Depression is a condition that changes millions of lives in a certain period of time. It is also necessary to admit that a peculiar feature of this mental disorder is that its progress may occur for years or cause functional impairment in several days. Globally, depression is observed among 5-17% of the population, including 10% of children (Lee, Lee, Hwang, Hong, & Kim, 2017; Roelofs et al., 2013). There are many forms of depression, as well as many ways to diagnose and treat it, which explains the importance of credible and effective screening instruments to be used. In this paper, special attention to one of the well-known psychometric tests, the Beck Depression Inventory, with its history, benefits, and limitations will be paid. The Beck Depression Inventory has a long way of development with two main editions of the original version, and despite its subjectivity, this tool is characterized by its usefulness and accessibility to clinicians and researchers in their intentions to assess depression and the level of its severity.
General Description
Depression is a global health issue. It can be an outcome of various chronic medical illnesses such as heart disease, cancer, or diabetes, or a standing alone psychological problem that requires special treatment (Wang & Gorenstein, 2013). About 60% of depressed people have their first mental health problems at their adolescence and develop them into one of the more serious episodes of Major Depressive Disorder (MDD) in their adulthood (Lee et al., 2017). Therefore, the detection of depression at its early stage, the evaluation of the risks, and the definition of the level of depression are the main goals. Formal assessments with properly defined measures can be offered by clinicians to different patients.
The Beck Depression Inventory (BDI) is one of the most frequently used scales with the help of which people can evaluate the severity of depression. It consists of 21 items that introduce a self-reporting questionnaire (Jackson-Koku, 2016; Wang & Gorenstein, 2013). According to Huang and Chen (2015), this scale is applied to prove the presence of depression among adolescents and adults older than 13 years. One of the significant factors is the detection of behavioral changes or concerns during the last two weeks (Huang & Chen, 2015). Regarding the statistical data that depression can bother young children (Lee et al., 2017), the main question about the appropriateness of the BDI remains open for today’s discussion. Not much evaluation is available to prove the correctness of BDI results for the patients of different ages.
History
Despite the existing concerns and debates around the BDI in psychology, there are several historical facts that stay unchangeable. For example, this test was created as a part of psychotherapy for depression by Aaron T. Beck in 1961 (Wang & Gorenstein, 2013). The background of this psychiatrist was closely connected to cognitive therapy development. However, his first intention was to unite his career with neurology. He wanted to discover some new functions of the brain and focus on neurological impairments. The lack of workers made him one of the leading practitioners of psychoanalysis in the region.
The creation of the BDI is a significant achievement of this psychiatrist. It was originally created in English and then translated into many languages regarding the existing variety of cultures and traditions (Lee et al., 2017). The first test was based on the theory of negative cognitive distortions (Jackson-Koku, 2016). Two major revisions were made to this test. The first one, known as the BDI-IA, took place in 1978 and focused on the removal of a- and b-statements that facilitated the use of the test. The second one, now known as the BDI-II was offered in 1996 regarding the demands and standards of the American Psychiatric Association. Compared to the original version, it was not based on any theory and included a list of questionnaire questions (Jackson-Koku, 2016). Still, it was improved in accordance with the DSM-IV criteria that are used to diagnose MDD. Today, the BDI-II is used by many psychiatrists around the whole world, and its analysis is one of the ways to clarify its benefits and limitations.
Benefits
The main advantage of any scale is the possibility for patients who may experience depressive symptoms to come to certain conclusions independently and investigate their situations from multiple perspectives. A variety of items are mentioned in the chosen inventory so that the participants can check their cognition, as well as existing affective, somatic, and vegetative signs (Huang & Chen, 2015). Patients are not limited in time and may choose if to take the test orally or in a pen-and-paper format. Therefore, this test can be used either by people without disabilities or some physical impairment or by those who have reading difficulties and concentration problems. As a rule, about 10-15 minutes are necessary to take the BDI-II. This time is enough to identify the major problems and focus on treatment or prevention of complications.
Another benefit of the chosen scale is the possibility to interpret the results independently without clinician assistance. As soon as the scores are defined, the range of the disorder can be discovered: minimal depression (from 0 to 13 points), mild depression (from 14 to 19 points), moderate depression (from 20 to 28 points), and severe depression (from 29 to 63 points) (Roelofs et al., 2013). The examination of psychometric properties proves if the patient suffers from depression and has to be treated accordingly or the identified symptoms are not enough to make final conclusions. Such test can regularly be taken with the possibility to detect behavioral, emotional, or mental changes quickly. Regarding the results achieved, people can understand if treatment improvements are required, and what outcomes can be achieved.
Even after several revisions, this inventory is defined as a credible source of information and evaluation. The validity of the BDI-II is explained in terms of the DSM-IV criteria with the correlation coefficient between 0.60 and 0.72 (Jackson-Koku, 2016). As a rule, researchers find it necessary to calculate Pearson product-moment correlations are used to assess the validity of the BDI-II (Lee et al., 2017). The check of the concurrent validity becomes an important aspect of the inventory. The convergent validity between the different editions of the BDI was 0.93, and the divergent validity was characterized as poor (Wang & Gorenstein, 2013). This convergent type of validity also included the results of comparison between such instruments as Hamilton’s Anxiety Rating Scale and Penn State Worry Questionnaire (Wang & Gorenstein, 2013). However, in total, no questions and concerns about the quality of the test, its validity, and correlation with other credible tools occur. Many psychologists and therapists admit its easy accessibility and the possibility to obtain the results fast.
Limitations
Among the existing variety of benefits and positive outcomes of the BDI-II in the field of psychology in general and depression treatment in particular, it is necessary to learn its possible limitations and unclear issues. These aspects prove that not all attempts and discoveries are made at this moment. For example, the already mentioned concerns about the test’s validity signalize that some issues may stay underreported or over-reported. In addition, Wang and Gorenstein (2013) underline that the main goal of the BDI-II is not to diagnose a patient and investigate the peculiarities of a recent depressive episode. The task is to identify the appropriateness of the possibility to detect the symptoms of depression and monitor available treatment efficacy (Wang & Gorestein, 2013). Therefore, the patients who use the BDI-II to check themselves for depression have to understand all these goals and distinctions clearly.
Another important limitation of the chosen psychiatric test is personalization. The BDI-II is the combination of self-reported questionnaires (Wang & Gorestein, 2013). Though the nature of writing and language chosen by the author is not complicated, some patients may face challenges because of the lack of knowledge or illiteracy. Normal adults and adolescents may take the test and check their depression predisposition quickly (Huang & Chen, 2015). Still, the same test is not recommended for the elderly (Wang & Gorestein, 2013). Personal biases, emotional changes, and the environment may have an impact on the results of the BDI-II. Therefore, the norms have to be properly chosen and established.
Talking about the norms appropriate for the BDI-II, it is also crucial to underline that many studies were based on the results obtained from White participants. For example, Huang and Chen (2015) worked with young White adults. Wang and Gorenstein (2013) included Brazilians in their White sample. Lee et al. (2017) invited the Koreans to participate in the study. Not many discussions cover the peculiarities of depression and the BDI-II effectiveness among African Americans or Native Americans. Therefore, the results of the BDI-II should be regarded as biased and self-reported. The generalizability of the results is also affected by the nature of the settings chosen and the inability to verify biases of patients, including multiple somatic factors (Wang & Gorenstein, 2013). Personal mood and behavior can change the results of the tests because of patient’s intentions to answer all questions and give fair and true information. Sometimes, even the most skilled practitioners and clinicians are not able to identify the reasons for diverse results and the challenges in treatment.
Conclusion
To conclude, the Beck Depression Inventory cannot be defined as a purely negative or a purely helpful tool in evaluating the mental health conditions of a person. Though there are certain limitations and challenges in the BDI-II tests, psychiatric experts know how to choose the right direction and achieve positive results. The BDI-II remains one of the latest and the most effective tool for people to define the stage of depression and the necessity of a care plan. Depression may vary and lead to different complications and changes. If the BDI-II is a chance to detect this problem and find a solution, it has to be used. Today, the majority of clinical decisions in relation to depressive symptoms and signs are based on the results of the BDI-II.
References
Huang, C., & Chen, J. H. (2015). Meta-analysis of the factor structures of the Beck depression inventory-II. Assessment, 22(4), 459-472.
Jackson-Koku, G. (2016). Beck depression inventory. Occupational Medicine, 66(2), 174-175.
Lee, E. H., Lee, S. J., Hwang, S. T., Hong, S. H., & Kim, J. H. (2017). Reliability and validity of the Beck depression inventory-II among Korean adolescents. Psychiatry Investigation, 14(1), 30-36.
Roelofs, J., van Breukelen, G., de Graaf, L. E., Beck, A. T., Arntz, A., & Huibers, M. J. (2013). Norms for the Beck depression inventory (BDI-II) in a large Dutch community sample. Journal of Psychopathology and Behavioral Assessment, 35(1), 93-98.
Wang, Y. P., & Gorenstein, C. (2013). Assessment of depression in medical patients: A systematic review of the utility of the Beck depression inventory-II. Clinics, 68(9), 1274-1287.