BDI Intro
BDI Intro
BDI Intro
Depression is a common and serious medical illness that negatively affects how you feel, the
way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of
sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of
emotional and physical problems and can decrease your ability to function at work and at home.
Depression symptoms can vary from mild to severe and can include:
Symptoms must last at least two weeks and must represent a change in your previous level of
functioning for a diagnosis of depression.
Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic
symptoms of depression so it is important to rule out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people
(16.6%) will experience depression at some time in their life. Depression can occur at any time,
but on average, first appears during the late teens to mid-20s. Women are more likely than men
to experience depression. Some studies show that one-third of women will experience a major
depressive episode in their lifetime. There is a high degree of heritability (approximately 40%)
when first-degree relatives (parents/children/siblings) have depression.
Beck developed a cognitive explanation of depression which has three components: a) cognitive
bias; b) negative self-schemas; c) the negative triad.
a) Cognitive Bias
Beck found that depressed people are more likely to focus on the negative aspects of a situation,
while ignoring the positives. They are prone to distorting and misinterpreting information, a
process known as cognitive bias.
Beck detailed numerous cognitive biases, two of which include: over-generalisations and
catastrophising. For example, a depressed person may make over-generalisations, where they
make a sweeping conclusion based on a single incident, for example: ‘I’ve failed one end of unit
test and therefore I’m going to fail ALL of my AS exams!’ Alternatively, a depressed person
may experience catastrophising, where they exaggerate a minor setback and believe that it’s a
complete disaster, for example: ‘I’ve failed one end of unit test and therefore I am never going to
study at University or get a good job!’
b) Negative self-schemas
A schema is a ‘package’ of knowledge, which stores information and ideas about our self and the
world around us. These schemas are developed during childhood and according to Beck,
depressed people possess negative self-schemas, which may come from negative experiences, for
example criticism, from parents, peers or even teachers.
Beck claimed that cognitive biases and negative self-schemas maintain the negative triad, a
negative and irrational view of ourselves, our future and the world around us. For sufferers of
depression, these thoughts occur automatically and are symptomatic of depressed people.
The negative triad (pictured below) demonstrates these three components, including:
TYPES OF DEPRESSION
The four most common types of depression are major depression, persistent depressive disorder
(formerly known as dysthymia), bipolar disorder, and seasonal affective disorder.
Major depression- The classic depression type, major depression is a state where a dark mood is
all-consuming and one loses interest in activities, even ones that are usually pleasurable.
Symptoms of this type of depression include trouble sleeping, changes in appetite or weight, loss
of energy, and feeling worthless. Thoughts of death or suicide may occur. It is usually treated
with psychotherapy and medication. For some people with severe depression that isn't alleviated
with psychotherapy or antidepressant medications, electroconvulsive therapy may be effective.
Persistent depressive disorder- Formerly called "dysthymia," this type of depression refers to low
mood that has lasted for at least two years but may not reach the intensity of major depression.
Many people with this type of depression type are able to function day to day, but feel low or
joyless much of the time. Other depressive symptoms may include appetite and sleep changes,
low energy, low self-esteem, or hopelessness.
Seasonal affective disorder (SAD)- This type of depression emerges as days get shorter in the
fall and winter. The mood change may result from alterations in the body's natural daily rhythms,
in the eyes' sensitivity to light, or in how chemical messengers like serotonin and melatonin
function. The leading treatment is light therapy, which involves daily sessions sitting close to an
especially intense light source. The usual treatments for depression, such as psychotherapy and
medication, may also be effective.
Although women are at higher risk for general depression, they are also at risk for two different
depression types that are influenced by reproductive hormones—perinatal depression and
premenstrual dysphoric disorder (PMDD).
1. Perinatal depression. This type of depression includes major and minor depressive
episodes that occur during pregnancy or in the first 12 months after delivery (also known
as postpartum depression). Perinatal depression affects up to one in seven women who
give birth and can have devastating effects on the women, their infants, and their
families. Treatment includes counseling and medication.
2. PMDD. This type of depression is a severe form of premenstrual syndrome, or PMS.
Symptoms of PMDD usually begin shortly after ovulation and end once menstruation
starts. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and
sertraline (Zoloft), may reduce symptoms.
THEORETICAL APPROACHES TO DEPRESSION
Defective mood regulation by the brain, genetic vulnerability, stressful life events, drugs, and
medical conditions are all possible causes of depression. It’s also thought that some of these
Mood can be affected by a range of disorders and medicines, which can lead to depression.
Researchers looking for a biological explanation for unipolar illnesses have investigated a variety
of elements.
Genetic Factors: According to family studies, the prevalence of depression is two to three times
higher among blood relatives of those with clinically diagnosed unipolar depression than it is in
the general population. Twin studies which can provide much more conclusive evidence of
Neurophysiological factors: People with depression have reduced activity in the left hemisphere
of the brain’s prefrontal regions. Damage to the left side, but not the right, anterior prefrontal
Sleep and other biological rhythms: Patients who are depressed often show one or more of a
variety of sleep problems, ranging from early morning awakening, periodic awakening during
the night (poor sleep maintenance), and, for some, difficulty falling asleep. Research has also
Neurochemical Factors: Depression can also be caused by changes in the delicate balance or
depletion of neurotransmitter molecules (such as serotonin and norepinephrine) that regulate and
modulate the activity of the brain’s nerve cells. This depletion could come about through
impaired synthesis of these neurotransmitters in the presynaptic neuron, through increased
degradation of the neurotransmitters once they were released into the synapse, or through altered
Sex differences: For a small minority of women who are already at high risk, hormonal
fluctuations may trigger depressive episodes, possibly by causing changes in the normal
● Assuming responsibility for terrible occurrences but not for good events are examples of
● Believing that you know what people are thinking about you and that they are negatively
Loss: Loss is a common occurrence in people’s lives, and this can lead to despair. The loss of a
loved one through bereavement or separation, the loss of a job, the loss of a friendship, the loss
of a promotion, the loss of face, the loss of support, and so on are all examples of loss.
Sense of Failure: Some people may place a high value on attaining specific objectives, such as
receiving “As” on tests, landing a specific job, making a certain amount of profit from a business
venture, or finding a life mate. If they are unable to reach those goals for some reason, they may
believe that they have failed in some way, and it is this sense of failure that can sometimes lead
to depression.
Stress: Depression can be brought on by a series of stressful life experiences. Unemployment,
financial worries, substantial difficulties with a spouse, parents, or children, physical disease, and
Lack of Social Support and Social-Skills Deficits: People who are lonely, socially isolated, or
lacking social support are more vulnerable to becoming depressed and that individuals with
depression have smaller and less supportive social networks, which tends to precede the onset of
depression.
The Effects of Depression on Others: Depressive behavior can, and over time frequently does,
elicit negative feelings and rejection in other people, including strangers, roommates, and
spouses. Ultimately a downwardly spiraling relationship usually results, making the person with
Marriage and Family Life: A significant proportion of couples experiencing marital distress have
at least one partner with clinical depression. One possibility is that criticism perturbs some of
the neural circuitry that underlies depression. Even after full recovery, criticism may still be a
powerful trigger for those who are vulnerable to depression. Parental depression puts children at
Treatment Approaches
● Selective Inhibitors of Serotonin Recovery (SSRIs): These medicines are considered safer
than other types of antidepressants and usually produce fewer side effects. Blocks
etc.
● Atypical Antidepressants: These drugs do not fit into any other category of antidepressant
effective. Thus, tricyclics are not usually prescribed unless first tried to improve an SSRI.
● Monoamine oxidase inhibitors (MAOIs): A MAO-I can be prescribed, for example, when
other drugs have not worked because they may have severe side effects. These include
tranylcypromine (parnate), phenelzine (Nardil) etc. SSRIs cannot be combined with these
medications.
● Cognitive therapy: Monitor and identify automatic thoughts. Replacing negative thoughts
prevent relapse.
● Light Therapy: Exposure to artificial light that mimics natural light, to treat seasonal
The original BDI, first published in 1961, consisted of twenty-one questions about how
the subject has been feeling in the last week. Each question had a set of at least four possible
responses
According to Beck's publisher, 'When Beck began studying depression in the 1950s, the
prevailing psychoanalytic theory attributed the syndrome to inverted hostility against the self.'
By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim
descriptions of their symptoms and then using these to structure a scale which could reflect the
inaccurate, and often intrusive negative thoughts about the self. In his view, it was the case that
Beck developed a triad of negative cognitions about the world, the future, and the self, which
play a major role in depression. An example of the triad in action taken from Brown (1995) is the
● The student has negative thoughts about the world, so he may come to believe he does
● The student has negative thoughts about his future because he thinks he may not pass the
class.
● The student has negative thoughts about himself, as he may feel he does not deserve to be
in college
The BDI-II was a 1996 revision of the BDI, developed in response to the American
Disorder.
Items involving changes in body image, hypochondriasis, and difficulty working were
replaced. Also, sleep loss and appetite loss items were revised to assess both increases and
decreases in sleep and appetite. All but three of the items were reworded; only the items dealing
with feelings of being punished, thoughts about suicide, and interest in sex remained the same.
Finally, participants were asked to rate how they have been feeling for the past two weeks, as
The BDI-II contains 21 items on a 4-point scale from 0 (symptom absent) to 3 (severe
symptoms). The 21 depressive symptoms and attitudes chosen by Beck et al. (1961) for inclusion
in the BDI were based on the verbal descriptions by patients and were not selected to reflect any
particular theory of depression. These items were (1) Mood, (2) Pessimism, (3) Sense of Failure,
(4) Self-Dissatisfaction (anhedonia), (5) Guilt, (6) Punishment, (7) Self-Dislike, (8) Self-
Accusations, (9) Suicidal Ideas, (10) Crying, (11) Irritability, (12) Social Withdrawal, (13)
Indecisiveness, (14) Body Image Change, (15) Work Difficulty, (16) Insomnia, (17) Fatigability,
(18) Loss of Appetite, (19) Weight Loss, (20) Somatic Preoccupation, and (21) Loss of Libido.
So in summary, in the revised version the respondent must recall, based on the previous two
weeks, the relevance of each statement relating to: sadness, pessimism, sense of failure, loss of
insomnia, irritability, loss of appetite, preoccupation, fatigue, and loss of interest in sex (Beck &
Steer, 1988).
Plan
To measure the severity of depression in adults and adolescents aged 13 years and older.
Materials
2. Norms
3. Writing material
Procedure
The subject is seated comfortably. The subject is given a copy of Beck’s Depression Inventory
and is asked to read each statement carefully and is asked to respond to each statement by
circling the statement that best describes the subject. The subject’s responses need to be scored
and interpreted.
Scoring
Each of the 21 items corresponding to a symptom of depression is summed to give a single score
for the Beck Depression Inventory-II (BDI-II). There is a four-point scale for each item ranging
from 0 to 3. On two items (16 and 18) there are seven options to indicate either an increase or
decrease of appetite and sleep. Cut-off score guidelines for the BDI-II are given with the
recommendation that thresholds be adjusted based on the characteristics of the sample, and the
purpose for use of the BDI-II. Total score of 0–13 is considered a minimal range, 14–19 is mild,
One measure of an instrument's usefulness is to see how closely it agrees with another similar
instrument that has been validated against information from a clinical interview by a trained
clinician. In this respect, the BDI-II is positively correlated with the Hamilton Depression Rating
Reliability
The test was also shown to have a high one-week test–retest reliability (Pearson r =0.93),
suggesting that it was not overly sensitive to daily variations in mood. The test also has high
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