Custom «Beck Depression Inventory» Essay Paper

A description of the test and its purpose

Beck Depression Inventory Second Edition (BDH-II) test can be said to be a 21- item based self-report instrument test aiming at assessing the severity of the existing symptoms of depression. This is according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders in the Fourth Edition (American Psychiatric Association. 2000). BDI test’s main purposes include indexing symptoms of the severe depression requiring hospitalization. The new revised test was changed from BDI to BDI-1A due to changes in the items indicating both increase and decrease in the levels of sleep and appetites. Items labeled as body image, work difficulties, weight loss, and somatic preoccupation, were respectively replaced in the new BDI-1 items to agitation, concentration difficulties, and energy loss items respectively. Revision of BDI led to rewording of many statements, which later led to the development of BDI-II, which enabled the patients to consider the way every statement presented to them relates to their feelings for the past two weeks, providing accurate correspondence of DSM-IV criteria (Beck et al., 1961).

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What the test measures, its uses, and what the results mean

Each of the 21 items corresponds to a certain symptom of depression, which is summed up to give a single score for the BDI-II. BDI consists of the four point scales, ranging between 0 and 3. In the 16^th and 18^th items, BDI-II provides seven options to indicate either increase or decrease of both sleep and appetite. The cut score for sample, thus, is guided by the recommendations that begin the adjustments based on the sample characteristics and also the intended use of BDI-II. The total score ranging from 0 to 13 is considered to be the minimal range; from 14 to 19  is mild; from 20 to 28 is moderate; from 29 to 63 is severe. Mild effects involve fem symptoms that are in excess to make a BDI diagnosis present. The symptoms results to minor social impairment and occupational functioning. In moderate cases symptoms and functional impairment ranges from mild to severe, while in severe specifies excess symptoms are observed, resulting in impairments in both social and occupational functioning (American Psychiatric Association, 2000). BDI for the past 35 years has been used in order to identify and assess all depressive symptoms. The test has been reported to be highly reliable for all population variances, having a co-efficient alpha of 0.80 constructing its validity. This is because it’s able to detect the existing differences between depressed and non-depressed patients (Beck et al., 1961).

Validity and reliability of the test, citing studies

Validity is among the main objectives of BDI in conformance to close diagnosis criteria for depression, items added/removed, and rewording specific assesses of symptoms depression listed in DSM-IV reinforcing validity of the measure (Beck et al., 1961). Validity is basically enhanced in the two main areas: cross-cultural research and multilingual studies, which are translational instruments and assessment measurement procedures, respectively.

Cross cultural research applies instruments of the different languages in a single study. This research procedure arrived at the translation that gives an equivalent of a psychological perspective and methods evaluation of equivalence, as evident in Bracken & Barona, 1991; Brasin, 1980; Van de Vijver & Hambleton, 1996. Validity of multilingual studies is by use of instruments that were developed for a single language and cultural setting/successive development, making it more prevalent.

Norm groups and populations with whom the test should not be used

This BDI–II test should not be used with people aged 13 and less, but only with psychiatrically diagnosed adults and adolescents of 13 years of age and above (Beck et al., 1961). The test should also be excluded from the immigrant children, who, by chance, are unfamiliar or uncomfortable with the official language of their immediate host country. This is because they have a tendency of refusing to talk to strangers, who they find in their new environment; hence, cannot be used to diagnose the selective mutism. This selective mutism feature is more common for females than for their counterpart’s males. Moreover, the test should not be done performed on the individuals with pervasive developmental disorder, schizophrenia, or any other psychotic disorders or severe mental retardation, because they might have problems or be completely unable to speak appropriately in the social situations. The special case for selective mutism occurring in diagnosis of children takes place, when a child has an established capacity to speak appropriately in the social situations (American Psychiatric Association, 2000).

Your personal evaluation of the test and its uses

BDI test proves to be one of the world’s greatest discoveries among psychiatrics at all times. It has led to the development of many researches and studies including that of Alfier, Ruble & Higgins, 1996, where the supporting intensification of gender related characteristics in the early ages of adolescents is seen. This test has proven to be especially efficient in concern of the case studies solved by it.

The BDI test has helped in handling instances, where a patient is almost charged with the legal offences. In a case study of Brujeria, published in Puerto Rico, Celia Vega, aged 21, is a victim of mental disorder. She is brought by police to the emergency room of the city hospital in handcuffs and leg chains. The BDI test is conducted on her, in order to bring the understanding whether Ms. Vega was actually in her normal thinking or under mental distress during her actions. A psychiatrist attending to her does a test to make her open up and explain everything she can remember. The test is able to make Cecilia open up and share her shortcomings. Fortunately, at the end of the test, it’s revealed that she was a victim of rape at the tender age of 9, got married later at 14, and this has made her not even enjoy sex since then. She can only have sexual intercourse when on high drugs; moreover, now she is a parent of two children. She is faced with frequent nightmares, and has a depression after having an abortion in the past few months. She thinks she will be better off dead.

With the help of a psychiatrist, Ms. Vega’s situation about traumatic rape experiences is brought to light using BDI. Symptoms of Post-Traumatic Stress Disorder (PTSD) are later discovered, as seen of her having dreams and recollection during sex. PTSD makes her avoid sex, and unable to finish school; she could not keep a job and this has ruined her impersonal relationship with others (American Psychiatric Association, 2000). The patient is put under mental medical care and later discharged to stay with her sister under the care of a psychiatrist and help of social workers.

According to that case study, BDI has played a major role in restoring Ms. Vega’s lost conscious and making her life worth living again. The care she obtains after she shares her disturbing memories, as revealed by the test, guides the psychiatrist and social workers to offer her the best care and hope for restoration (Spitzer et al., 2002).

Any current research using this test. Cite at least three studies; if you did not locate any studies using this test, provide a rationale for the lack of research.

Based on BDI in 28 countries that have conducted a meta-analysis to determine why BDI has been used as an instrument to assess depression, it proved that depression has correlation to an individual and his country level, and the BDI score becomes negatively correlated with economic and political variables, as indicators of the societal equality.

In the PsycInfo, originally known as PsyLit reports, the keywords BDI, Beck, and depression are widely used in the period between 1960 and July 1999. Some data was found in Beck’s reports, where BDI and sample sizes were reported in his references, where data of the mean scores and BDI sample sizes were reported. There was also a consistency of mean and standard deviation of ages measured in Cronbach’s alpha.

Myers’ (1992) study showed that there exists a correlation between different countries in measuring demographic and psychological variables. Different countries have different levels of depressions, as it’s evident in Beck depression Inventory that he has investigated. His research found that equivalence of BDI scores across different levels examined could be compared to an individual level and his country due to the existing similarities. The only difference he found was the difference caused by both suicide rates and alcohol use, where wealthy countries were found to have higher levels of suicides.

In the Apostolou’s et al., 1999 study, the researchers used BDI to determine why different countries have different means, as it appeared in the three tables provided different standard deviation and values of Cronbach’s alpha for different versions of the BDI. They aggregated correlation between different BDI countries scores and the country characteristics to obtain weighted sample size that they standardized with each of the three data sets to form one total data set. Then the scores obtained were aggregated to each country level in order to obtain specific score per country. Political situations in some countries, like Israel, were said to contribute to the un-safety feelings and high depressions; thus, were eliminated to obtain a standard data set (Van Hemert et al., 2004). 

Uses of the instrument with culturally diverse individuals

The instruments are used to enhance further understanding of the under-lying nature of depression between different individuals in different populations. Their main objectives are to assess diagnostic efficiency of BDI in detecting Major Depressive Disorder (MMD), and to seek treatment sample of adolescence in Substance Use Disorder (SUD). The instruments are also used to assess BDI for its internal consistency, its factor structure, and any discriminant validity existing in the sample given. These instruments are used in procedures of using demographic instruments, structured interviews Diagnosis for Children & Adolescents-IV (DICA-IV) for all psychiatric disorders, and composite international diagnosis for Diagnosis and Statistical Manual of Mental Disorders (DSM) SUD and BDI instruments.

The instrument used for Diagnostic Instruments for Children and Adolescents-IV seeks to interview children (Reich et al., 2000), and at the same time to provide information on several lifetime and also to the current DSMV- IV axis I diagnosis. The instruments assess psychiatric disorders considering Attention-Deficit/Hyperactivity Disorder (ADHD), Major Depressive Episodes (MDE), Maniac Episodes, Generalized Anxiety Disorders (GAD), Post-Traumatic Stress Disorder (PTSD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) (Subramaniam et al., 2008).

Uses and abuses of the test

BDI- II is used to assess the severity of depression in psychiatrically diagnosed adults and adolescents of 13-years of age and above. It should not be used to serve purposes of diagnosis only, but to identify the presence of severity of symptoms, which are consistent with the criteria of DSM-IV.  

Abuses of this test can be seen especially in the cross cultural assessment. This is mostly in taxonomy of bias and equivalence (Van de Vijver et al., 1997), because most cross cultural researches use applications of different linguistic groups. The biases will occur, when the score differences on the indicator, if the questions asked to a patient, do not correspond his/her intellectual ability and his/her level of education. Also the test can be abused, if there are construct measured biases, which are not identical across all cultural groups. Another abuse of the BDI test can be said to occur in the filial piety situations. This is, when the test is only conducted on the individuals perceived to have behaviors of a good son or daughter. This can be a bias, since, as opposed to the Western societies, the Chinese society’s children have more and completely different obligations towards their parents. Such differences are mostly caused by education and income levels. Similarly, such value of children, as security, in the old age will tend to decrease with the levels of income. Therefore, there is a clear comparison of the filial piety across cultural populations; hence, very much susceptible to abuses (Vijver et al., 2004).

Instrument biases may also exist causing further biases. An example includes stimulus familiarity. This involved a test that was done to both Zambian and Scottish children in one condition, asked to sort miniature models of both animals and motor vehicles, and in another condition sought photographs of the two models. At the end of the test, no cross cultural test differences were realized, but the Scottish children gave a higher score than the Zambian children in sorting the photographs. Such a response procedure can as well induce bias in the test (Vijver et al., 2004).

Administration biases can also lead to abuse of the test. Improper communication between the interviewer and interviewee can easily lead to abuse. This is prone to the test, when either of them have different first languages and different backgrounds. Interviewee’s insufficient knowledge of the testing language, inappropriate modes of address, and cultural norms violation by an interviewer can cause poor quality data collection abusing the intended test goals/targets. This has devastating consequences on validity of cross cultural comparisons (Vijver et al., 2004).