Easy to use, widely known, results easy to interpret. Item content improved over BDI-I to increase its correspondence with DSM-IV.
Weaknesses: Includes several items assessing physical symptoms which may be elevated in ALS patients due to motor neuron degeneration and not depression. However non-ALS clinical studies have provided evidence of the presence of at least two factors, a cognitive-affective factor and a somatic depressive symptom factor, which is more stable than in the BDI. However, this factor structure requires confirmation in ALS.
Psychometric Properties:
Feasibility: Easy to complete, relatively short compared to interview-based assessments.
Reliability: 1 week test-retest stability is high (.93). Internal consistency (coefficient alpha) is .92–.94 depending on the sample.
Validity: Construct validity was high when compared to the BDI (.93).
Sensitivity to Change: Designed to assess mood within the most recent 2-week period, so comparison across assessments should reflect change over time.
Relationships to other variables:  BDI-II scores were not correlated with functional disability (ALSFRS-R scores) (Rabkin et al., 2005) in late-stage ALS patients, but did correlate with suffering, anger, perceived caregiver burden, weariness, and negative effect. In non-ALS studies, BDI-II scores correlate with measures of hopelessness, suicidal ideation and anxiety.
Purpose of Tool: Screening for severity of depression.
Used in: Observational studies.
Administration time: 5 minutes, scoring 1 minute.
Sport-Related Concussion Specific:
Advantages: Widely used and accepted instrument. Quantifies depressive symptoms, but is not a diagnostic instrument. Some symptoms overlap with "concussive symptoms". Any study looking at factors contributing to persistent symptoms should use this measure.
Age Range: age 13 and older
ME/CFS Specific:
Advantages: Useful in ME/CFS because of the differentiation between somatic and affective symptoms. The investigator can ferret out whether mood symptoms exist or whether symptoms can be attributed mainly to the somatic symptoms of the disease. The BDI-II is a valid and reliable tool to evaluate mood in ME/CFS (Brown et al., 2012).
Limitations: Investigators should be careful not to attribute elevations to affective reasons only as there is a large overlap with somatic symptoms in ME/CFS patients due to the nature of the disease.
Beck AT, Steer RA, Brown GK. Manual for The Beck Depression Inventory Second Edition (BDI-II). San Antonio: Psychological Corporation; 1996.
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.
Steer RA, Ball R, Ranieri WF, Beck AT. Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. J Clin Psychol. 1999;55(1):117–128.
Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depress Anxiety. 2004;19(3):187–189.
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006;46 Suppl 3:S98–S109.
Wang Y, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Revista Brasileira de Psiquiatria. 2013;35(4):416–431.
ALS-Specific References:
Taylor L, Wicks P, Leigh PN, Goldstein LH. Prevalence of depression in amyotrophic lateral sclerosis and other motor disorders. Eur J Neurol. 2010;17(8):1047–1053.
Rabkin JG, Albert SM, Del Bene ML, O'Sullivan I, Tider T, Rowland LP, Mitsumoto H. Prevalence of depressive disorders and change over time in late-stage ALS. Neurology. 2005;65(1):62–67.
Trail M, Nelson ND, Van JN, Appel SH, Lai EC. A study comparing patients with amyotrophic lateral sclerosis and their caregivers on measures of quality of life, depression, and their attitudes toward treatment options. J Neurol Sci. 2003;209(1-2):79–85.
ME/CFS-Specific References:
Brown M, Kaplan C, Jason L. Factor analysis of the Beck Depression Inventory-II with patients with chronic fatigue syndrome. Journal of health psychology. 2012;17(6):799–808.
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