A preliminary review of the Beck Depression Inventory-II (BDI-II) in veterans: Are new norms and cut scores needed?

Abstract

The Beck Depression Inventory-II (BDI-II) is used within the Veterans Health Administration (VHA) to measure depression symptom severity. This naturalistic study aimed to examine VHA-specific BDI-II use and establish normative data and psychometric properties. Initial BDI-II data for 152,260 individual veterans were extracted from preexisting medical records using the VA Informatics and Computing Infrastructure. BDI-II scores were compared against Beck, Steer, and Brown (1996)’s original sample, as well as across veteran subgroups. Exploratory and confirmatory factor analyses were also conducted. Similar to Beck et al.’s (1996) sample, the BDI-II was most frequently administered in outpatient psychiatric VHA settings, although it was also used in inpatient and medical settings. Veterans scored significantly higher on the BDI-II than the original comparison groups. This was true across diagnostic categories. The largest discrepancy was seen between nondepressed veterans and corresponding patients from the original sample (Cohen’s d = 1.34). Older veterans endorsed less severe levels of depression symptomatology. Additionally, a 2-factor model similar to Beck et al.’s (1996) original solution provided the best fit to the data. Veterans reported higher levels of somatic-affective symptoms than cognitive symptoms. Although potentially useful, the BDI-II requires further investigation in veterans. Standard cut scores are not recommended for use in this population when evaluating severity of depression. A cut score of 27 or higher best differentiated between veterans with and without mood disorders in the current sample. Treatment providers should also consider using BDI-II factor scores, rather than the total score, to measure depressive symptom change.

Measurement-based care and psychological assessment: Using measurement to enhance psychological treatment.

“…Reis, Namekata, Oehlert, and King (2020) conducted a study utilizing data from over 150,000 veterans who had taken the Beck Depression Inventory-II (BDI-II) with the purpose of establishing norms for a veteran population. Veterans were found to score significantly higher than norms from nonveteran populations and were found to endorse higher levels of somatic-affective symptoms than cognitive symptoms.…”

The unique association of posttraumatic stress disorder with hypertension among veterans: A replication of Kibler et al. (2009) using Bayesian estimation and data from the United States-Veteran Microbiome Project.

“…The BDI-II consists of 21 items and patients are asked to rate how much a symptom has bothered them in the past two weeks, with total scores ranging from 0 to 63 and higher scores reflective of more severe depressive symptoms (Beck et al, 1996). Initial validation of the measure categorized total scores from 14 to 19 as mild depression, 20 to 28 as moderate depression, and 29–63 as severe depression (Beck et al, 1996), although it should be noted that the BDI-II has been found to overestimate depressive symptom severity in medical populations and veterans (Brown et al, 2012; Reis et al, 2020).…”

Cross-cultural comparison of depressive symptoms on the Beck Depression Inventory-II, across six population samples

“…11,12 On the contrary, different cut-off points have been suggested for the studied subgroup in some study settings, such as a cut-off score of ≥27 to differentiate veterans with mood disorder. 13 In addition, population-based studies on the psychometric properties and validity of the BDI-II included a description of the distribution of the item scores of the BDI-II. 12,[14][15][16][17] However, there are few studies describing the distribution of symptoms in representative population-based samples.…”