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Beck Depression Inventory — What It Is and How It Works

There are plenty of tools available to help learn more about different mental health illnesses and how to help diagnose which mental health illness or disorder a person may have, one of which is the Beck Depression Inventory.

Many people know of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which defines and classifies mental disorders in order to improve diagnoses, treatment, and research.

The DSM-5 includes definitions and descriptions for things like Major Depressive Disorder. However, there are other tools that delve into illnesses more specifically, such as the Beck Depression Inventory (BDI). 

What is the Beck Depression Inventory?

The BDI, which was was first introduced in 1961, has been revised several times since (Beck et al., 1988). The BDI has been widely used as an assessment instrument in gauging the intensity of depression in patients who meet clinical diagnostic criteria for depressive syndromes.

However, the BDI has also found a place in research with normal populations, where the focus of use has been on detecting depression or depressive ideation.

Unlike the DSM-5, which reviews a variety of mental illnesses, this tool is used specifically for determining the severity of a person’s depression. The Beck Depression Inventory BDI is a 21-question, self-report rating inventory that measures characteristic attitudes and symptoms of depression.

It takes approximately 10 minutes to complete, although clients require a fifth–sixth-grade reading level to adequately understand the questions. The sheet is self-scored, meaning the person using it can track the severity of their symptoms on a scale of 0 (not severe) to 3 (most severe).

The 21 items included reflect a variety of symptoms and attitudes commonly found among clinically depressed individuals (e.g., mood, self-dislike, social withdrawal, sleep disturbance). It is straightforward, and it can be given as an interview by the clinician or as a self-report instrument.

Some examples of these questions include:

(Number 8)

0 I don’t feel I am any worse than anybody else.

1 I am critical of myself for my weaknesses or mistakes.

2 I blame myself all the time for my faults.

3 I blame myself for everything bad that happens.

(Number 13)

0 I make decisions about as well as I ever could.

1 I put off making decisions more than I used to.

2 I have greater difficulty in making decisions more than I used to.

3 I can’t make decisions at all anymore.

(Number 19)—an analysis of this below.

0 I haven’t lost much weight, if any, lately.

1 I have lost more than five pounds.

2 I have lost more than ten pounds.

3 I have lost more than fifteen pounds.

Depending on how the user feels, they may choose one of these three on the Beck Depression Inventory. They would then add this to a score as they continue to complete the self-report.

Once the user has finished scoring, they add up the score for each of the questions by counting the number to the right of each question you marked. The highest possible total for the whole test is 63.

This would mean you circled number three on all 21 questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circle zero on each question.

Interpreting the Score on the Beck Depression Inventory

Depending on the score the user gets, they can land on one of the following categories:

1. These ups and downs are considered normal

2. Mild mood disturbance

3. Borderline clinical depression

4. Moderate depression

5. Severe depression

6. Extreme depression

The Beck Depression Inventory is interpreted through the use of cut-off scores. Cut-off scores may be derived based on the use of the instrument (i.e., if a clinician wishes to identify very severe depression, then the cut-off score would be set high).

According to Beck et al. (1988), the Center for Cognitive Therapy has set the following guidelines for Beck Depression Inventory cut-off scores to be used with affective disorder patients:

  • scores from 0 through 9 indicate no or minimal depression
  • scores from 10 through 18 indicate mild to moderate depression
  • scores from 19 through 29 indicate moderate to severe depression
  • scores from 30 through 63 indicate severe depression

This tool takes a deeper look at what level your depression is by considering the frequency and severity of the symptoms, while the DSM-5 simply lists out the symptoms.

This can help a person decipher how intense their depression is, or perhaps monitor if their depression has decreased/increased over time.

There are multiple types of Beck patient assessment tools to help healthcare professionals measure patient needs and progress. There are different assessments of children, adults, and different contexts. These different subtypes include:

Drawbacks to the Beck Depression Inventory

While this tool can be incredibly useful, there may be some drawbacks. For example, if a clinician decides to give this assessment to a patient, they need to be aware that the patient could be faking, lying, or have variance in their responses.

A patient may not take the test seriously, may act defensively, or question the validity of the test. These reactions may skew the answers and thus the assessment of their depression.

Additionally, depression is different for everyone. People may feel or express their symptoms in a variety of ways, which can make it hard to pin down what is depression and what is considered “normal.”

The BDI is extremely sensitive to differences in the instructions given to the user. such that certain instructions yield a state-like index of depressive thinking, whereas, other instructions yield a more trait-like index of depressive thinking.

So, clinicians and healthcare providers are encouraged to use caution when administering the Beck Depression Inventory and to tailor the administration instructions to those specific states or traits.

The BDI isn’t a perfect assessment or tool, but it is a helpful way of assessing the severity of depression. It is more specific than the DSM-5 and gives the user more control in terms of how to assess and monitor their depression.

Given depression and its symptoms are so subjective, it may be difficult to fully capture a person’s experience. That’s why conversations about depression and all the ways it can manifest and be expressed is important as we continue to normalize mental health.

Additionally, some questions, while the intent is to be useful, could be problematic. Number 19 (see above) specifically talks about weight. While weight is a tool to measure overall health and happiness, it alone is not a good indicator. For someone who already deals with an eating disorder, they may or not respond to this question accurately.

Or, even if a person does “accurately” respond, the scoring may not accurately reflect the person’s overall mental or physical health.

For example, if a person answers “0 I haven’t lost much weight, if any, lately,” that doesn’t account for poor eating habits. Weight alone may not account for binge eating, bulimia, orthorexia, fasting or fad diet, or over/under-exercising.

Additionally, words like “sad” may hit different individuals differently. Sadness feels different from grief, irritation, frustration. When we limit our linguistic tools to describe a condition, we are not accounting for a wide range of symptoms.

The BDI Can Be Helpful to Start With

It’s important to remember that while Beck Depression Inventory may be helpful for some users, we still have a long way to go when it comes to helping people determine and better understand their depression.

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Samantha Mineroff

Samantha Mineroff is a writer, mental health advocate, and aspiring author. In 2018, her paper, “The Rhetoric of Major Depressive Disorder: Performativity and Intra-activity of Emotions in Major Depression” won best seminar paper award at West Chester University of Pennsylvania. At the Poetics And Linguistics Association (PALA) Conference in 2019, she went to The University of Liverpool to present her paper “An Application of Scripts, Schemas, and Negative Accommodation Theory in Leslie Jamison’s The Empathy Exams.” She currently works as a marketing writer for clinical research. She enjoys live jazz, good conversation, and writing letters. You can reach her at sammineroff@gmail.com

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