Saturday, August 20, 2011
Psychological Measure: The BDI
The Beck Depression Inventory (BDI), the creation of Aaron T. Beck, is one of the most widely used tests for assessing depression. The BDI is a reliable multiple-choice self-report inventory, for the purpose of assessing the presence and severity of depression (Beck, Ward, Mendelson, Mock, & Erbaugh, 1061). The following articles address the use of the BDI in a variety of circumstances including alcohol dependency and with young girls between the ages of nine and 13. In both populations the BDI-II and the BDI-Y provided both valid and reliable results. The test is easy to use and can be administered by individuals with a minimal amount of training. Accounting for the complex nature of co-morbidities in any substance dependency, and for children between the ages of nine and 13, the BDI-II and the BDI-Y are assessments sufficient for the initial determination of depression and its severity for the two distinct populations measured.
Articles Discussing the Beck Depression Inventory
Using the BDI in Alcohol-dependent Populations
McPherson and Martin (2009) studied the use of the BDI in an alcohol-dependent population and found 80% of people with alcohol dependency experience clinical symptoms of depression. There is often confusion on how to treat someone who is depressed and dependent on alcohol, although the recommended treatment is a combination of pharmacology and psychotherapy as well as educating the individuals and their families (McPherson & Martin, 2009). The BDI was first created to assist in evaluating the progress of treatment, but later used to determine whether individuals were depressed or not depressed. McPherson and Martin (2009) claim “these characteristics and the recurring factors in a range of studies highlighted led to a conclusion that the BDI is a rational choice as a screening instrument for depression in an alcohol-dependent population” (p. 28).
Considering the reliability and validity of using the BDI, McPherson and Martin (2009) claim “an initial literature search carried out for this study shows research into its use with an alcohol-dependent population is scarce” (p. 20). Test-retest reliability shows stability of a test over time and the study by McPherson and Martin (2009) demonstrated reliability. Using internal consistency to confirm test items are consistent with each other, the internal correlation retained its consistency in an alcohol-dependent population. In sum, the BDI is a reliable and valid measure of depression in this population.
Using the BDI in a Sample of Girls
In 2007, the Beck’s Depression Inventory for Youth (BDI-Y) was used in a study involving girls ages nine to13. The ethnic background of the girls varied with roughly five different ethnicities included (Stapleton et al., 2007). The BDI-Y measured different domains of anxiety, depression, and self-concept. The depression inventory asks for responses about negative self perspective, generally negative world views, lack of hope, and average emotional and other symptoms of depression (Stapleton et al., 2007). The BDI includes 20 questions in the inventory and the questionnaire is formulated for the reading level of second graders. The questions have a negative connotation. The girls in the study answered each question with responses of never, sometimes, often, or always, depending on how closely the question related to them. Upon completion, tests were scored determining the presence and severity of depression.
The results of the study demonstrated the effectiveness of the BDI-Y. "Predictive validity of the BDI-Y was supported, as the mean score of girls eventually diagnosed with depression was higher than that of girls who did not receive a diagnosis of depression" (Stapleton et al., 2007, p. 232). Furthermore, it demonstrated the BDI-Y as both reliable and valid in a variety of ethnic backgrounds, as the results did not vary because of this variable. Reliability was slightly off in regard to age because the results of the BDI-Y varied marginally when compared the Children’s Depression Inventory, only for the nine-year-old girls, however. Because of this, further research is recommended to test the effectiveness of the BDI-Y for girls ages seven to eight. This test is designed for youth ages seven through 18. Another consideration is to include both positive and negative words on the test to determine if this would produce different responses (Stapleton et al., 2007). The Children's Depression Inventory makes use of both types of wording, which varies from the BDI.
Uses of Beck Depression Inventory
The BDI-II is designed for adults and adolescents over the age of 13. Beck designed the inventory as a screening tool, although it is used by many health care professionals to ascertain a more immediate diagnosis (Sharp & Lipsky, 2001). According to McPherson and Martin (2010), the BDI-II is both reliable and valid for use in detecting depression and changes in depression in a variety of populations, and furthermore, an effective screening tool for alcohol-dependent populations (McPherson & Martin, 2010). Research (Luty & O'Gara, 2006) suggests further study into the areas of addiction and dependency and the use of the BDI-II. Other research (Buckley, Parker & Heggie, 2001) has determined the BDI-II is valid in addiction research and research concerning alcohol-dependent individuals. McPherson and Martin (2010) claim depression can be "expressed as either a primary or secondary component" (p. 22) and central to primary depression are mood issues, although in secondary depression other problems such as alcohol dependence are of issue, and central to the depression. Understanding the issues associated with depression, and the multiple causalities contributing to this disorder, help to explain why the BDI-II can effectively be used in populations with depression even with a variety of causalities. The BDI-Y is a reliable and valid measure for young girls ages nine to 13 with more research suggested for the its application to seven and eight-year-olds (Stapleton, Sander, & Stark, 2007). As measured against the Children's Depression Inventory, the BDI is valid and reliable for the ages and ethnic backgrounds accounted for in the research.
Qualifications for Administration and Interpretation
The goal of Beck’s cognitive therapy is to help people develop realistic appraisals of the situations they encounter (Beck, 1991). The therapist acts as trainer and co-investigator, providing data to be examined, and guidance in understanding how cognition influences behavior (Beck & Weishaar, 1989). The BDI-II and the BDI-Y can be self-administered, although the scoring and measurements may not be as easy to interpret for self-administration. In a clinical setting the test can be administered and scored by a paraprofessional, although the interpretation of the final scores requires a professional with clinical training and experience (Smith & Erford, 2001). The scoring for both BDI assessments is dependent on those who have been diagnosed with depression and scores vary by population.
The interpretive ranges of the test are 0 to 13: minimal depression, 14 to 19: mild depression, 20 to 28: moderate depression, and 29 to 63: severe depression (Polgar, 2011). The BDI has been tested over time for its validity as it was constructed by clinicians and experts on depression among psychiatric patients. The BDI has been tested for reliability and has followed all testing standards for psychological testing since 1985. Internal consistency has been demonstrated in more than 25 studies in varied populations. The BDI has been shown to be valid and reliable and resulting in corresponding ratings of depression in more than 90% of cases (Polgar, 2011). The BDI would be appropriate to use for individuals already experiencing symptoms of depression and is best used in cases in which a patient is already undergoing counseling or treatment.
Populations for Valid and Invalid Use
The test served as a self-report assessment accurately demonstrating the severity of depression symptoms in each group. According to McPherson and Martin (2010), the test shows 80% of the alcohol-dependent population have co-morbidities including depression. The BDI-II is useable for alcohol-dependent populations with the caveat that more research on addictive and substance-dependent populations is necessary. Regarding the BDI-Y on the girl's group, the test is reliable and valid except for the group of seven to eight-year-old girls. Furthermore, the test was reliable and valid across the five ethnic groups represented in the study (Stapleton, Sander, & Stark, 2007). More research is necessary for the younger age group (ages seven to eight) to further examine reliability and validity. The BDI-II is a valid and reliable psychometric evaluation for measuring the presence and severity of depression and is designed for individuals over the age of 13. The BDI-Y is preferable for children under the age of 13, and as advised by Stapleton, Sander, & Stark (2007), caution should be used in children under the age of nine. Although more research is suggested for populations with substance dependency, the BDI-II is an accurate and reliable measure of depression's severity and its changes over time in a clinical setting.
According to Hersen (2004), there have not been adequate norms for diverse ethnic groups. The majority of psychometric studies on the BDI-II have used Caucasians. Although some population-specific norms have been created for the BDI, more appropriate norms for the variety of ethnic groups are needed (Hersen, 2004). Regarding the BDI-Y, Hersen (2004) claims there is insufficient published data on this inventory other than the reports contained in the test manual.
The BDI-II "has had an enduring legacy in psychiatry as a measure for depression" (McPherson & Martin, 2010, p. 27) and is effective for measuring depression and its changes over time (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Depression has a variety of co-morbidities, and the use of the BDI-II depends on contemporary empirical evidence supporting its use in a variety of populations. Research supports using the BDI in alcohol-dependent and other addictive groups (Buckley, Parker, & Heggie, 2001; McPherson & Martin, 2010; Sharp & Lipsky, 2001) and for young girls between the ages of nine and 13 from various ethnic backgrounds (Subramaniam, Harrell, & Huntley, 2009).
Beck, A.T., (1991). Cognitive therapy. American Psychologist, 46, 368-375
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561-571.
Beck, A.T. & Weishaar, M. (1989). Cognitive Therapy. Comprehensive Handbook of Cognitive Therapy. New York: Plenum
Buckley T.C., Parker J.D. & Heggie J. (2001) A psychometric evaluation of the BDI-II in treatment-seeking substance abusers. Journal of Substance Abuse Treatment 20, 197– 204.
Hersen, M. (2004). Comprehensive handbook of psychological assessment. Hoboken, NJ: Wiley.
Luty, J., & O'Gara, C. (2006). Validation of the 13-Item Beck Depression Inventory in alcohol- dependent people. International Journal of Psychiatry in Clinical Practice, 10(1), 45-51. doi: 10.1080/13651500500410117
McPherson, A. A., & Martin, C. R. (2010). A narrative review of the Beck Depression Inventory and implications for its use in an alcohol-dependent population. Journal of Psychiatric & Mental Health Nursing, 17(1), 19-30. Doi:10.1111/j.1365-2850.2009.01469.x
Polgar, M. (2011). Beck Depression Inventory. In Encyclopedia of Mental Disorders. Retrieved July 30, 2011, from http://www.minddisorders.com/A-Br/Beck-Depression-Inventory.html
Sharp, L. K., & Lipsky, M. S. (2001). Screening for depression across the lifespan: a review of measures for use in primary care settings. American Family Physician, 66(6), 1001-1008.
Smith, C., & Erford, B. T. (2001). Test review: Beck depression inventory - II. Association for Assessment in Counseling. Retrieved July 30, 2011, from http://aac.ncat.edu/newsnotes/y98fall.html
Stapleton, L. M., Sander, J. B., & Stark, K. D. (2007). Psychometric properties of the Beck
depression inventory for youth in a sample of girls. Psychological Assessment, 19(2), 230-235. doi: 10.1037/1040-35184.108.40.206
Subramaniam, G., Harrell, P., Huntley, E., & Tracy, M. (2009). Beck depression inventory for
depression screening in substance-abusing adolescents. Journal of Substance Abuse Treatment, 37(1), 25-31. doi: 10.1016/j.jsat.2008.09.008