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Beck Depression Inventory II (BDI-II)
Availability
Please visit this website for more information about the instrument: Beck Depression Inventory II
Classification
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, Huntington's Disease (HD), 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
The Beck Depression Inventory II (BDI-II) is a widely used 21-item self-report inventory measuring the severity of depression in adolescents and adults. The BDI-II was revised in 1996 to be more consistent with DSM-IV criteria for depression. The BDI-II differs from the BDI in that individuals are asked to respond to each question based on a two-week time period rather than a one-week timeframe. The BDI-II also has improved clinical sensitivity with a coefficient alpha equal to .92. (Beck et al., 1996a,b)
Comments/Special Instructions
The BDI-II is widely used as an indicator of the severity of depression and can be used to support the early identification of depression and diagnosis but should not solely be used as a diagnostic tool. It may be self-administered or given verbally by a trained administrator. A number of studies provide evidence for its reliability and validity across different populations and cultural groups and it has been used in numerous treatment outcome studies and in numerous studies with trauma-exposed individuals. (Beck et al., 1996c) The scale administration time is 5 minutes and takes about 1 minute to score. This is a proprietary scale and requires purchase to use. 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. As a proprietary measure, it 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 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).
Rationale/Justification
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.
 
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.
 
Huntington's Disease-Specific:
Strengths: The International Parkinson and Movement Disorder Society classified the instrument as "recommended" for screening purposes for HD studies. (Mestre et al., 2016)
 
Weaknesses: The instrument has many somatic items that are confounded by HD somatic symptoms and can diagnose depression based on HD symptoms; there is a licensing fee for use.
 
ME/CFS-Specific:
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.
 
Sport-Related Concussion-Specific:
Strengths: 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
References
Key References:
Beck AT, Steer RA, Brown GK. Manual for The Beck Depression Inventory Second Edition (BDI-II). San Antonio: Psychological Corporation; 1996a.
 
Beck AT, Steer RA, Brown GK. (1996b). Beck Depression Inventory (BDI-2) [Internet] Accessed 09 November 2023. Available from:
 
Beck AT, Steer RA, Brown GK. (1996c). Beck Depression Inventory-II (BDI-II) [Internet] APA PsycNet Direct Accessed 09 November 2023. Available from:
 
Additional References:
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996 Dec;67(3):588-97.
 
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006 Oct;46 Suppl 3:S98-109.
 
Steer RA, Ball R, Ranieri WF, Beck AT. Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. J Clin Psychol. 1999 Jan;55(1):117-28.
 
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):187-9.
 
Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry. 2013 Oct-Dec;35(4):416-31.
 
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 Jul 12;65(1):62-7.
 
Taylor L, Wicks P, Leigh PN, Goldstein LH. Prevalence of depression in amyotrophic lateral sclerosis and other motor disorders. Eur J Neurol. 2010 Aug;17(8):1047-53.
 
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 May 15;209(1-2):79-85.
 
Huntington's Disease-Specific References:
De Souza J, Jones LA, Rickards H. Validation of self-report depression rating scales in Huntington's disease. Mov Disord. 2010 Jan 15;25(1):91-6.
 
Mestre TA, van Duijn E, Davis AM, Bachoud-Levi AC, Busse M, Anderson KE, Ferreira JJ, Mahlknecht P, Tumas V, Sampaio C, Goetz CG, Cubo E, Stebbins GT, Martinez-Martin P; Members of the MDS Committee on Rating Scales Development. Rating scales for behavioral symptoms in Huntington's disease: Critique and recommendations. Mov Disord. 2016 Oct;31(10):1466-1478.
 
Smith MM, Mills JA, Epping EA, Westervelt HJ, Paulsen JS; PREDICT-HD Investigators of the Huntington Study Group. Depressive symptom severity is related to poorer cognitive performance in prodromal Huntington disease. Neuropsychology. 2012 Sep;26(5):664-9.
 
ME/CFS-Specific Reference:
Brown M, Kaplan C, Jason L. Factor analysis of the Beck Depression Inventory-II with patients with chronic fatigue syndrome. J Health Psychol. 2012 Sep;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, Djelilovic-Vranic J, Nakicevic A, Todorovic L, Tiric-Campara M. Post stroke depression. Med Arch. 2014;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. J Neurol Sci. 2013 May 15;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. 2014 Apr;158:48-52.
 
Document last updated January 2024