Test no : 4

Beck Depression Inventory-BDI II

Introduction

The Beck Depression Inventory (BDI, BDI-1A, BDI-II),was created by Aaron T. Beck and has

21-question multiple-choice self-report inventory, one of the most widely used psychometric
tests for measuring the severity of depression. Its development marked a shift among mental
health professionals, who had until then, viewed depression from a psychodynamic perspective,
instead of it being rooted in the patient's own thoughts.

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. The BDI-II does not rely on any particular theory of depression and the
questionnaire has been translated into several languages. In its current version, the BDI-II is
designed for individuals aged 13 and over, and is composed of items relating to symptoms of
depression such as hopelessness and irritability, cognitions such as guilt or feelings of being
punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex.

The BDI was used as a model for the development of the Children's Depression Inventory (CDI),
first published in 1979 by clinical psychologist Maria Kovacs.

According to Beck's publisher, 'When Beck began studying depression in the 1950s, the
prevailing psychoanalytic theory attributed the syndrome to inverted hostility against the self. By
contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim
descriptions of their symptoms and then using these to structure a scale, which could reflect the
intensity or severity of a given symptom.

Beck drew attention to the importance of "negative cognitions" described as sustained,

inaccurate, and often-intrusive negative thoughts about the self. In his view, it was the case that
these cognitions caused depression, rather than being generated by depression.

Beck developed a triad of negative cognitions about the world, the future, and the self, which
play a major role in depression. An example of the triad in action taken from Brown (1995) is the
case of a student obtaining poor exam results:
 The student has negative thoughts about the world, so he may come to believe he does
not enjoy the class.
 The student has negative thoughts about his future because he thinks he may not pass the
class.
 The student has negative thoughts about his self, as he may feel he does not deserve to be
in college.

The development of the BDI reflects that in its structure, with items such as "I have lost all of my
interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the
future, and "I blame myself for everything bad that happens" to reflect the self. The view of
depression as sustained by intrusive negative cognitions has had particular application
in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through
techniques such as cognitive restructuring.

BDI

The original BDI, first published in 1961, consisted of twenty-one questions about how the
subject has been feeling in the last week. Each question had a set of at least four possible
responses, ranging in intensity. For example:

 (0) I do not feel sad.

 (1) I feel sad.
 (2) I am sad all the time and I cannot snap out of it.
 (3) I am so sad or unhappy that I cannot stand it.

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

 0–9: indicates minimal depression

 10–18: indicates mild depression
 19–29: indicates moderate depression
 30–63: indicates severe depression.
Higher total scores indicate more severe depressive symptoms.

Some items on the original BDI had more than one statement marked with the same score. For
instance, there are two responses under the Mood heading that score a 2: (2a) "I am blue or sad
all the time and I can't snap out of it" and (2b) "I am so sad or unhappy that it is very painful”.

BDI-IA

The BDI-IA was a revision of the original instrument developed by Beck during the 1970s, and
copyrighted in 1978. To improve ease of use, the "a and b statements" described above were
removed, and respondents were instructed to endorse how they had been feeling during the
preceding two weeks. The internal consistency for the BDI-IA was good, with a Cronbach's
alpha coefficient of around 0.85, meaning that the items on the inventory are highly correlated
with each other.

However, this version retained some flaws; the BDI-IA only addressed six out of the nine DSM-
III criteria for depression. This and other criticisms were addressed in the BDI-II.

BDI-II

The BDI-II was a 1996 revision of the BDI, developed in response to the American Psychiatric
Association's publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, which changed many of the diagnostic criteria for Major Depressive Disorder.

Items involving changes in body image, hypochondriasis, and difficulty working were replaced.
In addition, sleep loss and appetite loss items were revised to assess both increases and decreases
in sleep and appetite. All but three of the items were reworded; only the items dealing with
feelings of being punished, thoughts about suicide, and interest in sex remained the same.
Finally, participants were asked to rate how they have been feeling for the past two weeks, as
opposed to the past week as in the original BDI.

Like the BDI, the BDI-II also contains 21 questions, each answer being scored on a scale value
of 0 to 3. Higher total scores indicate more severe depressive symptoms. The standardized
cutoffs used differ from the original:
 0–13: minimal depression
 14–19: mild depression
 20–28: moderate depression
 29–63: severe depression.

Objectives:
To assess severity of depression symptoms by using BDI-II Test.

Used Test and Materials

i. Booklet of BDI-II Questionnaire

ii. Manual for BDI-II
iii. Pen/pencil

General Information of the Subject:

Name Puspa Kumar Karki
Age 31
Sex Male
Marital Status Single
Address Kathmandu
Occupation Service
Academic Qualification Masters in Business Studies
Physical & Mental Health Mentally Sound & physically fit
Date of Test February 1st, 2021
Time 2:00 PM (Lunch Time)
Location Office Cabin, Newroad

Test Description
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. The BDI-II does not
rely on any particular theory of depression and the questionnaire has been translated into several
languages. A shorter version of the questionnaire, the BDI Fast Screen for Medical Patients
(BDI-FS), is available for primary care use. That version contains seven self-reported items each
corresponding to a major depressive symptom in the preceding 2 weeks.
The questionnaire was developed from clinical observations of attitudes and symptoms occurring
frequently in depressed psychiatric patients and infrequently in non-depressed psychiatric
patients. 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. Self-administration takes 5–10 min. The recall period for
the BDI-II is 2 weeks for (major depressive symptoms) as operationalized in the fourth edition of
Diagnostic and Statistical Manual (DSM-IV).
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).

Test Administration:
Before starting administration, a good rapport was established with the subject and made
him clear about the test. Testing instructions were introduced before the subject before
starting the test work. After filling details of the demographic information, one test booklet
was given to the subject and another was kept with the test taker. Before answering,
administrator read the instructions loudly. After it is ascertained that the subject has
understood the process of answering. While answering, subject was inspected if he was
doing the work rightly. When the subject asked any questions during the process of
answering, the administrator helped the subject checking the responses.
After finishing the test, the subject was asked how she felt about the test. The subject was
released after taking her introspective report regarding the test taken.

Introspective report
“Such a lot of the emotional situational statements. I had to think for a while in some of the
situations. Anyways I answered it appropriately as far as I think. It feels me good. I had
very good time while filling the report.”

Instruction for administration

Inside this booklet are 21 questions. There is no “right” and “wrong” answers because
everyone has the right to their own vies. To be able to get the best advice from your
consults, you will want to answer them exactly and truly.
There are four possible answers to each question. Tick in the answers you feel the best
option matches you among 0.1.2 and 3.
When your answer, keep these points in mind:
1. Give the first, natural answer as it comes to you. Of course, the questions are too short to
give you all the particulars you would sometimes like to have. Give the best answer you
can.
2. Be sure not to skip anything, but answer every question, some may not apply to you very
well, but give you best answer that you think best matches your condition. Some may seem
personal; but remember that the answers are kept confidential.
3. Answer as honestly as possible what is true of you. Do not nearly mark what seems “the
right thing to say” to impress the examiner.

After given proper instructions, the test was conducted, when the subject finished his task he
was requested for introspective report and released from with thanks.

Measurement of Design
The BDI-II Test includes 21 different dimensions represented by 21 different questions. The
dimensions are Sadness, Pessimism, Past Failure, Loss of Pleasure, Guilty Feelings, Punishment
Feelings, Self Dislike, Self- Criticalness, Suicidal Thoughts or Wishes, Crying, Agitation, Loss
of Interest, Indecisiveness, Worthlessness, Loss of Energy, Changes in Sleeping Pattern,
Irritability, and Changes in Appetite, Concentration Difficulty, Tiredness or Fatique and Loss of
Interest in Sex. Each questions have four different options(Keys); 0,1,2, and 3. The scores are
provided based on the answers selected. If the answer selected is option 0, the score is 0 and the
if the answer selected is option 1, the score is 1 and so on. The minimum total score is 0 and
maximum total score is 63.
Table I: Scoring Key
Score Key Interpretation
0 Not At All
1 Mildly
2 Moderately
3 Severely

The option (Key) selected has different meaning(Interpretation). The key 0 means that the
question statement is not true for present time since 2 weeks. The key 1 means the question has
mildly affected and key 2 means the question has moderate truth and key 3 means the condition
has severe impact.
Table II: Total Score and Level of Depression
Total Score Level of Depression
1-10 These ups and downs are considered normal
11-16 Mild mood disturbance
17-20 Borderline clinical depression
21-30 Moderate depression
31-40 Severe depression
Over 40 Extreme depression

Based on score range, the level of depression is measured. If the total score ranges from 1-
10, the subject is considered having no symptoms of depression. If the total score ranges
from 11-16, the subject is considered having mild mood disturbances. If the total score
ranges from 17-20, the subject is considered standing on the borderline of clinical
depression. If the total score ranges from 21-30, the subject is having moderate depression.
If the total score ranges from 31-40, the subject is having Severe Depression and if the total
score ranges over 40, the depression is on extreme level.
Scoring & interpretation.
Table III: Dimensions and Scoring from the Test
The score of each dimension was added and total score from the manual booklet.
S.No Option Scor
Dimension
. Selected e
 1 Sadness 0 0
2 Pessimism 1 1
3 Past failure 0 0
4 Loss of pleasure 2 2
5 Guilty Feelings 0 0
6 Punishment Feelings 1 1
7 Self-Dislike 0 0
8 Self-Criticalness 1 1
Suicidal Thoughts or
9 1 1
Wishes
10 Crying 2 2
11 Agitation 1 1
12 Loss of interest 2 2
13 Indecisiveness 3 3
14 Worthlessness 0 0
15 Loss of Energy 1 1
16 Changes in Sleeping Pattern 0 0
17 Irritability 0 0
18 Changes in Appetite 0 0
19 Concentration Difficulty 0 0
20 Tiredness or Fatigue 0 0
21 Loss of Interest in Sex 0 0
Total Score 15

For every question, there are four options and the marking was done as per the scoring
provided in the manual. The questions represented different dimensions.
Maximum Score= 0
Minimum Score= 63

Interpretation
The total score of the complete test obtained by the subject is 15 out of maximum score 63.
It falls in range of 11-16 indicating mild mood disturbance.
1. The subject has obtained 0 score in sadness meaning he has no symptoms of sadness.
2. The score in Pessimism is 1 indicating he has started being pessimist about his future.
3. The score in Past Failure is 0, indicating he thinks he has not faced the failure.
4. The score in Loss of Pleasure is 2, indicating he gets less pleasure from the things he
used to enjoy.
5. The score in Guilty Feeling is 0, he does not feel guilty at all.
6. The score in Punishment Feeling is 1 , indicating he fears of being punished.
7. The score in Self Dislike is 0, indicating no change in feeling about him.
8. The score in Self Criticalness is 1, indicating feeling of being more critical than before.
9. The score in Suicidal thoughts or Wishes is 1, indicating that he has feeling of himself
but would not carry them out.
10. The Score in Crying is 3, indicating he has urges to cry but cannot cry.
11. The sore in Agitation is 1, indicating he is more restless than usual.
12. The score in Loss of Interest is 2, indicating loss of interest in most of the things and
people.
13. The score in Indecisiveness is 0, indicating having problems in making decision.
14. The score in Worthlessness is 0, indicating he has no any feeling of self-worthlessness.
15. The score in Loss of Energy is 1, indicating he has less energy than before.
16. The score in Changes in Sleeping Pattern is 0, indicating no change in sleeping patterns.
17. The score in Irritability is 0, indicating he feels less irritated than before.
18. The score in Changes in Appetite is 0, indicating he has no change in appetite.
19. The score in Concentration Difficulty is 0, indicating he has no issues in concentrating
on anything.
20. The score in Tiredness or Fatigue is 0, indicating he has no more tiredness as he used to
feel before.
21. The score in Loss of Interest in Sex is 0, indicating he has not lost interest in sex.

The total score is 15, which stands in range between 11-16 indicating he has mild mood
disturbance but no depression.

Analysis and conclusion:

The subject has scored 15, which means he has mild mood disturbance. He does not have
sadness, feeling of past failure and guilty feeling, self-dislike, worthlessness, changes in
sleeping pattern, irritability, changes in appetite, concentration difficulty, tiredness or
fatigue and loss of interest in sex. The subject is also mildly pessimist, has punishment
feelings, self-criticalness and suicidal thought, agitation and loss of energy. He has
moderately loss of pleasure. He feels like crying but cannot. He has loss in interest on
people and things he used to enjoy before. He is severely indecisive.

Impression
The person has mild mood disturbances.

Conclusion
The person does not have any depression but has mild mood disturbances.
References
Beck AT (1972). Depression: Causes and Treatment. Philadelphia: University of Pennsylvania
Press. ISBN 0-8122-1032-8.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (June 1961). "An inventory for
measuring depression". Arch. Gen. Psychiatry. 4 (6): 561–71. 
Appendix
Sadness
0 I do not feel sad. √
1 1 I feel sad much of the time.  
2 I am sad all the time.  
3 I am so sad or unhappy that I cannot stand it.  
Pessimism
0 I am not discouraged about my future.  
2 1 I feel more discouraged about my future than I used to be. √
2 I do not expect things to work out for me.  
3 I feel my future is hopeless and will only get worse.  
Past failure
0 I do not feel like a failure. √
3 1 I have failed more than I should have.  
2 As I look back, I see a lot of failure.  
3 I feel I am a total failure as a person.  
Loss of pleasure
0 I get as much pleasure as I ever did from the things I enjoy.  
4 1 I do not enjoy things as much as I used to.  
2 I get very little pleasure from the things I used to enjoy. √
3 I cannot get any pleasure from the things I used to enjoy.  
Guilty Feelings
0 I do not feel particularly guilty. √
5 1 I feel guilty over many things I have done or should have done.  
2 I feel guilty most of the time.  
3 I feel guilty all of the time.  
Punishment Feelings
0 I do not feel I am being punished.  
6 1 I feel I may be punished. √
2 I expect to be punished.  
3 I feel I am being punished.  
Self-Dislike
7
0 I feel the same about myself as ever. √
 1 I have lost confidence in myself.  
2 I am disappointed in myself.  
3 I dislike myself.  
Self-Criticalness
0 I feel the same about myself more than usual.  
8 1 I am more critical of myself than I used to be. √
2 I criticize myself for all of my faults.  
3 I blame myself for everything bad that happens.  
Suicidal Thoughts or Wishes
0 I do not have any thoughts of killing myself.  
9 1 I have thoughts of killing myself, but I would not carry them out. √
2 I would like to kill myself.  
3 I would kill myself if I had a chance.  
Crying
0 I don’t cry anymore than I used to.  
10 1 I cry more than I used to.  
2 I cry over every little thing.  √
3 I feel like crying, but I cannot.
Agitation
0 I am no more restless or wound up than usual.  
11 1 I feel more restless or wound up than usual. √
2 I am so restless or agitated that it is hard to stay still.  
3 I am so restless or agitated that I have to keep moving or doing something.  
Loss of interest
0 I have not lost interest in other people or activities.  
12 1 I am less interested in other people or things than before.  
2 I have lost most of my interest in other people or things. √
3 It is hard to get interested in anything.  
Indecisiveness
0 I make decisions about things as well as ever.  
13 1 I find it more difficult to make decisions than usual.  
2 I have much greater difficulty in making decisions than I used to.  
3 I have trouble making any decisions. √
Worthlessness
0 I do not feel I am Worthless.  √
14 1 I don’t consider myself as worthwhile and useful as I used to.  
2 I feel more worthless as compared to other people.  
3 I feel utterly worthless.
Loss of Energy
15
0 I have as much energy as ever.  
 1 I have less energy than I used to have. √
2 I don’t have enough energy to do very much.  
3 I don’t have enough energy to do anything.  
Changes in Sleeping Pattern
0 I have not experienced any change in my sleeping pattern.  √
1a I sleep somewhat more than usual.  
1b I sleep somewhat less than usual.  
16
2a I sleep a lot more than usual.  
2b I sleep a lot less than usual.
3a I sleep most of the day.  
3b I wake up 1-2 hours early and can’t get back to sleep.  
Irritability
0 I am no more irritable than usual.  
17 1 I am more irritable than usual. √
2 I am much more irritable than usual.  
3 I am irritable all the time.  
Changes in Appetite
0 I have not experienced any change in my appetite. √
1a My appetite is somewhat less than usual.  
1b My appetite is somewhat greater than usual.  
18
2a My appetite is much less than before.  
2b My appetite is much greater than usual.  
3a I have no appetite at all.  
3b I crave food all the time.  
Concentration Difficulty
0 I can concentrate as well as ever.  √
19 1 I can’t concentrate as well as usual.  
2 It’s hard to keep my mind on anything for very long.  
3 I find I can’t concentrate on anything.
Tiredness or Fatigue
0 I am no more tired or fatigued than usual. √
20 1 I get more tired or fatigued more easily than usual.  
2 I am too tired or fatigued to do a lot of the things I used to do.  
3 I am too tired or fatigued to do most of the things I used to do.  
Loss of Interest in Sex
0 I have not noticed any recent change in my interest in sex. √
21
1 I am less interested in sex than I used to be.  
2 I am much less interested in sex now.  
  3 I have lost interest in sex completely.