Bdi-ii Manual

[Adimar Poynter]

Includesunlimited scoring per user within an accountNote: Subscription covers scoring of manually entered data only. On-screen (OSA) or remote on screen (ROSA) administrations require individual usages for scoring & reporting.

This BDI-2 consists of 21 items to assess the intensity of depression in clinical and normal patients. Each item is a list of four statements arranged in increasing severity about a particular symptom of depression.

Relevant studies of the BDI-II were retrieved through a search of electronic databases, a handsearch, and contact with authors. Retained studies (k = 118) were allocated into three groups:non-clinical, psychiatric/institutionalized, and medical samples.

The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high andsubstantial overlap with measures of depression and anxiety was reported. The criterion-basedvalidity showed good sensitivity and specificity for detecting depression in comparison to theadopted gold standard. However, the cutoff score to screen for depression varied according to thetype of sample. Factor analysis showed a robust dimension of general depression composed by twoconstructs: cognitive-affective and somatic-vegetative.

The BDI-II is a relevant psychometric instrument, showing high reliability, capacity todiscriminate between depressed and non-depressed subjects, and improved concurrent, content, andstructural validity. Based on available psychometric evidence, the BDI-II can be viewed as acost-effective questionnaire for measuring the severity of depression, with broad applicability forresearch and clinical practice worldwide.

Depression is projected to become a globally prevalent disorder11. Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Globalvariation in the prevalence and incidence of major depressive disorder: a systematic review of theepidemiological literature. Psychol Med. 2013;43:471-81.,22. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression,chronic diseases, and decrements in health: results from the World Health Surveys. Lancet.2007;370:851-8. with a huge burden to the population.33. World Health Organization (WHO). The Global burden of disease. 2004 Update.Geneva: WHO; 2008. Among the available self-assessment instruments, the 21-item BeckDepression Inventory (BDI) is one of the most popular measures of depressive symptomsworldwide.44. McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rded. New York: Oxford University; 2006. First proposed by Beck et al.,55. Beck AT, Ward CH, Mendelson M, Mock JE, Erbaugh JK. An inventory for measuringdepression. Arch Gen Psychiatry. 1961;4:561-71. this instrument has been used in more than 7,000 studies so far.The theoretical assumption of the original BDI relied upon the belief that negativistic distortedcognitions would be the core characteristic of depression.66. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck DepressionInventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77-100.

The BDI has undergone two major revisions: in 1978 as the BDI-IA77. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York:Guilford; 1979. and in 1996 as the Beck Depression Inventory-II (BDI-II).88. Beck AT, Steer RA, Brown GK. BDI-II: Beck Depression Inventory Manual. 2nd ed.San Antonio: Psychological Corporation; 1996. The updated BDI-II taps psychological and somatic manifestations of 2-week majordepressive episodes, as operationalized in the DSM-IV.99. American Psychiatric Association. Diagnostic and statistical manual of mentaldisorders - DSM-IV-TR. 4th ed. Washington: American Psychiatric Publishing;1994. Thisversion was modified to reword and replace some items. Four items of the BDI-IA that proved lesssensitive for identification of typical symptoms of severe depression - weight loss, distorted bodyimage, somatic preoccupation, and inability to work - were dropped and replaced by agitation,worthlessness, difficulty concentrating, and energy loss to assess a distinctive degree of intensityof depression. In addition, the items on appetite and sleep change were amended to evaluate theincrease and decrease of these depression-related behaviors. Unlike the original version, the BDI-IIdoes not reflect any particular theory of depression.

Despite widespread use in both non-clinical and clinical studies for more than 15 years after itspublication, to the best of our knowledge, no relevant summary of the performance of this versionhas been conducted. In addition, the last decade has seen major progress in psychometric theoriesthat were not fully developed at the time the BDI was reformulated. Within this context, we carriedout a search of articles dealing with the psychometric properties of the BDI-II. This review is notintended to be a systematic review or meta-analysis, but a synopsis of the subject matter addressingthe feasibility of using BDI-II in different population samples. Whenever possible, psychometricadvantages and criticisms are underscored, discussing recommendations for use in a variety ofsettings.

Both investigators, with previous experience in psychometric instruments, searched MEDLINE andPsycINFO databases. The following MeSH terms were used to filter relevant studies: psychometrics anddepression. We restricted the search to articles containing the BDI and published between the timeperiods of January 1st, 1996 and October 10th, 2012. The following non-psychometric article typeswere left out: clinical trials, editorials, letters, meta-analyses, practice guidelines, randomizedcontrolled trials, and case reports. There was no language or age range restriction.

All retained articles were read for exclusion of additional criteria: non-psychometric studies;other versions of the BDI; small samples (fewer than 30 participants1010. Nunnally JC, Bernstein IH. Psychometric theory. New York: McGraw;1994.), unless the study addressed a very important problem, such as between-version comparisonor content analysis. Secondary analyses of previously reported datasets were excluded. Summaryanalysis of the complete sample was preferable when multiple analyses were available (such asseparate reports by gender, ethnicity, or depressed vs. non-depressed groups).

The reference sections of review articles1111. Furukawa TA. Assessment of mood: guides for clinicians. J Psychosom Res.2010;68:581-9.

12. McPherson A, Martin CR. A narrative review of the Beck Depression Inventory(BDI) and implications for its use in an alcohol-dependent population. J Psychiatr Ment Health Nurs.2010;17:19-30.-1313. Shafer AB. Meta-analysis of the factor structures of four depressionquestionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol. 2006;62:123-46. and book chapters44. McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rded. New York: Oxford University; 2006.,1414. Dozois DJA. Beck Depression Inventory-II. In: Weiner IB, Craighead WE, editors.The Corsini Encyclopedia of psychology. 4th ed. New York: John Wiley & Sons; 2010. p.210-1.,1515. Kazdin AE. Encyclopedia of Psychology. Oxford: American PsychologicalAssociation; 2000. that were notretrieved in the computer search were examined to identify potential studies for inclusion.Additional efforts to locate relevant studies included contacting authors in the field and a handsearch of the reference lists of retained articles.

The MeSH search strategy detailed above yielded 2,611 articles. Filtering these studies using BDIresulted in 253 articles, 198 of which matched the time period of interest. The exclusion ofnon-psychometric study types narrowed the sample to 178 articles. Among those retained from theelectronic database plus hand search, 60 did not meet the inclusion criteria: 33 articles did notpresent relevant psychometric data; 18 used the BDI-I; five used the BDI-Fast Screen; and fourpresented a small sample. The final list resulted in 118 articles dedicated to investigatepsychometric performance of the BDI-II.

The English version of the BDI-II has been translated into 17 languages, and is used in Europe,the Middle East, Asia, and Latin America (Table 1). Althoughthe English version prevailed among the studies (65%), the increasing number of language versionssuggests international acceptance of the instrument.

Table 1 shows that the mean score ranged from 5.1 to38.4. In general, psychiatric samples presented the highest mean scores, medical samplesintermediate, and non-clinical samples the lowest means. Since sample standardization is notdemographically representative of the population and little evidence has been provided regarding thegender and culture fairness of the items and total score, the original authors recommendeddevelopment of local norms.

Twenty-nine of the 118 retrieved articles (25%) did not report reliability coefficients,indicating that the assumption of test score reliability generally has not prevailed in clinicalpractice regarding application of the BDI. In comparison to the internal consistency of the previousversions of the BDI (average Cronbach's alpha coefficient around 0.85),88. Beck AT, Steer RA, Brown GK. BDI-II: Beck Depression Inventory Manual. 2nd ed.San Antonio: Psychological Corporation; 1996. most studies on BDI-II reported an average alpha coefficient around 0.9, rangingfrom 0.83 to 0.96 (Table 1). Probably, the replacement ofparticular items has improved the homogeneity of the scale. Its ability to assess different types ofdepression, e.g., atypical depression, is superior to that of the BDI-IA, as symptoms of increasedand decreased appetite and sleep were included in the BDI-II items. However, superior reliabilitydoes not necessarily indicate improvement of the clinical validity of the scale.

3a8082e126