BDI - II

Instructions: This questionnaire consists of 21 groups of statements. Please read each 4. Loss of Pleasure
group of statements carefully. And then pick out the one statement in each group that 0. I get as much pleasure as I ever did from the things I
best describes the way you have been feeling during the past two weeks, including enjoy.
today. Circle the number beside the statement you have picked. If several statements in 1. I don't enjoy things as much as I used to.
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, including Item 16
2. I get very little pleasure from the things I used to enjoy.
(Changes in Sleeping Pattern) or Item 18 (Changes in Appetite). 3. I can't get any pleasure from the things I used to enjoy.

5. Guilty Feelings
1. Sadness 0. I don't feel particularly guilty.
0. I do not feel sad. 1. I feel guilty over many things I have done or should
1. I feel sad much of the time. have done.
2. I am sad all the time.
2. I feel quite guilty most of the time.
3. I am so sad or unhappy that I can't stand it.
3. I feel guilty all of the time.
2. Pessimism
0. I am not discouraged about my future. 6. Punishment Feelings
1. I feel more discouraged about my future than I used to. 0. I don't feel I am being punished.
2. I do not expect things to work out for me. 1. I feel I may be punished.
3. I feel my future is hopeless and will only get worse. 2. I expect to be punished.
3. I feel I am being punished.
3. Past Failure
0. I do not feel like a failure. 7. Self-Dislike
1. I have failed more than I should have. 0. I feel the same about myself as ever.
2. As I look back, I see a lot of failures. 1. I have lost confidence in myself.
3. I feel I am a total failure as a person. 2. I am disappointed in myself.
3. I dislike myself.
16. Changes in Sleeping Pattern 19. Concentration Difficulty
0. I have not experienced any change in my sleeping. 0. I can concentrate as well as ever.
1a I sleep somewhat more than usual. 1. I can't concentrate as well as usual.
1b I sleep somewhat less than usual. 2. It's hard to keep my mind on anything for
2a I sleep a lot more than usual. very long.
2b I sleep a lot less than usual. 3. I find I can't concentrate on anything.
3a I sleep most of the day.
3b I wake up 1-2 hours early and can't get back to
sleep. 20. Tiredness or Fatigue
0. I am no more tired or fatigued than usual.
1. I get more tired or fatigued more easily than usual.
17. Irritability 2. I am too tired or fatigued to do a lot of the things I
0. I am not more irritable than usual. used to do.
1. I am more irritable than usual. 3. I am too tired or fatigued to do most of the
2. I am much more irritable than usual. things I used to do.
3. I am irritable all the time.

21. Loss of Interest in Sex

18. Changes in Appetite 0. I have not noticed any recent change in my
0. I have not experienced any change in my interest in sex.
appetite. 1. I am less interested in sex than I used to be.
1a My appetite is somewhat less than usual. 2. I am much less interested in sex now.
1b My appetite is somewhat greater than usual. 3. I have lost interest in sex completely.
2a My appetite is much less than before.
2b My appetite is much greater than usual.
3a I have no appetite at all. Total Score: _______
3b I crave food all the time.
THE PSYCHOLOGICAL CORPORATION
Harcourt Brace & Company
Copyright 1996, by Aaron T. Beck. All rights reserved.
8. Self-Criticalness 12. Loss of Interest
0. I don't criticize or blame myself more than usual. 0. I have not lost interest in other people or
1. I am more critical of myself than I used to be. activities.
2. I criticize myself for all of my faults. 1. I am less interested in other people or things
3. I blame myself for everything bad that happens. than before.
2. I have lost most of my interest in other people or
things.
9. Suicidal Thoughts or Wishes 3. It's hard to get interested in anything.
0. I don't have any thoughts of killing myself.
1. I have thoughts of killing myself, but I would not 13. Indecisiveness
carry them out. 0. I make decisions about as well as ever.
2. I would like to kill myself. 1. I find it more difficult to make decisions than
3. I would kill myself if I had the chance. usual.
2. I have much greater difficulty in making
decisions than I used to.
10. Crying 3. I have trouble making any decisions.
0. I don't cry anymore than I used to.
1. I cry more than I used to. 14. Worthlessness
2. I cry over every little thing. 0. I do not feel I am worthless.
3. I feel like crying, but I can't. 1. I don't consider myself as worthwhile and useful
as I used to.
2. I feel more worthless as compared to others.
11. Agitation 3. I feel utterly worthless.
0. I am no more restless or wound up than usual.
1. I feel more restless or wound up than usual. 15. Loss of Energy
2. I am so restless or agitated, it's hard to stay still. 0. I have as much energy as ever.
3. I am so restless or agitated that I have to keep 1. I have less energy than I used to have.
moving or doing something. 2. I don't have enough energy to do very much.
3. I don't have enough energy to do anything.
 NINDS CDE Notice of Copyright
Beck Depression Inventory-II (BDI-II)
Availability: Please visit this website for more information about the instrument:
Beck Inventory and Scales website.

Classification: Supplemental – Highly Recommended: Epilepsy

Supplemental: Amyotrophic Lateral Sclerosis (ALS), Epilepsy, Headache,

Multiple Sclerosis (MS), Parkinson’s Disease (PD), Sports-Related
Concussion (SRC) Subacute (after 72 hours to 3 months) and
Persistent/Chronic ( 3 months and greater post concussion), and
Traumatic Brain Injury (TBI)

Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid

Hemorrhage (SAH)
Short Description of Construct measured: This scale measures the existence and severity of
Instrument: symptoms of depression.
Generic vs. disease specific: Generic.
Means of administration: Self-administered.
Intended respondent: Self-Report.
# of items: 21 items.
# of subscales and names of sub-scales: 2 subscales: Affective and
Somatic subscales.
# of items per sub-scale: 8 for affective; 13 for somatic.

Comments/Special The Beck Depression Inventory-II (BDI-II) developed in 1996, was

instructions: derived from the BDI. The 21-item self-administered survey is scored
on a scale of 0–3 in a list of four statements arranged in increasing
severity about a particular symptom of depression.

Scoring: Scoring: Each of the 21 items corresponding to a symptom of

depression is summed to give a single score for the Beck Depression
Inventory-II (BDI-II). There is a four-point scale for each item ranging
from 0 to 3. On two items (16 and 18) there are seven options to
indicate either an increase or decrease of appetite and sleep. Cut-off
score guidelines for the BDI-II are given with the recommendation that
thresholds be adjusted based on the characteristics of the sample, and
the purpose for use of the BDI-II. Total score of 0–13 is considered
minimal range, 14–19 is mild, 20–28 is moderate, and 29–63 is severe.

Recommended Instrument for: ALS, Epilepsy, Headache, MS, PD, SAH, SRC and TBI Page 1 of 3
 NINDS CDE Notice of Copyright
Beck Depression Inventory-II (BDI-II)
Rationale / Strengths: Easy to use, widely known, results easy to interpret. Item
Justification: content improved over BDI-I to increase its correspondence with DSM-
IV.
Weaknesses: Includes several items assessing physical symptoms which
may be elevated in ALS patients due to motor neuron degeneration and
not depression. However non-ALS clinical studies have provided
evidence of the presence of at least two factors, a cognitive-affective
factor and a somatic depressive symptom factor, which is more stable
than in the BDI. However, this factor structure requires confirmation in
ALS.
Psychometric Properties:
Feasibility: Easy to complete, relatively short compared to interview-
based assessments.
Reliability: 1 week test-retest stability is high (.93). Internal consistency
(coefficient alpha) is .92–.94 depending on the sample.
Validity: Construct validity was high when compared to the BDI (.93).
Sensitivity to Change: Designed to assess mood within the most recent
2 week period, so comparison across assessments should reflect
change over time.
Relationships to other variables: BDI-II scores were not correlated
with functional disability (ALSFRS-R scores) (Rabkin et al., 2005) in late-
stage ALS patients, but did correlate with suffering, anger, perceived
caregiver burden, weariness, and negative effect. In non-ALS studies,
BDI-II scores correlate with measures of hopelessness, suicidal ideation
and anxiety.
Purpose of Tool: Screening for severity of depression.
Used in: Observational studies.
Administration time: 5 minutes, scoring 1 minute.
Sport Concussion Specific:
Advantages: Widely used and accepted instrument. Quantifies
depressive symptoms, but is not a diagnostic instrument. Some
symptoms overlap with "concussive symptoms". Any study looking at
factors contributing to persistent symptoms should use this measure.
Age Range: age 13 and older

Recommended Instrument for: ALS, Epilepsy, Headache, MS, PD, SAH, SRC and TBI Page 2 of 3
 NINDS CDE Notice of Copyright
Beck Depression Inventory-II (BDI-II)
References: Key References:
Beck AT, Steer RA, Brown GK. Manual for The Beck Depression
Inventory Second Edition (BDI-II). San Antonio: Psychological
Corporation; 1996.
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression
Inventories -IA and -II in psychiatric outpatients. J Pers Assess.
1996;67(3):588–597.
Steer RA, Ball R, Ranieri WF, Beck AT. Dimensions of the Beck
Depression Inventory-II in clinically depressed outpatients. J Clin
Psychol. 1999;55(1):117–128.
Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity,
and internal consistency of the Beck Depression Inventory-Second
Edition in a sample of college students. Depress Anxiety.
2004;19(3):187–189.
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for
psychiatric comorbidity in headache patients. Headache. 2006;46 Suppl
3:S98–S109.
ALS References:
Taylor L, Wicks P, Leigh PN, Goldstein LH. Prevalence of depression in
amyotrophic lateral sclerosis and other motor disorders. Eur J Neurol.
2010;17(8):1047–1053.
Rabkin JG, Albert SM, Del Bene ML, O'Sullivan I, Tider T, Rowland LP,
Mitsumoto H. Prevalence of depressive disorders and change over time
in late-stage ALS. Neurology. 2005;65(1):62–67.
Trail M, Nelson ND, Van JN, Appel SH, Lai EC. A study comparing
patients with amyotrophic lateral sclerosis and their caregivers on
measures of quality of life, depression, and their attitudes toward
treatment options. J Neurol Sci. 2003;209(1-2):79–85.

Recommended Instrument for: ALS, Epilepsy, Headache, MS, PD, SAH, SRC and TBI Page 3 of 3
 Beck Anxiety Inventory (BAI)

About: This scale is a self-report measure of anxiety.

Items: 21

Reliability:
Internal consistency for the BAI = (Cronbach’s α=0.92)
Test-retest reliability (1 week) for the BAI = 0.75 (Beck, Epstein,
Brown, & Steer, 1988).

Validity:
The BAI was moderately correlated with the revised Hamilton
Anxiety Rating Scale (.51), and mildly correlated with the
Hamilton Depression Rating Scale (.25) (Beck et al., 1988)

Scoring:
Not At All Mildly but it Moderately - Severely – it
didn’t it wasn’t bothered me
bother me pleasant at a lot
much times
All 0 1 2 3
questions

The total score is calculated by finding the sum of the 21 items.

Score of 0 – 21 = low anxiety
Score of 22 – 35 = moderate anxiety
Score of 36 and above = potentially concerning levels of anxiety

References:

Beck, A. T., Epstein, N., Brown, G., Steer, R. A. (1988). An

inventory for measuring clinical anxiety: Psychometric
properties. Journal of Consulting and Clinical Psychology,
56, 893-897.
 Beck Anxiety Inventory (BAI)
Below is a list of common symptoms of anxiety. Please carefully read each
item in the list. Indicate how much you have been bothered by that
symptom during the past month, including today, by circling the number in
the corresponding space in the column next to each symptom.

Not At All Mildly but it Moderately - Severely – it

didn’t it wasn’t bothered
bother me pleasant at me a lot
much times
Numbness or tingling □ □ □ □
Feeling hot □ □ □ □
Wobbliness in legs □ □ □ □
Unable to relax □ □ □ □
Fear of worst □ □ □ □
happening
Dizzy or lightheaded □ □ □ □
Heart pounding/racing □ □ □ □
Unsteady □ □ □ □
Terrified or afraid □ □ □ □
Nervous □ □ □ □
Feeling of choking □ □ □ □
Hands trembling □ □ □ □
Shaky / unsteady □ □ □ □
Fear of losing control □ □ □ □
Difficulty in breathing □ □ □ □
Fear of dying □ □ □ □
Scared □ □ □ □
Indigestion □ □ □ □
Faint / lightheaded □ □ □ □
Face flushed □ □ □ □
Hot/cold sweats □ □ □ □
INTERPRETING THE BECK DEPRESSION INVENTORY (BDI-II)

Add up the score for each of the 21 questions by counting the number to the right of each
question you marked. The highest possible total for the whole test would be sixty-three and
the lowest possible score for the test would be zero. This would mean you circles zero on each
question. You can evaluate your depression according to the Table below.

Total Score Levels of Depression

0-10 = 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

A PERSISTENT SCORE OF 17 OR ABOVE INDICATES THAT YOU MAY NEED

TREATMENT.

___________________________________________________________________________

INTERPRETING THE BECK ANXIETY INVENTORY (BAI)

Scoring Key
Not At All =0
Mildly =1
Moderately =2
Severely =3
Add up the score for each of the 21 questions by using the scoring key above. The highest
possible total for the whole test would be sixty-three. Since the lowest possible score for each
question is zero, the lowest possible score for the test would be zero. This would mean you
circles zero on each question. You can evaluate your anxiety according to the Table below
which is based on the 1993 revisions.

Total Score Levels of Anxiety

0-7 = Minimal level of anxiety
8-15 = Mild anxiety
16-25 = Moderate anxiety
26-63 = Severe depression
INTERPRETING THE BECK SCALE FOR SUICIDE (BSS)

If the client responses with a 0 (0= no desire) to items 4 and 5 then skip ahead to items 20 and
21. The client does not need to complete items 6 through 17.

If the client responses with a 1 or 2 to items 4 and 5 then you would instruct them to complete
all the items on the scale. When they complete the scale you would add up the score for each
of the first 19 questions by counting the number to the right of each question you marked.
Items 20 and 21 are not part of the total scale score. They are provided to help gather
additional clinical information for the therapist. The manual contains general cutoff
guidelines, although the author recommends that cut-off scores should be based upon clinical
decisions. Generally scores above 24 are considered to be a clinical cutoff implying this
client is at a significant risk for suicide.

________________________________________________________________

INTERPRETING THE BECK HOPELESSNESS SCALE (BHS)

Scoring Template
Count one point if any of the items were answered with the following responses:
1. FALSE 6. FALSE 11. TRUE 16. TRUE
2. TRUE 7. TRUE 12. TRUE 17. TRUE
3. FALSE 8. FALSE 13. FALSE 18. TRUE
4. TRUE 9. TRUE 14. TRUE 19. FALSE
5. FALSE 10. FALSE 15. FALSE 20. TRUE

Add up the total points based on the scoring template above to find a total scale score. The
user bases his or her interpretation on the total scale score. The manual contains general cutoff
guidelines, although the author recommends that cut-off scores should be based upon clinical
decisions. Generally scores above 8 or 9 are considered to be a clinical cutoff implying this
client is at a greater risk for suicide.