Linking the Beck Depression Inventory (BDI-I) and the Depression Subscale from the

Depression Anxiety Stress Scale-21 (DASS-D)

Stephanie L. Haft1, Cannon Thomas2,3, Jacqueline B. Persons1,4

1
Department of Psychology, University of California, Berkeley, Berkeley, CA
2San Francisco Group for Evidence-Based Psychotherapy, San Francisco, CA
3University of California San Francisco, San Francisco, CA
4Oakland Cognitive Behavior Therapy Center, Oakland, CA

Corresponding author: Stephanie L. Haft, stephanie.haft@berkeley.edu

Publication status: Unpublished
Draft date: February 3, 2023
LINKING THE BDI-I AND DASS-D 2

Abstract

The Beck Depression Inventory (BDI-I) and depression subscale from the Depression

Anxiety Stress Scale-21 (DASS-D) are two common measures of depressive symptoms. The aim

of the present study was to use unidimensional item response theory (IRT) and equipercentile

linking methods to produce score cross-walk tables so that the BDI-I and DASS-D could be

compared. A sample of college students (N=455; 75% female, 21% White) completed both the

BDI-I and the DASS-D simultaneously. Methodology outlined by the PROsetta Stone project

(Choi et al., 2021) was used to link the BDI-I and DASS-D using data from this sample. A

separate validation sample of individuals recruited from Amazon mTurk (N=136) was used to

further test the accuracy of instrument linking methods. Results suggested that the BDI-I and

DASS-D were sufficiently unidimensional to be linked, and that IRT-based methods with fixed

parameter calibration produced the most accurate score cross-walk tables.

LINKING THE BDI-I AND DASS-D 3

Depression is a salient public health issue given its relatively high lifetime prevalence

(2%-15%) and its disease burden (Moussavi et al., 2007). Consequently, numerous research

studies aim to better understand causes of and treatment for depression and depressive

symptoms. Over 280 measures of depression currently exist (Santor et al., 2006), making

comparisons across studies and across time challenging. Recently, the issue of multiple measures

in patient outcomes research has been addressed by the PROsetta Stone project and the Patient-

Reported Outcomes Measurement Information System (PROMIS; Bjorner, 2021). PROMIS uses

unidimensional item response theory (IRT) and equipercentile linking methods to establish a

common, standardized metric for frequently used patient-reported outcome measures. The

PROsetta Stone project publicly provides linking tables for several common metrics for

researchers to equate two measures of the same construct. In addition, the project has

outlined an optimal methodology for general IRT-based measurement linking procedures (Choi

et al., 2021). The aim of the present study is to link two common measurements of depression:

the Beck Depression Inventory (BDI-I) and depression subscale from the Depression Anxiety

Stress Scale-21 (DASS-D). Although the DASS-D is not included in the current PROsetta Stone

linking bank, the present study will use the methodology outlined by the PROsetta Stone project

to link the BDI-I and DASS-D using a sample of adults who simultaneously completed both

measures.

Methods

Sample

Main Sample (N=455)

A sample of 510 participants who met initial eligibility requirements (English fluency,

age 18 or older) were recruited from a large West Coast university to complete online
LINKING THE BDI-I AND DASS-D 4

questionnaires. For the present study, participants were included if they did not complete the

BDI-I (N=31) or if they completed questionnaires in less than fifteen minutes (N=24), which

could indicate invalid responses. The final sample of 455 undergraduate participants was 75%

female, and 62% Asian, 21% White, 12% multiracial, 1% Black, <1% American Indian/Alaska

Native, <1% Native Hawaiian/Pacific Islander, and 4% chose not to report race. Participants

received course credit for completing the questionnaires, and all participants provided informed

consent.

Validation Sample (N=136)

A sample of 243 participants were initially recruited from Amazon Mechanical Turk who

met initial eligibility requirements (English fluency, age 18 or older). After excluding those who

did not complete key study measures, those who were excluded by a suspicious-ISP detection

algorithm (Prims et al., 2018), and those who completed the questionnaire in an improbably fast

time (less than 15 minutes), the final sample consisted of 136 participants for the present study.

This sample was 57% female and 85% White, 6% Native Hawaiian/Pacific Islander, 3% Asian,

3% multiracial, 2% American Indian/Alaska Native, and 1% chose not to report race.

Participants received $5 compensation for completing the questionnaires, and all participants

provided informed consent.

Measures

Beck Depression Inventory

The Beck Depression Inventory (BDI-I; Beck et al., 1987) is a 21-item self-report

inventory that assesses depression severity using a 4-point Likert scale. For the present study,

item 9 assessing suicidality was excluded from participant questionnaires, resulting in a 20-item

BDI-I. To score the BDI-I, individual item scores are summed to yield a possible score ranging
LINKING THE BDI-I AND DASS-D 5

from 0 to 80 for the present study. In the main sample, the internal consistency of the 20-item

BDI was 0.91, and the split-half reliability was 0.86.

Depression Anxiety Stress Scale-21 – Depression

The depression subscale of the Depression Anxiety Stress Scale-21 (DASS-D; Lovibond

& Lovibond, 1995) consists of 7 items that asks individuals to rate the extent of several

depressive symptoms using a 4-point scale. To score the DASS-D, individual item scores are

summed to yield a possible score ranging from 0 to 21 for the present study. In the main sample,

the internal consistency of the 7-item DASS-D was 0.90, and the split-half reliability was 0.79.

Analytic Plan

We used a single group design in which a main sample (N=455) completed all items on

both the DASS-D and BDI-I. Factor analyses were conducted in Mplus (Muthén & Muthén,

2017), while all other analyses were conducted using the PROsetta package in R (Choi et al.,

2021).

Evaluating Linking Assumptions

To ensure that our data met assumptions for linking, we first qualitatively inspected item

content overlap between the DASS-D and BDI-I to select items that were conceptually congruent

in measurement of depression. Second, we evaluated the unidimensionality of a combined BDI-I

and DASS-D scale using exploratory and confirmatory factor analytic methods. We also

estimated the proportion of total variance that was attributable to a general factor with

hierarchical omega (ωh) –values of 0.70 or higher indicate sufficient unidimensionality for

linking procedures (Reise et al., 2013). In addition, we calculated the correlation between the

separate BDI-I and DASS-D instruments, which is recommended to be a minimum of 0.70 (Cella

et al., 2016). We also calculated coefficient alpha and item-total correlations of the combined
LINKING THE BDI-I AND DASS-D 6

item set. Third, we tested for another linking assumption, subgroup invariance, by comparing

standardized mean differences between the BDI-I and DASS-D among demographic subsamples

based on gender, age, and racial identity – the recommended SMD to demonstrate adequate

subgroup invariance is below 0.08 (Dorans & Holland, 2000).

IRT-based and Equipercentile Linking

Once linking assumptions were met, we proceeded to link the BDI-I and DASS-D using

two main methods: item response theory (IRT)-based fixed-parameter equating, and

equipercentile linking. When deriving the BDI-to-DASS linking functions, we treated DASS-D

item parameters as the anchor measure during equating, and used a graded response model. From

the IRT-based estimated item parameters, we created a cross-walk score conversion table of

summed scores. We also used equipercentile linking (Kolen, 2004), which is a non-IRT model

that identifies the score on a target measure with the sample percentile rank for each value

provided on the anchor or source measure. This method also produces a cross-walk score

conversion table. Because of the noise in equipercentile equating linking functions, loglinear

smoothing was used.

Evaluating Linking Results

Ultimately three linking methods were compared and evaluated for accuracy by

computing the correlation, mean difference, and standard deviation of difference scores for

linked and actual scores. The first linking method evaluated was IRT pattern scoring with an

expected a posteriori (EAP) estimate – this uses the item parameter estimates and pattern of item

responses to produce a linked score). The second linking method was IRT cross-walk scoring,

which also uses EAP estimation but derives linked scores from the cross-walk table of summed

scores. The third linking method was equipercentile linking with loglinear smoothing. To
LINKING THE BDI-I AND DASS-D 7

evaluate these three methods, we first compared actual and linked scores using the main sample

(N=455). Next, we used the produced cross-walk score tables to evaluate the accuracy of IRT

cross-walk scoring and equipercentile linking in a separate validation sample (N=136).

Results

Item Content Overlap

Comparison of item content across the 20-item BDI-I and 7-item depression subscale

from the DASS-21 (DASS-D) revealed that the BDI-I had several items that assessed constructs

not measured on the DASS-D, including guilt feelings, sense of punishment, self-accusation,

crying, irritability, social withdrawal, indecisiveness, somatic distortion, sleep disturbance,

fatigability, loss of appetite, weight loss, somatic preoccupation, and loss of libido (see Table 1).

Results from factor analyses from another study that compared the BDI-I and DASS-D

suggested that “the BDI differs from the DASS Depression scale primarily in that the BDI

includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to

discriminate between depression and other affective states” (Lovibond and Lovibond, 1995,

p.335). In addition, the DASS-D had an item evaluating devaluation of life, which was not

measured by any BDI-I items. These items without conceptual overlap were consequently

dropped from both scales, resulting in a 6-item BDI-I and 6-item DASS-D.

Testing Unidimensionality

Exploratory factor analysis (EFA) on the 12-item combined BDI-I and DASS-D revealed

that the ratio of first to second eigenvalues was above 6, indicating sufficient unidimensionality

(ratio > 4; Reeve et al., 2007). A confirmatory factor analysis (CFA) was conducted on the

combined measure to evaluate fit of a unidimensional model. The following conventions were

used, which are considered adequate to evaluate appropriateness for IRT modeling approaches
LINKING THE BDI-I AND DASS-D 8

(Choi et al., 2011): comparative fit index (CFI) > 0.90, Tucker Lewis index (TLI) > 0.90, and

root-mean-square-error of approximation (RMSEA) < 0.10. All items loaded onto a single factor

in significant and expected directions, and model fit was adequate (CFI = 0.93, TLI = 0.91,

RMSEA = 0.078). In addition, the hierarchical omega (ωh) value of 0.79 indicated a sufficient

index of unidimensionality (ωh>0.70; Reise et al., 2013). The computed Pearson correlation of

the BDI-I and DASS-D summed scores was r=0.75, which is above the recommended threshold

(>0.70) for scale linking (Cella et al., 2016). In addition, coefficient alpha for the combined scale

indicated good internal consistency (0.92), and item-total correlations ranged from 0.64 to 0.82.

Subgroup Invariance Analysis

Standardized mean differences (SMD) were computed for gender-related differences,

education-related differences (>14 years vs. < 14 years), and racial identity differences (person

of color vs. White). The SMDs were comparable between the DASS-D and BDI-I summed

scores for each subgroup – differences between SMDs were 0.068 for gender, 0.026 for

education, and 0.043 for racial identity. Given that SMD values were less than 0.08, subgroup

invariance was supported and this assumption for scale linking was met (Dorans & Holland,

2000).

Evaluation of Linking Results

Table 2 displays item parameters for the IRT model using fixed-parameter calibration.

Score cross-walk tables are shown in Table 3, using IRT-based item parameter estimates as well

as equipercentile linking methods. To compare the accuracy of the three linking methods (IRT-

based pattern scoring, IRT-based cross-walk scoring, and equipercentile linking), we first

compared the linked DASS-D summed raw score to the actual DASS-D summed score within

the main sample. We then used the crosswalk tables generated in Table 3 to produce linked
LINKING THE BDI-I AND DASS-D 9

scores for the DASS-D based on BDI-I scores in a separate validation sample. Results from these

comparisons are showin in Table 4. The IRT-based cross-walk scoring and equipercentile linking

produced adequate and identical correlations for both the main sample (0.74) and the validation

sample (0.84). However, compared to equipercentile linking, the IRT-based cross-walk method

resulted in the least variation in difference scores (SD difference) in the main sample. Therefore,

the IRT-based cross-walk method was selected as the most accurate linking method.

Conclusion

The present study produces a score cross-walk table that can be used to link a modified 6-

item version of the BDI-I and 6-item version of the DASS-D. Linking the BDI-I and DASS-D

can help researchers who study depression compare these metrics across studies and across time.

Of the methods tested, results suggested that using IRT-based cross-walk tables was the most

accurate linking method. This study is limited in that findings are derived from a Western,

nonclinical sample of adults – it will be important for future studies to replicate these equating

procedures and relationships across clinical and non-Western samples.

LINKING THE BDI-I AND DASS-D 10

References

Beck, A. T., Steer, R. A., & Brown, G. K. (1987). Beck depression inventory. Harcourt Brace

Jovanovich New York:

Bjorner, J. B. (2021). Solving the tower of babel problem for patient-reported outcome measures:

comments on: linking scores with patient-reported health outcome instruments: a validation

study and comparison of three linking methods. Psychometrika, 86(3), 747–753.

Cella, D., Lai, J.-S., Jensen, S. E., Christodoulou, C., Junghaenel, D. U., Reeve, B. B., & Stone,

A. A. (2016). PROMIS fatigue item bank had clinical validity across diverse chronic

conditions. Journal of Clinical Epidemiology, 73, 128–134.

Choi, S. W., Lim, S., Schalet, B. D., Kaat, A. J., & Cella, D. (2021). PROsetta: An R package for

linking patient-reported outcome measures. Applied Psychological Measurement, 45(5),

386–388.

Dorans, N. J., & Holland, P. W. (2000). Population invariance and the equatability of tests: Basic

theory and the linear case. Journal of Educational Measurement, 37(4), 281–306.

Kolen, M. J. (2004). Linking assessments: Concept and history. Applied Psychological

Measurement, 28(4), 219–226.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states:

Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and

Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.

Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression,

chronic diseases, and decrements in health: results from the World Health Surveys. The

Lancet, 370(9590), 851–858.

Muthén, B., & Muthén, L. (2017). Mplus. In Handbook of item response theory (pp. 507–518).
LINKING THE BDI-I AND DASS-D 11

Chapman and Hall/CRC.

Reise, S. P., Scheines, R., Widaman, K. F., & Haviland, M. G. (2013). Multidimensionality and

structural coefficient bias in structural equation modeling: A bifactor perspective.

Educational and Psychological Measurement, 73(1), 5–26.

Santor, D. A., Gregus, M., & Welch, A. (2006). FOCUS ARTICLE: Eight decades of

measurement in depression. Measurement: Interdisciplinary Research and Perspectives,

4(3), 135–155.
LINKING THE BDI-I AND DASS-D 12

Table 1

Item Conceptual Content and Overlap in the Beck Depression Inventory (BDI-I) and DASS
Depression Scales (DASS-D)

BDI-I DASS-D
Item # Construct Assessed Dropped (d) Item # Construct Assessed Dropped (d)
1 Mood 3 Anhedonia
2 Hopelessness 5 Inertia
3 Self-deprecation 10 Hopelessness
4 Anhedonia 13 Mood
5 Guilt feelings d 16 Anhedonia
6 Sense of Punishment d 17 Self-deprecation
7 Self-deprecation 21 Devaluation of life d
8 Self-accusation d
10 Crying d
11 Irritability d
12 Social withdrawal d
13 Indecisiveness d
14 Somatic Distortion d
15 Inertia
16 Sleep disturbance d
17 Fatigability d
18 Loss of Appetite d
19 Weight loss d
20 Somatic preoccupation d
21 Loss of libido d
LINKING THE BDI-I AND DASS-D 13

Table 2

DASS-D and BDI-I Item Parameter Estimates from Fixed-Parameter Calibration

Item Slope CB1 CB2 CB3

DASS3 2.994 0.558 1.390 1.851
DASS10 3.902 0.515 1.169 1.713
DASS13 2.311 -0.008 1.213 1.521
DASS16 3.009 0.487 1.365 1.712
DASS17 2.706 0.680 1.211 1.757
DASS21 2.666 0.878 1.320 1.640
BDI1 2.700 0.061 1.409 2.073
BDI2 2.567 0.247 1.436 2.286
BDI3 2.233 0.533 1.529 2.646
BDI4 2.095 0.346 1.887 2.453
BDI7 2.391 0.174 1.814 2.408
BDI15 2.237 0.060 1.301 2.469
LINKING THE BDI-I AND DASS-D 14

Table 3

Summed Score Cross-walk Tables for the BDI-I and DASS-D

IRT-Based Method Equipercentile Linking

BDI-I Score DASS-D Score BDI-I Score DASS-D Score
6 6 6 6
7 6 7 6
8 7 8 7
9 8 9 8
10 9 10 9
11 10 11 10
12 11 12 12
13 13 13 14
14 14 14 15
15 16 15 16
16 17 16 18
17 19 17 19
18 20 18 19
19 21 19 20
20 22 20 21
21 23 21 22
22 23 22 22
23 24 23 23
24 24 24 24
LINKING THE BDI-I AND DASS-D 15

Table 4

Correlations, Mean Differences, and Standard Deviations of Actual vs. Linked DASS-D Scores

Linking Method Correlation Mean Difference SD of Differences

Main Sample (N=455)
IRT Pattern Scoring 0.69 -0.53 2.83
IRT Cross-Walk Scoring 0.74 0.15 2.76
Equipercentile Linking 0.74 0.00 2.80
Validation Sample (N=136)
IRT Cross-Walk Scoring 0.87 0.54 2.50
Equipercentile Linking 0.87 0.48 2.50