Beck’s Depression Inventory

Introduction

Depression, otherwise known as major depressive disorder or clinical depression, is a common and
serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and
hopelessness and lose interest in activities they once enjoyed. Depression is different from regular
mood changes and feelings about everyday life. It can affect all aspects of life, including
relationships with family, friends and community. It can result from or lead to problems at school
and at work.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people
(16.6%) will experience depression at some time in their life. Depression can occur at any time, but
on average, first appears during the late teens to mid-20s. Women are more likely than men to
experience depression. Some studies show that one-third of women will experience a major
depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when
first-degree relatives (parents/children/siblings) have depression.

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a
person to endure. It is normal for feelings of sadness or grief to develop in response to such
situations. Those experiencing loss often might describe themselves as being “depressed.” But being
sad is not the same as having depression. The grieving process is natural and unique to each
individual and shares some of the same features of depression. Both grief and depression may
involve intense sadness and withdrawal from usual activities. Grief and depression can co-exist For
some people, the death of a loved one, losing a job or being a victim of a physical assault or a major
disaster can lead to depression. When grief and depression co-occur, the grief is more severe and
lasts longer than grief without depression. Distinguishing between grief and depression is important
and can assist people in getting the help, support or treatment they need.

To be diagnosed with depression, symptoms must be present for at least two weeks.
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must
be experiencing five or more symptoms during the same 2-week period and at least one of the
symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day.
2. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly
every day.
3. A slowing down of thought and a reduction of physical movement (observable by others, not
merely subjective feelings of restlessness or being slowed down).
4. Fatigue or loss of energy nearly every day.
5. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
6. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
7. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant
distress or impairment in social, occupational, or other important areas of functioning. The symptoms
must also not be a result of substance abuse or another medical condition.

Beck’s Depression Inventory:

The Beck Depression Inventory (BDI) is a 21-item self-reporting questionnaire for evaluating the
severity of depression in normal and psychiatric populations. Developed by Beck et al. in 1961, it
relied on the theory of negative cognitive distortions as central to depression. It underwent revisions
in 1978: the BDI-IA and 1996 and the BDI-II, both copyrighted. Twenty-one items were
consolidated from those observations and ranked 0–3 for severity. The questionnaire is commonly
self-administered although initially designed to be administered by trained interviewers.

The BDI evaluates 21 symptoms of depression, 15 of which cover emotions, four cover behavioural
changes, and six somatic symptoms. The 21 items cover sadness, pessimism, past failure, self-dislike,
self-criticism, suicidal thoughts or wishes, crying, agitation, loss of interest, indecisiveness,
worthlessness, loss of energy, changes in sleeping patterns, irritability, changes in appetite, difficulty
concentrating, tiredness or fatigue, and loss of interest in sex. The reading level of the revised
version is at a fifth or sixth grade level.

History of the Beck Depression Inventory:

Dr. Aaron T. Beck originally established the BDI in 1961. It is a screening tool that measures the
severity of depression. In both clinical practice and research, it has been frequently utilised. It was
updated to reflect changes to the DSM and incorporate new items in 1996, making it the most often
used version.

Items:

The BDI-II contains 21 items on a 4-point scale from 0 (symptom absent) to 3 (severe symptoms).
Anxiety symptoms are not assessed but affective, cognitive, somatic and vegetative symptoms are
covered, reflecting the DSM-IV criteria for major depression. Scoring is achieved by adding the
highest ratings for all 21 items. The minimum score is 0 and maximum score is 63. Higher scores
indicate greater symptom severity. In non-clinical populations, scores above 20 indicate depression.
In those diagnosed with depression, scores of 0–13 indicate minimal depression, 14–19 (mild
depression), 20–28 (moderate depression) and 29–63 (severe depression).

Validity and Reliability:

The BDI has good reliability and validity.12 The test-retest reliability of the BDI-II ranged from 0.73
to 0.92, which means that the scores are consistent over time. The internal consistency of the BDI-II
was 0.9, which means that the items on the questionnaire relate to each other and measure the same
construct.
The Beck Depression Inventory-II (BDI-II) has good convergent and discriminant validity, as noted
in a comprehensive review by Wang YP and Gorenstein C. The BDI-II is highly correlated with
other depression measures, such as the PHQ-9. (Braz J Psychiatry, 2013)

Application Value:

The BDI has numerous applications in clinical psychology, research, and mental health assessment.
The following are some key applications of the Beck Depression Inventory:

1. Clinical Assessment: The BDI is frequently used by clinicians to screen for and diagnose
depression in patients. It helps clinicians evaluate the severity of depressive symptoms, track changes
over time, and monitor treatment progress. The inventory covers a range of symptoms such as
sadness, guilt, fatigue, and changes in appetite or sleep patterns.

2. Research: Researchers utilize the BDI to study various aspects of depression, including its
prevalence, risk factors, treatment outcomes, and the effectiveness of interventions. The inventory
provides a standardized measure of depressive symptoms, enabling researchers to compare results
across different studies and populations.

3. Treatment Planning: The BDI assists clinicians in developing personalized treatment plans for
individuals with depression. By identifying specific symptoms and their severity, clinicians can tailor
interventions such as psychotherapy, medication, or lifestyle changes to address the unique needs of
each patient.

4. Outcome Evaluation: The BDI is used to assess treatment outcomes and evaluate the
effectiveness of interventions for depression. By administering the inventory before and after
treatment, clinicians can determine whether depressive symptoms have improved, worsened, or
remained stable over time.

5. Screening Programs: The BDI is employed in screening programs aimed at identifying

individuals at risk of depression in various settings such as primary care clinics, schools, and
community health centers. Early detection of depressive symptoms can facilitate timely intervention
and prevent the development of more severe forms of depression.

6. Population Studies: Epidemiological studies use the BDI to estimate the prevalence of depression
in specific populations and demographic groups. This information is valuable for public health
planning, resource allocation, and the development of preventive strategies.

7. Clinical Trials: Pharmaceutical companies and researchers conducting clinical trials for
antidepressant medications often use the BDI as an outcome measure to assess the drug's efficacy in
reducing depressive symptoms compared to a placebo or other treatments.

Limitations:

Researchers have identified several potential limitations of using the BDI in the measurement of
depression. Some of the limitations of the Beck Depression Inventory are as follows:
1. The BDI is a self-report measure: This means that it relies on the individual's own perception of
their symptoms. Not everyone experiences depression in the same way, and some people may have
difficulty accurately reporting their symptoms.

2. The BDI only assesses symptoms of depression: It does not assess other important factors, such
as family history or genetic predisposition.

3. The BDI is a static measure: This means that it does not take into account changes in symptoms
over time.

4. The BDI is not specific to any one culture: This means that it may not be as accurate in
measuring depression in people from different cultures.

References:

https://psycnet.apa.org/record/2004-15398-002
https://dictionary.apa.org/major-depressive-disorder
https://www.sciencedirect.com/science/article/abs/pii/B9780128179338000207

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan and Sadock's Synopsis of Psychiatry:
Behavioral Sciences/Clinical Psychiatry (11th ed.). Philadelphia, PA: Lippincott Williams and
Wilkins.

Ahuja, N. (2011). A Short Textbook of Psychiatry. New Delhi: Jaypee Publishers.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders
(5th ed.). American Psychiatric Publishing.
Assessor: RRN Experiment No.: 1
Assessee: ZC Experiment Date: 8.03.2024

Aim: To assess the level of depression of the participant by using Beck’s Depression Inventory.

Materials Required: 1. The BDI questionnaire 2. Manual 3. Writing Materials

Procedure: Seat the participant comfortably and establish rapport with him/her. Give
the following instructions before administering the test;
“This questionnaire consists of 21 groups of statements. Please read each group of statements
carefully. And then pick out the one statement in each group that best describes the way you have
been feeling during the past two weeks, including today. Circle the number beside the statement you
have picked. If several statements in the group seem to apply equally well, circle the highest number
for that group. Be sure that you do not choose more than one statement for any group.”
With these instructions given, the test is administered, the results are evaluated and conclusion is
drawn.

Scoring: The items in the Beck’s Depression Inventory are rated on a 4-point scale ranging 0-3
based on the severity of each item. The highest possible total for the whole test would be 63. This
would be when the subject circled number three on all 21 questions. Since the lowest possible score
for each question is 0, the lowest possible score for the test would be 0. This is if the subject answers
each question. After the scoring we can evaluate the depression level according to the given table.

Interpretation: When the test is scored, a value of 0 to 3 is assigned for each answers and then the
total score is compared to a key to determine the depression severity. The standard cut-off are as
follows:

Precautions:
1. Before administering the test, the experimenter should
check all materials and keep the cubicle ready for testing.
2. Test booklet should not be open before instructions.
3. Proper rapport should be established before starting the test.
4. Instructions should be loud and clear.
Result and discussion:
Table-1 shows the score and interpretation of the participant in the BDI

Name Age Sex Score Interpretation

ZC 23 Female 6 Normal

The BDI scale was administered to the participant ZC pursuing masters in Biotechnology at
Yenepoya University.
The participant has obtained a score of 6, which shows that the she has no depression symptoms. It
depicts that if the subject is temporarily affected by the situational stresses, she is able to cope up
with it effectively.

Conclusion:
The participant exhibits no depressive symptoms.