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Beck Depression Inventory II (BDI-II)
Please visit this website for more information about the instrument: Beck Depression Inventory
NeuroRehab Supplemental - Highly Recommended
Recommendation for use: Indicated for studies requiring a measure of emotional impairment.
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), Stroke, 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.
Comments/Special Instructions
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.
This scale is proprietary and requires purchase to use.
NeuroRehab-Specific: Applicable to the following populations: multiple sclerosis; TBI; ALS; chronic fatigue syndrome; stroke; The BDI-II has evidence of validity compared to a diagnostic interview in multiple sclerosis. It is a proprietary measure. May require different scoring in some cohorts.
Scoring and Psychometric Properties
Scoring: 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.
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).
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.
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
Strengths: 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).
Weaknesses: 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.
Parkinson's Disease-Specific:
Strengths: Valid and reliable self-report depression screening tool in PD; Two-factor model of Affective and Somatic subscales is supported in PD (Stohlman et al., 2021). Sensitive to change in severity of depressive symptoms in various treatment-outcome studies involving PD patients.
Weaknesses: Some PD patients may have difficulty with response format. Proprietary.
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.
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006;46 Suppl 3:S98-S109.
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.
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:
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.
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.
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.
NeuroRehab-Specific Reference:
Homaifar BY, Brenner LA, Gutierrez PM, Harwood JF, Thompson C, Filley CM, Kelly JP, Adler LE. Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury. Arch Phys Med Rehabil. 2009 Apr;90(4):652-6.
Parkinson's Disease-Specific References:
Calleo J, Williams JR, Amspoker AB, Swearingen L, Hirsch ES, Anderson K, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone GM, Weiss H, Rabins P, Marsh L. Application of depression rating scales in patients with Parkinson's disease with and without co-Occurring anxiety. J Parkinsons Dis. 2013;3(4):603-8.
Stohlman SL, Barrett MJ, Sperling SA. Factor structure of the BDI-II in Parkinson's disease. Neuropsychology. 2021 Jul;35(5):540-546.
Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Rabins P, Marsh L. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012 Mar 27;78(13):998-1006.
Stroke-Specific References:
Alajbegovic A, Djeliliovic-Vranic J, Alajbegovic S, Nakicevic A, Todorovic L, Tiric-Campara M. Post Stroke Depression. Medical Archives. 2014 Feb;68(1):47-50.
Haghgoo HA, Pazuki ES, Hosseini, AS, Rassafiani M. Depression, activities of daily living and quality of life in patients with stroke. Neuro Sci. 2013;328(1-2):87-91.
Lerdal A, Kottorp A, Gay CL, Grov EK, Lee KA. Rasch analysis of the Beck Depression Inventory-II in stroke survivors: A cross-sectional study. J Affect Disord. April 2014;158:48-52.
Document last updated August 2022