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Beck Depression Inventory II (BDI-II)
Beck Depression Inventory II (BDI-II)
Please visit this website for more information about the instrument: Beck Depression Inventory
NeuroRehab Supplemental - Highly Recommended
Recommendations 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.
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.
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.
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
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.
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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.
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 January 2022