Discriminability of the Beck Depression Inventory and its Abbreviations in an Adolescent Psychiatric Sample

Variable	Males	Females	Total
Participants	202	550	752
Age, mean	16.74	16.47	16.55
Age, SD	1.67	1.62	1.64
Major depressive disorder	84 (42%)	294 (53%)	378 (50%)
Dysthymia	24 (12%)	87 (16%)	111(15%)
Other depressive disorder	7 (3.5%)	29 (5%)	36 (5%)
Exclusion diagnosis	6 (3%)	61 (11%)	67 (9%)

[i] SCID = Structured Clinical Interview for DSM-IV; SD = Standard deviation. Note: an individual may have diagnoses in more than one category. Exclusion diagnoses: psychotic disorders other than major depressive disorder (MDD) with psychotic features, bipolar disorder, and cyclothymic disorder

Flow diagram of participants based on the primary diagnostic categorization (MDD vs. no depression). Note: MDD vs. no depression diagnosis refers to the main comparison categorization used in the analysis. For more details, see Methods section: Research Diagnoses.

TABLE 2.

BDI sum score distributions by version and diagnostic category.

Condition*	Version	Diagnosis +			Diagnosis −			Brunner–Munzel test		Stochastic Superiority
Condition*	Version	n	M	SD	n	M	SD	Statistic	p	Estimate	CI
MDD vs. no depr.	BDI-1A	351	30.22	9.64	239	12.13	9.49	31.7	< 0.001	0.902	[0.88, 0.93]
MDD vs. no depr.	BDI-SF	359	20.24	6.60	243	7.75	6.56	32.3	< 0.001	0.902	[0.88, 0.93]
MDD vs. no depr.	BDI-PC	361	11.58	3.91	245	4.54	3.91	29.5	< 0.001	0.892	[0.87, 0.92]
MDD vs. no depr.	BDI-6	368	10.02	3.04	246	4.00	3.29	32.7	< 0.001	0.899	[0.88, 0.92]
Depr. vs. none	BDI-1A	389	29.13	10.04	239	12.13	9.49	28.3	< 0.001	0.884	[0.86, 0.91]
Depr. vs. none	BDI-SF	397	19.53	6.87	243	7.75	6.56	28.7	< 0.001	0.885	[0.86, 0.91]
Depr. vs. none	BDI-PC	399	11.20	4.03	245	4.54	3.91	26.8	< 0.001	0.876	[0.85, 0.90]
Depr. vs. none	BDI-6	406	9.74	3.12	246	4.00	3.29	29.8	< 0.001	0.886	[0.86, 0.91]
MDD vs. no MDD	BDI-1A	351	30.22	9.64	275	13.04	9.55	30.7	< 0.001	0.892	[0.87, 0.92]
MDD vs. no MDD	BDI-SF	359	20.24	6.60	279	8.42	6.63	30.9	< 0.001	0.891	[0.87, 0.92]
MDD vs. no MDD	BDI-PC	361	11.58	3.91	281	4.95	3.96	28.1	< 0.001	0.880	[0.85, 0.91]
MDD vs. no MDD	BDI-6	368	10.02	3.04	282	4.40	3.35	30.2	< 0.001	0.883	[0.86, 0.91]

[i] MDD = Major Depressive Disorder; BDI-IA= Beck Depression Inventory (revised version); BDI-SF = Beck Depression Inventory – Short Form; BDI-PC = Beck Depression Inventory for Primary Care; BDI-6 = Beck Depression Inventory-6; MDD = Major Depressive Disorder; Depr = Depression; M = Mean; SD = Standard deviation; P = P-value; CI = Confidence interval.

[ii] Note: Missingness of BDI responses was minimal, with only 85 responses of the 752 respondents missing (0.5%).

[iii] Note: *Condition refers to the comparison categorizations used in the analysis.

[iv] For more details, see Methods section 2.2.1: Research Diagnoses.

TABLE 3.

Version membership and standardized one-factor model parameters of BDI-IA items

Item	Content	Item included in version			Factor loading	Item thresholds
Item	Content	BDI-SF	BDI-PC	BDI-6	Factor loading	1	2	3
1	Mood	✓	✓	✓	0.80	−0.51	0.64	1.52
2	Pessimism	✓	✓	–	0.75	−0.83	0.25	1.12
3	Sense of failure	✓	✓	–	0.84	−0.74	0.45	1.11
4	Lack of satisfaction	✓	✓	–	0.83	−0.55	0.44	1.46
5	Guilty feeling	✓	–	✓	0.88	−0.46	0.28	1.00
6	Sense of punishment	–	–	–	0.65	0.07	0.74	1.27
7	Negative self-view	✓	✓	–	0.84	−0.69	0.32	0.96
8	Self-accusations	–	✓	–	0.81	−0.90	−0.21	0.31
9	Self-destructiveness	✓	✓	–	0.70	−0.68	1.12	2.11
10	Crying	–	–	–	0.71	−0.48	0.26	0.69
11	Irritability	–	–	✓	0.66	−0.92	0.32	1.31
12	Social withdrawal	✓	–	–	0.74	−0.36	0.64	1.82
13	Indecisiveness	✓	–	✓	0.75	−0.68	0.05	1.60
14	Negative body image	✓	–	–	0.73	−0.13	0.36	0.63
15	Work inhibition	✓	–	✓	0.71	−0.91	−0.03	1.49
16	Sleep disturbance	–	–	–	0.56	−0.67	0.81	1.34
17	Fatigability	✓	–	✓	0.78	−0.78	0.08	1.26
18	Loss of appetite	✓	–	–	0.58	−0.05	0.73	1.54
19	Weight loss	–	–	–	0.24	0.68	1.19	1.73
20	Somatic preoccupation	–	–	–	0.42	0.25	1.48	1.93
21	Loss of libido	–	–	–	0.58	0.20	0.93	1.62

TABLE 4.

Diagnostic test results, MDD vs. no depressive disorder, mean score cut-off equivalent to BDI-1A sum ≥ 16.

Version	Items	Mean cut-off	AP	Confusion matrix					Basic ratios			κ	Diagnostic odds ratio		Number needed to diagnose		Global test		Individual test adjusted p-values
Version	Items	Mean cut-off	AP	TP	FP	FN	TN	Sens.	Spec.	PPV	NPV	κ	DOR	95% Cl	NND	95% Cl	Stat.	Adj. p	Sens.	Spec.
BDI-1A	21	0.76	71%	350	89	23	160	0.938	0.643	0.797	0.874	0.608	27.36	[16.67, 44.89]	1.72	[1.51, 2.05]	–	–	–	–
BDI-SF	13	0.82	69%	348	84	25	165	0.933	0.663	0.806	0.868	0.620	27.34	[16.86, 44.34]	1.68	[1.48, 1.99]	2.22	0.329	–	–
BDI-PC	7	0.86	72%	354	95	19	154	0.949	0.618	0.788	0.890	0.598	30.20	[17.82, 51.19]	1.76	[1.54, 2.10]	3.12	0.211	–	–
BDI-6	6	1.00	69%	349	81	24	168	0.936	0.675	0.812	0.875	0.634	30.16	[18.45, 49.29]	1.64	[1.45, 1.93]	2.36	0.307	–	–

[i] Mean cut-off = smallest mean score yielding a positive test; AP = apparent prevalence; TP = true positives; FP = false positives; FN = false negatives; TN = true negatives; Sens. = sensitivity; Spec. = specificity; PPV/NPV = positive/negative predictive value; κ = Cohen's kappa; Global test = joint comparison of sensitivity and specificity against the BDI-1A in this condition; Stat. = test statistic; Adj. p = adjusted p-value

TABLE 5.

Diagnostic test results, MDD vs. no depressive disorder, factor score cut-off equivalent to BDI-1A sum ≥ 16.

Version	Items	Factor score cut-off	AP	Confusion matrix					Basic ratios			κ	Diagnostic odds ratio		Number needed to diagnose		Global test		Individual test adjusted p-values
Version	Items	Factor score cut-off	AP	TP	FP	FN	TN	Sens.	Spec.	PPV	NPV	κ	DOR	95% Cl	NND	95% Cl	Stat.	Adj. p	Sens.	Spec.
BDI-1A	21	−0.35	70%	350	85	23	164	0.938	0.659	0.805	0.877	0.623	29.36	[17.87, 48.24]	1.68	[1.48, 1.98]	2.70	0.250	–	–
BDI-SF	13	−0.33	70%	350	85	23	164	0.938	0.659	0.805	0.877	0.623	29.36	[17.87, 48.24]	1.68	[1.48, 1.98]	1.34	0.512	–	–
BDI-PC	7	−0.32	71%	350	90	23	159	0.938	0.639	0.795	0.874	0.604	26.88	[16.39, 44.09]	1.73	[1.52, 2.06]	0.04	0.980	–	–
BDI-6	6	−0.35	70%	350	86	23	163	0.938	0.655	0.803	0.876	0.619	28.84	[17.56, 47.37]	1.69	[1.48, 2.00]	0.36	0.835	–	–

Sample-optimal cut-offs for the main diagnostic condition, MDD vs. no depression diagnosis, criterion Cohen's kappa, all participants together.

Sample-optimal cut-offs for the main diagnostic condition, MDD vs. no depression diagnosis, criterion Cohen's kappa, by gender.

BDI mean scores versus factor scores with fit lines. Note: The higher and lower horizontal cut-off lines correspond to BDI-IA sums 16 and 11, respectively, and the factor score cut-offs to the matched sensitivities.

TABLE 6.

Optimal cut-off results.

BDI version	Optimization criterion	Subgroup	Optimal cut-off	κ	Sensitivity	Specificity	AUC	DOR	NND
BDI-1A	Cohen's kappa	-	0.89	0.638	0.895	0.731	0.902	–	1.60
BDI-SF	Cohen's kappa	-	1.01	0.619	0.845	0.775	0.903	–	1.61
BDI-PC	Cohen's kappa	-	1.10	0.634	0.861	0.771	0.893	–	1.58
BDI-6	Cohen's kappa	-	1.04	0.615	0.866	0.743	0.900	–	1.64
BDI-1A	Cohen's kappa	Male	0.86	0.682	0.821	0.860	0.910	–	1.47
BDI-1A	Cohen's kappa	Female	0.90	0.611	0.927	0.654	0.896	–	1.72
BDI-SF	Cohen's kappa	Male	0.79	0.629	0.869	0.763	0.912	–	1.58
BDI-SF	Cohen's kappa	Female	1.07	0.597	0.886	0.699	0.896	–	1.71
BDI-PC	Cohen's kappa	Male	1.01	0.646	0.738	0.903	0.893	–	1.56
BDI-PC	Cohen's kappa	Female	1.12	0.605	0.896	0.692	0.890	–	1.70
BDI-6	Cohen's kappa	Male	0.95	0.650	0.857	0.796	0.895	–	1.53
BDI-6	Cohen's kappa	Female	1.14	0.623	0.910	0.692	0.899	–	1.66
BDI-1A	Misclassification cost 1:1	-	0.86	0.638	0.895	0.731	0.902	–	1.60
BDI-SF	Misclassification cost 1:1	-	0.89	0.606	0.893	0.699	0.903	–	1.69
BDI-PC	Misclassification cost 1:1	-	1.05	0.634	0.861	0.771	0.893	–	1.58
BDI-6	Misclassification cost 1:1	-	1.02	0.615	0.866	0.743	0.900	–	1.64
BDI-1A	Misclassification cost 1:3	-	0.62	0.599	0.962	0.602	0.902	–	1.77
BDI-SF	Misclassification cost 1:3	-	0.68	0.611	0.979	0.594	0.903	–	1.75
BDI-PC	Misclassification cost 1:3	-	0.72	0.594	0.949	0.614	0.893	–	1.77
BDI-6	Misclassification cost 1:3	-	0.74	0.565	0.957	0.574	0.900	–	1.88

[i] κ = Cohen's kappa; AUC = Area under the curve; DOR = Diagnostic odds ratio; NND = Number needed to diagnose

Articles in this issue

DOI: https://doi.org/10.2478/sjcapp-2025-0002 | Journal eISSN: 2245-8875

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Language: English

Page range: 9 - 21

Published on: Apr 25, 2025

Published by: Center for Evidence-based Psychiatry

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© 2025 Fatemeh Seifi, Sebastian Therman, Tommi Tolmunen, published by Center for Evidence-based Psychiatry
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Volume 13 (2025): Issue 1 (January 2025)

Discriminability of the Beck Depression Inventory and its Abbreviations in an Adolescent Psychiatric Sample

Figures & Tables

TABLE 1.

FIGURE 1.

TABLE 2.

TABLE 3.

TABLE 4.

TABLE 5.

FIGURE 2a.

FIGURE 2b.

Figure 3.

TABLE 6.

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