• One of the most widely used screening instruments for measuring the severity of depression in adults and adolescents.
  • Self-report inventory composed of items relating to depressive symptoms (hopelessness and irritability), cognitions (guilt or feelings of being punished), and physical symptoms (fatigue, weight loss, and lack of interest in sex).
  • The BDI can be used with, but is not limited to, persons with SCI.

Clinical Considerations

  • Several somatic symptoms included in the BDI are common in SCI and may be confused with symptoms of depression. Therefore, BDI score may be artificially inflated among SCI patients, representing higher levels of depression than is actually the case.
  • The BDI is quick and easy to administer but you should be aware of any physical limitations that may affect scores.

ICF Domain

Body Function ▶ Mental Functions

Administration

  • Patient-reported; patient reads the scale and marks the statements that have been true during the past week.
  • Each item consists of 4 statements that range from a mild/neutral (mild=0) to severe (severe=3).
  • Completion of the BDI is normally approximately 10 minutes, though completion time may vary due to patient’s level of depression.

Number of Items

21

Equipment

None

Scoring

Items are summed such that the measure’s total score is between 0 – 63.

Languages

English, Arabic, Chinese, Japanese, Farsi, and many European languages

Training Required

Does not require advanced training

Availability

Can be found here.

# of studies reporting psychometric properties: 4

Interpretability

  • Higher scores reflect more symptoms of depression
  • No normative data have been established for the SCI population
  • Standard cut-off (from Beck et al. 1998)  for the general population are as follows:

0-9: indicates minimal depression
10-18: indicates mild depression
19-29: indicates moderate depression
30-63: indicates severe depression

  • Published data for the SCI population is available for comparison (see the Interpretability section of the Research Summary).

MCID: not established in SCI population
SEM: not established in SCI population
MDC: not established in SCI population

Reliability

Moderate Internal Consistency:

α = 0.85

(Soler et al. 2013: Spanish version, n=126, 78 males; mixed injury types; mean (SD) time since injury = 11.8 (10.8) years)

Validity

Low to Moderate correlation with SF-36 Domains:

General Health = -0.229

Vitality = -0.329

Social functioning = -0.283

Mental health = -0.247

(Ataoglu et al. 2015: n = 140, 104 males; mixed injury types; inpatient; mean (SD) time since injury = 25.2 (43.9) months)

Low correlation with Wheelchair Outcome Measure (WhOM):

WhOM mean Sat= -0.220
WhOM mean Sat x Imp= -0.262

(Alimohammad et al. 2016: N=75 with SCI; no info on injury type; Farsi speakers, wheelchair as primary mobility device; mean (SD) time post-SCI = 60 (61) months)

Moderate correlation with Functional Independence Measure (FIM):

Correlation = -0.486

(Koca et al. 2014: n=44, 29 males; mixed injury types; outpatient; mean (SD) time since injury=31.2(4.7) months)

Moderate correlation with Spinal Cord Injury Lifestyle Scale (SCILS):
r = -0.45

Moderate correlation with Health Behaviour Questionnaire (HBQ):
r = -0.33

(Shabany et al. 2018: N=97 traumatic SCI (77 males); age range: 26+; 79.4% paraplegia, 20.6% tetraplegia; 61.9% complete injury, 38.1% incomplete injury)

Responsiveness

Not established in SCI

Floor/Ceiling Effect

Not established in SCI

Reviewers

Dr. Ben Mortenson, Jeremy Mak, John Zhu, Gita Manhas

Date Last Updated

20 July 2020

Alimohammad S, Parvaneh S, Ghahari S, Saberi H, Yekaninejad MS, Miller WC. Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury. Disabil Health J. 2016;9(2):265-71.
http://www.ncbi.nlm.nih.gov/pubmed/26586171

Ataoğlu E, Tiftik T, Kara M, Tunç H, Ersöz M, Akkuş S. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord. 2013;51(1):23-6.
http://www.ncbi.nlm.nih.gov/pubmed/22547044

Beck AT, Ward CH, Mendelsohn M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 1961; 4: 561-571.
http://www.ncbi.nlm.nih.gov/pubmed/13688369

Chan RCK, Lee PWH, Lieh-Mak F. Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting. Spinal Cord, 2000; 38: 687-696.
http://www.ncbi.nlm.nih.gov/pubmed/11114777

Kendall PC, Hollon SD, Beck AT, Hammen CL, Ingram RE. Issues and recommendations regarding use of the Beck Depression Inventory. Cognitive Ther Res. 1987; 11(3): 289-99
http://link.springer.com/article/10.1007/BF01186280

Koca I, U­çar M, Unal A, Tutoğlu, Boyaci A, BülBül F, Karakuş V, Gür A. Anxiety and depression level and related factors in patients with spinal cord injury. Acta Medica Mediterr. 2014; 30: 291-295.
http://www.actamedicamediterranea.com/year.php?y=2014

Metcalfe M, Goldman E. Validation of an inventory for measuring depression. Br J Psychiatry, 1965; 111: 240-242.
http://www.ncbi.nlm.nih.gov/pubmed/14288071

Radnitz CL, McGrath RE, Tirch DD, Willard J, Perez-Strumolo L, Festa J, Binks M, Broderick CP, Schlein IS, Walczak S, Lillian LB. Use of the Beck Depression Inventory in Veterans with Spinal Cord Injury. Rehabilitation Psychology 1997; 42(2): 93-101.
http://psycnet.apa.org/journals/rep/42/2/93/

Salkind MR. Beck depression inventory in general practice J R Coll Gen Pract 1969; 18: 267-271.
http://www.ncbi.nlm.nih.gov/pubmed/5350525

Shabany M, Nasrabadi AN, Rahimi-Movaghar V, Mansournia MA, Mohammadi N, Pruitt SD. Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behaviour questionnaire in persons with spinal cord injury. Spinal Cord 2018; 56:509-515. https://pubmed.ncbi.nlm.nih.gov/29335476/

Soler MD, Cruz-almeida Y, Saurí J, Widerström-noga EG. Psychometric evaluation of the Spanish version of the MPI-SCI. Spinal Cord. 2013;51(7):538-52.
http://www.ncbi.nlm.nih.gov/pubmed/23608807

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