Sunday, September 16, 2012
The Beck Depression Inventory -II (BDI-II) was created to determine the presence and severity of depressive symptoms. This assessment can be given during the initial assessment in counseling with the client. According to Whiston (2008) the quality of the initial meeting with a client is vital to the eventual success of therapy and durably impacts the whole of the counseling process. Choosing an appropriate assessment instrument in this introductory phase will definitively contribute to clients' expectations as well as the beginnings of case conceptualization (Whiston, 2008). The BDI-II is utilized when the client reports depressive symptoms or when such symptoms are apparent to the counselor.
The BDI-II coincides with the DSM-IV, which will allow for a specific diagnosis, which is often necessary for insurance purposes. It takes only 5-10 minutes so can easily be given during the first meeting with the client (Whiston, 2008). This is especially important when a client demonstrates severe depressive symptoms because of the increased risk of suicide. The BDI-II assesses twenty-one constructs including 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, changes in appetite, concentration difficulty, tiredness or fatigue, and loss of interest in sex (Beck, Steer, & Brown, 1961-1996).
The BDI-II asks 21 questions that are answered on a scale of 0-3, where 0 describes not having the symptom and 3 rates the symptom as severe. Higher scores represent more severe symptoms of depression. The ranges of scores for diagnostic purposes are 0-13 scores are interpreted as minimal depression; 14-19 scores indicate mild depression; scores of 20-28 indicate moderate depression; and scores of 29-63 indicate severe depression (Beck, Steer, Ball, & Ranieri, 1996).
When choosing an instrument during the initial assessment, Sedlacek (1994) described several issues that must be navigated, but perhaps the most significant is realizing no single assessment exists that will be fair and appropriate to all clients. Barring any additional severe distress or apparent immediate needs or acute symptoms, I would choose the BDI when the client presents with obvious depressive symptoms.
Following the guidelines of the American Counseling Association (ACA) (2005), assessments must consider clients' cultural contexts and be used in a way that benefits and supports clients' well-being. Furthermore, counselors must be fair and appropriate in their interpretation of any assessment, and always respect the clients' privacy (ACA, 2005).
Nuevo et al., (2009) found this assessment culturally sensitive (for the most part) in a five-country study. From previously learned material, it remains critical for counselors to implement any assessment, including the BDI-II in a way that is considerate of cultural contexts. For example, some people may respond negatively to the exploration of personal data (Stewart, 2002). When appropriate, counselors may implement the Culture Grid to familiarize themselves with the clients' beliefs, values, and worldviews, as well as understanding clients' diverse cultural aspects.
[Note: for more information and a visual presentation of Pedersen's (2001) Cultural Grid, please see: http://academic.marion.ohio-state.edu/dchristie/Peace%20Psychology%20Book_files/Chapter%2016%20-%20The%20Cultural%20Context%20of%20Peacemaking%20%28Pedersen%29.pdf].
Cultural affects must be taken into consideration prior to forming a holistic conceptualization for client concerns (Stewart, 2002). Furthermore, culturally competent counselors are aware of their own bias, and throughout the assessment process, make inferences that take such bias into account (Association for Multicultural Counseling and Development (AMCD), 1996). Given the increased awareness of cultural diversity in counseling practice, even in the initial exploration of client information, counselors should select an assessment that aligns with the cultural contexts and the background of the client (Association for Assessment in Counseling, 2003).
Nuevo, et al., (2009) demonstrated the BDI-II is reliable and valid for screening depression and its severity for a variety of cultural contexts. It is a valuable assessment tool for clients with depressive symptoms, although there may be caveats to its use in some diverse populations. Sashidharan, Pawlow, and Pettibone (2012) found the BDI-II valid with African Americans, even though the original sample measured predominantly Caucasian females. Utilizing any psychometric evaluation that does not consider the cultural context of the client, or is normed on a population unlike the client's may be inappropriate or even pathologizing. Although the sample for the BDI-II was large, it did not contain a representative number of participants from diverse populations (Sashidharan, Pawlow, & Pettibone, 2012).
American Counseling Association. (2005). ACA Code of Ethics. Retrieved from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx
Association for Multicultural Counseling and Development. (1996). AMCD multicultural counseling competencies. Retrieved from http://www.counseling.org/Resources/Competencies/Multcultural_Competencies.pdf
Association for Assessment in Counseling. (2003). Standards for multicultural assessment. Retrieved from http://aac.ncat.edu/Resources/documents/STANDARDS%20FOR%20MULTICULTURAL%20ASSESSMENT%20FINAL.pdf
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients. Journal of Personality Assessment, 67(3), 588-597. doi: 10.1207/s15327752jpa6703_13
Nuevo, R., Dunn, G., Dowrick, C., Vázquez-Barquero, J. L., Casey, P., Dalgard, O. S., ... Ayuso-Mateos, J. L. (2009). Cross-cultural equivalence of the Beck Depression Inventory: A five-country analysis from the ODIN study. Journal of Affective Disorders, 114(1-3), 156-162. doi: 10.1016/j.jad.2008.06.021
Pederson, P. B. (2001). Chapter 16: The cultural context of peacemaking. In Peace, conflict, and violence: Peace psychology for the 21st century. Retrieved September 9, 2012, from http://academic.marion.ohio-state.edu/dchristie/Peace%20Psychology%20Book_files/Chapter%2016%20-%20The%20Cultural%20Context%20of%20Peacemaking%20%28Pedersen%29.pdf
Sashidharan,, T., Pawlow,, L. A., & Pettibone, J. C. (2012). An examination of racial bias in the Beck Depression Inventory-II. Cultural Diversity and Ethnic Minority Psychology, 18(2), 203-209. doi: 10.1037/a0027689
Sedlacek, W. E. (1994). Issues in advancing diversity through assessment. Journal of Counseling and Development, 72, 549-553.
Stewart, J. B. (2002). Using the culture grid in culture-centered assessment. Guidance & Counseling, 18(1), 10-17.
Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning