Aaron T. Beck

Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation

Abstract Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDIs internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.

Screening depressed patients in family practice. A rapid technic.

Depression assumes many masks in general medical practice. Thus, diagnosis is often difficult and may be missed. To help identify the depressed patient, the physician can use a simple 13 item questionnaire that the patient can complete in about five minutes. Although the physician may have to probe further for a more precise evaluation of the level of depression, the questionnaire can indicate probable severity.

Issues and recommendations regarding use of the Beck Depression Inventory

Issues concerning use of the Beck Depression Inventory (BDI) for the self-report of depressive symptomatology are raised and considered. Discussion includes the stability of depression and the need for multiple assessment periods, specificity and the need for multiple assessment measures, and selection cut scores and the need for terminological accuracy. Recommendations for the continued use of the BDI, designed to facilitate the integration of diverse studies and improve research on self-reported depression, are provided.

Internal consistencies of the original and revised beck depression inventory

Studied internal consistencies of the 1961 and 1978 versions of the Beck Depression Inventory in two different samples of psychiatric patients. The alpha coefficient for the 598 inpatients and outpatients who were administered the 1961 version was .88, and the alpha coefficient for the 248 outpatients who were self-administered the 1978 version was .86. The patterns of corrected item-total correlations were also similar, and it was concluded that the internal consistencies of both versions were comparable.

An information processing model of anxiety: automatic and strategic processes.

A three-stage schema-based information processing model of anxiety is described that involves: (a) the initial registration of a threat stimulus; (b) the activation of a primal threat mode; and (c) the secondary activation of more elaborative and reflective modes of thinking. The defining elements of automatic and strategic processing are discussed with the cognitive bias in anxiety reconceptualized in terms of a mixture of automatic and strategic processing characteristics depending on which stage of the information processing model is under consideration. The goal in the treatment of anxiety is to deactivate the more automatic primal threat mode and to strengthen more constructive reflective modes of thinking. Arguments are presented for the inclusion of verbal mediation as a necessary but not sufficient component in the cognitive and behavioral treatment of anxiety.

Comparative Efficacy of Cognitive Therapy and Pharmacotherapy in the Treatment of Depressed Outpatients

Forty-one unipolar depressed outpatients were randomly assigned to individual treatment with either cognitive therapy (N =19)or imipramine (N =22).As a group, the patients had been intermittently or chronically depressed with a mean period of 8.8 years since the onset of their first episode of depression, and 75%were suicidal. For the cognitive therapy patients, the treatment protocol specified a maximum of 20 interviews over a period of 12 weeks. The pharmacotherapy patients received up to 250 mg/day of imipramine for a maximum of 12 weeks. Patients who completed cognitive therapy averaged 10.90 weeks in treatment; those in pharmacotherapy averaged 10.86 weeks. Both treatment groups showed statistically significant decreases in depressive symptomatology. Cognitive therapy resulted in significantly greater improvement than did pharmacotherapy on both a self-administered measure of depression (Beck Depression Inventory)and clinical ratings (Hamilton Rating Scale for Depression and Raskin Scale).Moreover, 78.9%of the patients in cognitive therapy showed marked improvement or complete remission of symptoms as compared to 22.7%of the pharmacotherapy patients. In addition, both treatment groups showed substantial decrease in anxiety ratings. The dropout rate was significantly higher with pharmacotherapy (8 Ss)than with cognitive therapy (1 S).Even when these dropouts were excluded from data analysis, the cognitive therapy patients showed a significantly greater improvement than the pharmacotherapy patients. Follow-up contacts at three and six months indicate that treatment gains evident at termination were maintained over time. Moreover, while 68%of the pharmacotherapy group re-entered treatment for depression, only 16%of the psychotherapy patients did so.

The Evolution of the Cognitive Model of Depression and Its Neurobiological Correlates

Although the cognitive model of depression has evolved appreciably since its first formulation over 40 years ago, the potential interaction of genetic, neurochemical, and cognitive factors has only recently been demonstrated. Combining findings from behavioral genetics and cognitive neuroscience with the accumulated research on the cognitive model opens new opportunities for integrated research. Drawing on advances in cognitive, personality, and social psychology as well as clinical observations, expansions of the original cognitive model have incorporated in successive stages automatic thoughts, cognitive distortions, dysfunctional beliefs, and information-processing biases. The developmental model identified early traumatic experiences and the formation of dysfunctional beliefs as predisposing events and congruent stressors in later life as precipitating factors. It is now possible to sketch out possible genetic and neurochemical pathways that interact with or are parallel to cognitive variables. A hypersensitive amygdala is associated with both a genetic polymorphism and a pattern of negative cognitive biases and dysfunctional beliefs, all of which constitute risk factors for depression. Further, the combination of a hyperactive amygdala and hypoactive prefrontal regions is associated with diminished cognitive appraisal and the occurrence of depression. Genetic polymorphisms also are involved in the overreaction to the stress and the hypercortisolemia in the development of depression--probably mediated by cognitive distortions. I suggest that comprehensive study of the psychological as well as biological correlates of depression can provide a new understanding of this debilitating disorder.

Neural mechanisms of the cognitive model of depression

In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model — biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas — have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Becks cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Becks cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.

Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care.

To ascertain how effective the Beck Depression Inventory for Primary Care (BDI-PC) was for differentiating medical inpatients who were and were not diagnosed with DSM-IV major depression disorders (MDD), this 7-item self-report instrument composed of cognitive and affective symptoms was administered to 50 medical inpatients along with the Depression subscale (HDS) from the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983, Acta Psychiatrica Scandinavica, 67, 361-370). The Mood Module from the Primary Care Evaluation of Mental Disorders (Spitzer et al., 1995, Prime-MD instruction manual updated for DSM-IV) was used to diagnose MDD. The internal consistency of the BDI-PC was high (alpha = 0.86), and it was moderately correlated with the HDS (r = 0.62, P < 0.001). The BDI-PC was not significantly correlated with sex, age, ethnicity, or type of medical diagnosis. A BDI-PC cut-off score of 4 and above yielded the maximum clinical efficiency with both 82% sensitivity and specificity rates. The clinical utility of the BDI-PC for identifying medical inpatients who should be evaluated for MDD is discussed.

Scale for suicide ideation: Psychometric properties of a self‐report version

A self-report version of the Scale for Suicide Ideation (SSI) was administered to 50 inpatients diagnosed with mixed DSM-III psychiatric disorders and 55 outpatients with affective disorders. The self-report SSI was written for both paper-and-pencil and computer administration. The correlations between the self-reported and clinically rated versions for both inpatients and outpatients were greater than .90, which suggests strong concurrent validity. The Cronbach coefficient alphas for the paper-and-pencil and computer versions were also in the .90s and indicated high internal consistency. Furthermore, the mean SSI scores of the computer version for both the inpatients and outpatients were higher than the mean SSI scores of the clinical ratings; the patients described more severe suicide ideation than clinicians reported.