BECK DEPRESSION INVENTORY (BDI)

The Beck Depression Inventory (BDI) is a series of questions developed to measure

the intensity, severity, and depth of depression in patients with psychiatric diagnoses. Its

long form is composed of 21 questions, each designed to assess a specific symptom

common among people with depression. A shorter form is composed of seven questions

and is designed for administration by primary care providers. Aaron T. Beck, a pioneer in

cognitive therapy, first designed the BDI.

Purpose

The BDI was originally developed to detect, assess, and monitor changes in

depressive symptoms among people in a mental health care setting. It is also used to detect

depressive symptoms in a primary care setting. The BDI usually takes between five and ten

minutes to complete as part of a psychological or medical examination.

Precautions

The BDI is designed for use by trained professionals. While it should be

administered by a knowledgeable mental health professional who is trained in its use and

interpretation, it is often self-administered.

Description

The BDI was developed in 1961, adapted in 1969, and copyrighted in 1979. A

second version of the inventory (BDI-II) was developed to reflect revisions in the Fourth

Edition Text Revision of the Diagnostic and Statistical Manual of Mental

Disorders ( DSM-IV-TR , a handbook that mental health professionals use to diagnose

mental disorders).

The long form of the BDI is composed of 21 questions or items, each with four

possible responses. Each response is assigned a score ranging from zero to three, indicating

the severity of the symptom. A version designed for use by primary care providers (BDI-

PC) is composed of seven self-reported items, each correlating to a symptom of major

depressive disorder experienced over the preceding two weeks.

Individual questions of the BDI assess mood, pessimism, sense of failure, self-

dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying,

irritability, social withdrawal, body image, work difficulties, insomnia , fatigue , appetite,

weight loss, bodily preoccupation, and loss of libido. Items 1 to 13 assess symptoms that

are psychological in nature, while items 14 to 21 assess more physical symptoms.

Content of the Questionnaire

This depression inventory can be self-scored.

1.) 0

1

2

3

I do not feel sad.

I feel sad.

I am sad all the time and I can't snap out of it.

I am so sad and unhappy that I can't stand it.

2.) 0

1

2

3

I am not particularly discouraged about the future.

I feel discouraged about the future.

I feel I have nothing to look forward to.

I feel the future is hopeless and that things cannot improve.

3.) 0

1

2

3

I do not feel like a failure.

I feel I have failed more than the average person.

As I look back on my life, all I can see is a lot of failures.

I feel I am a complete failure as a person.

4.) 0

1

2

3

I get as much satisfaction out of things as I used to.

I don't enjoy things the way I used to.

I don't get real satisfaction out of anything anymore.

I am dissatisfied or bored with everything.

5.) 0

1

2

3

I don't feel particularly guilty

I feel guilty a good part of the time.

I feel quite guilty most of the time.

I feel guilty all of the time.

6.) 0

1

2

3

I don't feel I am being punished.

I feel I may be punished.

I expect to be punished.

I feel I am being punished.

7.) 0

1

2

3

I don't feel disappointed in myself.

I am disappointed in myself.

I am disgusted with myself.

I hate myself.

8.) 0

1

2

I don't feel I am any worse than anybody else.

I am critical of myself for my weaknesses or mistakes.

I blame myself all the time for my faults.

3 I blame myself for everything bad that happens.

9.) 0

1

2

3

I don't have any thoughts of killing myself.

I have thoughts of killing myself, but I would not carry them out.

I would like to kill myself.

I would kill myself if I had the chance.

10.

)

0

1

2

3

I don't cry any more than usual.

I cry more now than I used to.

I cry all the time now.

I used to be able to cry, but now I can't cry even though I want to.

11.

)

0

1

2

3

I am no more irritated by things than I ever was.

I am slightly more irritated now than usual.

I am quite annoyed or irritated a good deal of the time.

I feel irritated all the time.

12.

)

0

1

2

3

I have not lost interest in other people.

I am less interested in other people than I used to be.

I have lost most of my interest in other people.

I have lost all of my interest in other people.

13.

)

0

1

2

3

I make decisions about as well as I ever could.

I put off making decisions more than I used to.

I have greater difficulty in making decisions more than I used to.

I can't make decisions at all anymore.

14.

)

0

1

2

3

I don't feel that I look any worse than I used to.

I am worried that I am looking old or unattractive.

I feel there are permanent changes in my appearance that make me look

unattractive

I believe that I look ugly.

15.

)

0

1

2

3

I can work about as well as before.

It takes an extra effort to get started at doing something.

I have to push myself very hard to do anything.

I can't do any work at all.

16.

)

0

1

I can sleep as well as usual.

I don't sleep as well as I used to.

2

3

I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.

I wake up several hours earlier than I used to and cannot get back to sleep.

17.

)

0

1

2

3

I don't get more tired than usual.

I get tired more easily than I used to.

I get tired from doing almost anything.

I am too tired to do anything.

18.

)

0

1

2

3

My appetite is no worse than usual.

My appetite is not as good as it used to be.

My appetite is much worse now.

I have no appetite at all anymore.

19.

)

0

1

2

3

I haven't lost much weight, if any, lately.

I have lost more than five pounds.

I have lost more than ten pounds.

I have lost more than fifteen pounds.

20.

)

0

1

2

3

I am no more worried about my health than usual.

I am worried about physical problems like aches, pains, upset stomach, or

constipation.

I am very worried about physical problems and it's hard to think of much

else.

I am so worried about my physical problems that I cannot think of anything

else.

21.

)

0

1

2

3

I have not noticed any recent change in my interest in sex.

I am less interested in sex than I used to be.

I have almost no interest in sex.

I have lost interest in sex completely.

Results

The sum of all BDI item scores indicates the severity of depression. The test is scored

differently for the general population and for individuals who have been clinically

diagnosed with depression. For the general population, a score of 21 or over represents

depression. For people who have been clinically diagnosed, scores from 0 to 9 represent

minimal depressive symptoms, scores of 10 to 16 indicate mild depression, scores of 17 to

29 indicate moderate depression, and scores of 30 to 63 indicate severe depression. The

BDI can distinguish between different subtypes of depressive disorders, such as major

depression and dysthymia (a less severe form of depression).

The BDI has been extensively tested for content validity, concurrent validity, and

construct validity. The BDI has content validity (the extent to which items of a test are

representative of that which is to be measured) because it was constructed from a

consensus among clinicians about depressive symptoms displayed by psychiatric patients.

Concurrent validity is a measure of the extent to which a test concurs with already existing

standards; at least 35 studies have shown concurrent validity between the BDI and such

measures of depression as the Hamilton Depression Scale and

the Minnesota Multiphasic Personality Inventory-D . Following a range of biological

factors, attitudes, and behaviors, tests for construct validity (the degree to which a test

measures an internal construct or variable) have shown the BDI to be related to medical

symptoms, anxiety, stress , loneliness, sleep patterns, alcoholism, suicidal behaviors, and

adjustment among youth.

Factor analysis, a statistical method used to determine underlying relationships

between variables, has also supported the validity of the BDI. The BDI can be interpreted as

one syndrome (depression) composed of three factors: negative attitudes toward self,

performance impairment, and somatic (bodily) disturbance.

The BDI has also been extensively tested for reliability, following established

standards for psychological tests published in 1985. Internal consistency has been

successfully estimated by over 25 studies in many populations. The BDI has been shown to

be valid and reliable, with results corresponding to clinician ratings of depression in more

than 90% of all cases.

Higher BDI scores have been shown in a few studies to be inversely related to

educational attainment; the BDI, however, does not consistently correlate with sex, race, or

age.

MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPI)

The Minnesota Multiphasic Personality Inventory, known as the MMPI, and its

revised second edition (MMPI-2) are psychological assessment instruments completed by

the person being evaluated, and scored and interpreted by the examiner. The clinician

evaluates the test taker's personal characteristics by comparing the test taker's answers to

those given by various psychiatric and nonpsychiatric comparison groups. By analyzing the

test taker's patterns of response to the test items, the examiner is able to draw some

tentative conclusions about the client's level of adaptation, behavioral characteristics, and

personality traits. The MMPI-2 is preferred to the older MMPI because of its larger and

more representative community comparison group (also referred to as the "normative"

group). The original version of the MMPI is no longer available from the publisher,

although some institutions continue to use old copies of it.

Purpose

The results of the MMPI-2 allow the test administrator to make inferences about the

client's typical behaviors and way of thinking. The test outcomes help the examiner to

determine the test taker's severity of impairment, outlook on life, approaches to problem

solving, typical mood states, likely diagnoses, and potential problems in treatment. The

MMPI-2 is used in a wide range of settings for a variety of procedures. The inventory is

often used as part of inpatient psychiatric assessments, differential diagnosis, and

outpatient evaluations. In addition, the instrument is often used by expert witnesses in

forensic settings as part of an evaluation of a defendant's mental health, particularly in

criminal cases. The MMPI has also been used to evaluate candidates for employment in

some fields, and in educational counseling.

Description

The MMPI-2 is composed of 567 true/false items. It can be administered using a

printed test booklet and an answer sheet filled in by hand, or by responding to the items on

a computer. For the person with limited reading skills or the visually impaired respondent,

the MMPI-2 items are available on audiotape. Although the MMPI-2 is frequently referred

to as a test, it is not an academic test with "right" and "wrong" answers. Personality

inventories like the MMPI-2 are intended to discover what the respondent is like as a

person. A number of areas are "tapped into" by the MMPI-2 to answer such questions as:

"Who is this person and how would he or she typically feel, think and behave? What

psychological problems and issues are relevant to this person?" Associations between

patterns of answers to test items and particular traits or behaviors have been discovered

through personality research conducted with the MMPI-2. The inventory items are not

arranged into topics or areas on the test. The areas of personality that are measured are

interspersed in a somewhat random fashion throughout the MMPI-2 booklet. Some

examples of true-or-false statements similar to those on the MMPI-2 are: "I wake up with a

headache almost every day"; "I certainly feel worthless sometimes"; "I have had peculiar

and disturbing experiences that most other people have not had"; "I would like to do the

work of a choir director."

The MMPI-2 is intended for use with adults over age 18; a similar test, the MMPI-A,

is designed for use with adolescents. The publisher produces the MMPI-2 in English and

Spanish versions. The test has also been translated into Dutch-Flemish, two French dialects

(France and Canada), German, Hebrew, Hmong, Italian, and three Spanish dialects (for

Spain, Mexico or United States).Current scale compositionClinical scales

Scale 1 (AKA the Hypochondriasis Scale): Measures a person's perception and preoccupation with their health and health issuesScale 2 (AKA the Depression Scale): Measures a person's depressive symptoms levelScale 3 (AKA the Hysteria Scale): Measures the emotionality of a personScale 4 (AKA the Psychopathic Deviate Scale): Measures a person's need for control or their rebellion against controlScale 5 (AKA the Femininity/Masculinity Scale): Measures a stereotype of a person and how they compare. For men it would be the Marlboro man, for women it would be June Cleaver or Donna ReedScale 6 (AKA the Paranoia Scale): Measures a person's inability to trustScale 7 (AKA the Psychasthenia Scale): Measures a person's anxiety levels and tendenciesScale 8 (AKA the Schizophrenia Scale): Measures a person's unusual/odd cognitive, perceptual, and emotional experiencesScale 9 (AKA the Mania Scale): Measures a person's energyScale 0 (AKA the Social Introversion Scale): Measures whether people enjoy and are comfortable being around other people.The original clinical scales were designed to measure common diagnoses of the era.

Number Abbreviation Description What is measuredNo. of items

1 Hs Hypochondriasis Concern with bodily symptoms 32

2 D Depression Depressive Symptoms 57

3 Hy HysteriaAwareness of problems and vulnerabilities

60

4 Pd Psychopathic DeviateConflict, struggle, anger, respect for society's rules

50

5 MF Masculinity/FemininityStereotypical masculine or feminine interests/behaviors

56

6 Pa ParanoiaLevel of trust, suspiciousness, sensitivity

40

7 Pt PsychastheniaWorry, Anxiety, tension, doubts, obsessiveness

48

8 Sc SchizophreniaOdd thinking and social alienation

78

9 Ma Hypomania Level of excitability 46

0 Si Social Introversion People orientation 69

Code types are a combination of the one, two or three (and according to a few authors even four), highest-scoring clinical scales (ex. 4, 8, 2, = 482). Code types are interpreted as a single, wider ranged elevation, rather than interpreting each scale individually.Validity scales

The validity scales in the MMPI-2 RF are minor revisions of those contained in the MMPI-2, which includes three basic types of validity measures: those that were designed to detect non-responding or inconsistent responding (CNS, VRIN, TRIN), those designed to detect when clients are over reporting or exaggerating the prevalence or severity of psychological symptoms (F, Fb, Fp, FBS), and those designed to detect when test-takers are under-reporting or downplaying psychological symptoms (L, K)). A new addition to the validity scales for the MMPI-2 RF includes an over reporting scale of somatic symptoms scale (Fs).

AbbreviationNew in version

Description Assesses

CNS 1 "Cannot Say" Questions not answered

L 1 Lie Client "faking good"

F 1 InfrequencyClient "faking bad" (in first half of test)

K 1 Defensiveness Denial/Evasiveness

Fb 2 Back F Client "faking bad" (in last half of test)

VRIN 2Variable Response Inconsistency

answering similar/opposite question pairs inconsistently

TRIN 2True Response Inconsistency

answering questions all true/all false

F-K 2 F minus Khonesty of test responses/not faking good or bad

S 2Superlative Self-Presentation

improving upon K scale, "appearing excessively good"

Fp 2 F-PsychopathologyFrequency of presentation in clinical setting

Fs 2 RFInfrequent Somatic Response

Overreporting of somatic symptoms

Content scalesTo supplement these multidimensional scales and to assist in interpreting the frequently seen diffuse elevations due to the general factor (removed in the RC scales)[31][32] were also developed, with the more frequently used being the substance abuse scales (MAC-R, APS, AAS), designed to assess the extent to which a client admits to or is prone to abusing substances, and the A (anxiety) and R (repression) scales, developed by Welsh after conducting a factor analysis of the original MMPI item pool.Dozens of content scales currently exist, the following are some samples:Abbreviation Description

Es Ego Strength Scale

OH Over-Controlled Hostility Scale

MAC MacAndrews Alcoholism Scale

MAC-R MacAndrews Alcoholism Scale Revised

Do Dominance Scale

APS Addictions Potential Scale

AAS Addictions Acknowledgement Scale

SOD Social Discomfort Scale

A Anxiety Scale

R Repression Scale

TPA Type A Scale

MDS Marital Distress Scale

PSY-5 scalesUnlike the Content and Supplementary scales, the PSY-5 scales were not developed as a reaction to some actual or perceived shortcoming in the MMPI-2 itself, but rather as an attempt to connect the instrument with more general trend in personality psychology. The five factor model of human personality has gained great acceptance in non-pathological populations, and the PSY-5 scales differ from the 5 factors identified in non-pathological populations in that they were meant to determine the extent to which personality disorders might manifest and be recognizable in clinical populations. The five components were labeled Negative Emotionality (NEGE), Psychoticism (PSYC), Introversion (INTR), Disconstraint (DISC) and Aggressiveness (AGGR).

Results

The true/false items are organized after scoring into validity, clinical, and content

scales. The inventory may be scored manually or by computer. After scoring, the

configuration of the test taker's scale scores is marked on a profile form that contrasts each

client's responses to results obtained by the representative community comparison group.

The clinician is able to compare a respondent's choices to those of a large normative

comparison group as well as to the results derived from earlier MMPI and MMPI-2 studies.

The clinician forms inferences about the client by analyzing his or her response patterns on

the validity, clinical and content scales, using published guidebooks to the MMPI-2. These

texts are based on results obtained from over 10,000 MMPI/MMPI-2 research studies.

In addition to the standard validity, clinical, and content scales, numerous additional

scales for the MMPI have been created for special purposes over the years by researchers.

These special supplementary scale scores are often incorporated into the examiner's

interpretation of the test results. Commonly used supplementary scales include the

MacAndrews Revised Alcoholism Scale, the Addiction Potential Scale, and the Anxiety

Scale. The clinician may also choose to obtain computerized reporting, which yields

behavioral hypotheses about the respondent, using scoring and interpretation algorithms

applied to a commercial database.

COCAINE ADDICTION SEVERITY TEST (CAST) & COCAINE ASSESSMENT PROFILE (CAP)The Cocaine Addiction Severity Test (CAST) and Cocaine Assessment Profile (CAP)

were used to assess alcohol, tobacco & other drug use.Purposes

1. For greater awareness regarding drug abuse and drug issues2. For earlier identification and resolution of problems3. Designed to gather valuable information about areas of client’s life that may

contribute to their substance-abuse problemsA. Cocaine Addiction Severity Test

1. Do you have trouble turning down cocaine when it is offered to you?

2. Do you tend to use up whatever supplies of cocaine you have on hand even though you try to save some for another time?

3. Have you been trying to stop using cocaine but find that somehow you always go back to it?

4. Do you go on cocaine binges for 24 hours or longer?

5. Do you need to be high on cocaine in order to have a good time?

6. Are you afraid that you will be bored or unhappy without cocaine?

7. Are you afraid that you will be less able to function without cocaine?

8. Does the sight, thought or mention of cocaine trigger urges and cravings for the drug?

9. Does the sight, thought or mention of cocaine trigger urges and cravings for the drug?

10. Do you sometimes feel an irresistible compulsion to use cocaine?

11. Do you feel psychologically addicted to cocaine?

12. Do you feel guilty and ashamed of using cocaine and like yourself less for doing it?

13. Have you been spending less time with "straight" people since you've been using more cocaine?

14. Are you frightened by the strength of your cocaine habit?

15. Do you tend to spend time with certain people or go to certain places because you know that cocaine will be available?

16. Do you use cocaine at work?

17. Do people tell you that your behavior or personality has changed even though they might not know it’s due to drugs?

18. Has cocaine led you to abuse alcohol or other drugs?

19. Do you ever drive a car while high on cocaine, alcohol, or other drugs?

20. Have you ever neglected any significant responsibilities at home or at work due to cocaine use?

21. Have your values and priorities been distorted by cocaine use?

22. Do you deal cocaine in order to support your use?

23. Would you be using even more cocaine if you had more money to spend on it or otherwise had greater access to the drug?

24. Do you hide your cocaine use from straight friends or filmily because you afraid of their reactions?

25. Have you become less interested in health-promoting activities (e.g. exercise, sports, diet, etc.) due to cocaine use?

26. Have you become less involved in your job or career due to cocaine use?

27. Do you find yourself lying and making excuses because cocaine use?

28. Do you tend to deny and downplay the severity of your cocaine problem?

29. Have you been unable to stop using cocaine even though you know that it is having negative effects in your life?

30. Has cocaine use jeopardized your job or career?

31. Do you worry whether you are capable of living a normal and satisfying life without cocaine?

32. Are you having financial problems due to cocaine use?

33. Are you having problems with your spouse or mate due to cocaine use?

34. Has cocaine use had negative effects on your physical health?

35. Is cocaine having a negative effect on your mood or mental state?

36. Has your sexual functioning been disrupted by cocaine use?

37. Have you become less sociable due to cocaine use?

38. Have you missed days of work due to cocaine use?

B. Cocaine Assessment Profile1. How long ago did you first try cocaine?

2. How did you use it the first time?

3. How long did you use cocaine on an "occasional" basis before your use became regular and intensified?

4. Have you ever freebased?

5. Have you ever injected cocaine?

6. Currently, what is your usual method of use?

7. On average, how many grams of cocaine do you use per week?

8. How much money do you spend on cocaine per week?

9. On average, how many days per week do you use cocaine?

10. Do you tend to go on "binges"? If yes, how long does the binge usually last? How many grams do you use during a typical binge?

11. In what types of situations do you usually use cocaine? (check all that apply)

Alone  At parties With other sexual partner   

With spouse/mate   At home

With friends At work

12. During what portion of the day do you usually use cocaine? (check all that apply)

Morning Evening

Afternoon Late Night

13. Since you first started using cocaine on a regular basis, what is the longest time you've been able to stop completely?

14. Check below any physical problems caused by your cocaine use:

Low energy    Hepatitis

Sleep problems Other infections

Hands tremble Heart "flutters"

Runny Nose Nausea

Nasal sores, bleeding    Chills

Sinus congestion Seizures with loss of consciousness

Headaches Excessive weight loss

Cough, sore throat Black phlegm

Chest congestions Others (describe)

15. Check below any negative effects of cocaine on your mood or mental state:

16. Check any negative effects of cocaine on you relationships with other people:

Caused relationship to break up Caused arguments with spouse/mate

Spouse/mate has threatened to leave Harmed sexual relationship

Became socially isolated and withdrawn

Harmed ability to talk openly and honestly with others

17. Check any negative effects of cocaine on your work or studies:

Arrive late to work/school    Spend too much time on breaks

Miss days of work/school Harmed relationship with boss

Reduced productivity at work/school    Got fired from a job

18. Check any negative effects of cocaine use on your financial situation:

Used up all money in bank    Unable to keep up with bills

Gotten in debt No extra money

19. Check any legal consequences of your cocaine use:

Arrested for possession or sale of cocaine

Arrested for other crime(s) related to cocaine sale/use

20. Has your cocaine use caused you to:

Have a car accident    Have an unwanted sexual encounter   

Physically hurt someone Have a physical fight with someone

Attempt suicide Deal drugs

Steal from work, family, or friends

Analysis (CAST)If you’re answer is YES to one or more question, you may have a problem with

cocaine, alcohol, and/or other mind-altering substances. Severity ratings are base on the following:

0-1 no real problem, treatment not indicated2-3 slight problem, treatment probably not necessary4-5 moderate problem, treatment necessary6-7 considerable problem, treatment necessary8-9 extreme problem, treatment absolutely necessary

*the severity ratings scale allows for the interviewer to determine the seriousness of a client’s problem. The higher the score is, the greater the need for treatment in each area or immediate intervention. *CAP is used only for the assessment on how a person uses and is affected by cocaine.

Resources

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th

edition, text revised. Washington, D.C.: American Psychiatric Association, 2000.

Beck, A. T., A. J. Rush, B. F. Shaw, and D. Emery. Cognitive therapy of depression. New York:

Guilford Press, 1979.

Butcher, J. N., W. G. Dahlstrom, J. R. Graham, A. Tellegen, and B. Kaemmer. MMPI-2: Manual

for Administration, Scoring and Interpretation. Revised. Minneapolis: University of

Minnesota Press, 1989.

Butcher, J. N. and C. L. Williams. Essentials of MMPI-2 and MMPI-A Interpretation. Revised.

Minneapolis: University of Minnesota Press, 1999.

Graham, John R. MMPI-2: Assessing Personality and Psychopathology. 3rd edition, revised.

New York: Oxford University Press, 2000.

Graham, John R., Yossef S. Ben-Porath, and John L. McNulty. MMPI-2: Correlates for

Outpatient Community Mental Health Settings. Minneapolis: University of Minnesota Press,

1999.