Running head: Beck Depression Inventory in Primary Care
Beck Depression Inventory in Primary Care
Angela Theobald
Fort Hays State University
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Beck Depression Inventory in Primary Care
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Beck Depression Inventory in Primary Care
The Beck Depression Inventory (BDI) is a screening tool used in many settings including
medical outpatients, long-term care facilities, and drug abuse treatment centers (McPherson &
Martin, 2010). Designed to evaluate depression symptoms, the BDI measures severity of
cognitive and somatic aspects of depression (Aalto, Elovainio, Kivimaki, Uutela, & Pirkola,
2012). Use of a depression screening tool within primary care is essential to holistic care, and
according to Aalto et al. (2012), it is suggested that 25-49 percent of primary care patients who
meet the criteria for depressive disorders go unrecognized and in particular, milder cases go
easily undetected. The current practice guidelines recommend increased screening and
diagnosing of depression disorders; hence, the BDI’s use has become popular.
History of the Beck Depression Inventory
Used more than any other self-report depression symptom questionnaire, the original BDI
was developed in 1961 to “provide quantitative assessment of the intensity of depression”
(Delisle, Beck, Ziegelstein, & Thombs, 2012; as cited in McPherson & Martin, 2010, p. 20).
Initially revised in 1979 and again in 1996, the BDI is available in computerized and card
versions and has been translated into many different languages (McPherson & Martin, 2010).
Useful in detecting depressive disorders in the general population, many studies support use of
the BDI in both psychiatric and non-psychiatric populations (Aalto et al., 2012; Delisle et al.,
2012). Originally validated in 1961 using psychiatric outpatients and college students, the BDI
is has since been well-established and validated in a variety of settings (Kjaergaard, Arfweson
Wang, Waterloo, & Jorde, 2014; McPherson & Martin, 2010).
Application of Parse’s Human Becoming Theory
Within the Human Becoming Theory, health is a lived experience and specifies that
human becoming occurs through assigning significance through experiences (Pilkington, 1999).
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Furthermore, the goal of nursing is through these experiences, from the person’s perspective and
can only be described by the person living the life (Pilkington, 1999). Because depression
cannot be measured in concrete terms such as lab values, the Beck Depression Inventory seeks to
define lived experiences, or quality of life, that are described within Parse’s Human Becoming
Theory. Parse’s theory calls for nurses to focus on quality of life from the patient perspective,
and that the nature of each situation is determined by the patient interpretation of one’s situation
(Edwards, 2000). Thus, the patient who experiences depression will interpret his or her situation
and life experience much differently than the patient who does not suffer from depression. The
provider views patient health by way of how a patient perceives quality of life, rather than a
model of health based on lab or diagnostic test results.
Beck Depression Inventory Explanation
Statements within the BDI questionnaire are framed around how a patient has felt within
the past two weeks, and severity of depression is grouped into four categories. The BDI provides
an indication into the nature of depression and is useful in clinical research of the causes of
depression (McPherson & Martin, 2010). It is important to note that the scale is not designed to
diagnose depression; therefore, more accurate methods are needed to confirm diagnosis (Aalto et
al., 2012). The BDI scale is derived from a clinical theory of depression and correlates well to
professional clinical judgement (McPherson & Martin, 2010). A subsequent version of the tool,
BDI-II, includes fewer somatic symptom items and elimination of response options in order to
reduce the effect of somatic symptoms on total scores (Delisle et al., 2012).
Research Application of Beck Depression Inventory
In a 25-year review of the scale, BDI screening factors has been consistently replicated
across population ranges (McPherson & Martin, 2010). In a study to evaluate standardized
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scales screening for major depressive episode in a healthy population, researchers found the
BDI-II to be an acceptable tool (Kjaergaard et al., 2014). In another study evaluating BDI use
with chronic heart failure patients, Lahlou-Laforet, Ledru, Niarra, & Consoli (2015) found high
validity of the BDI and further suggest that the tool could be used to examine the role of
depressive symptoms in CHF patients’ cardiac outcome. Lastly, evaluation of the BDI as an
effective screening tool in an alcohol-dependent population found the correlation coefficient and
internal consistency reliability consistently above recommended thresholds and researchers
concluded that the BDI would likely be a reliable and valid screening tool in this population
(McPherson & Martin, 2010).
Treatment and Education Associated with Abnormal Results
The literature has made clear the use of the BDI as a screening tool rather than a
diagnostic tool, differentiating its purpose in screening for versus diagnosis of depression.
Elevated BDI screening results should direct the provider to standardized diagnostic criteria,
such as those provided in the DSM-IV. Treatment of psychiatric conditions, including
depression, is an increasing responsibility of the primary care provider, with roughly one-third of
all treated patients with mental disorder receiving care solely through primary care settings
(Dunlop, Scheinberg, & Dunlop, 2013). To improve treatment and control costs related to
psychiatry referrals, care models and treatment guidelines have been developed to assist primary
care providers in management of psychiatric disorders. In summary, actively managing
treatment of depressive disorders through medication initiation, dose increases, switching
medications or adding treatment components are important in achieving remission (Dunlop,
Scheinberg, & Dunlop, 2013). The aforementioned tools support decision-making for primary
care providers in treatment of depression.
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References
Aalto, A. M., Elovainio, M., Kivimaki, M., Uutela, A. & Pirkola, S. (2012). The Beck
Depression Inventory in the general population: A validation study using the Composite
International Diagnostic Interview as the gold standard. Psychiatry Research, 197(1-2),
163-171.
Delisle, V. C., Beck, A. T, Ziegelstein, R. C, & Thombs, B. D. (2012). Symptoms of heart
disease or its treatment may increase Beck Depression Inventory scores in hospitalized
post-myocardial infarction patients. Journal of Psychosomatic Research, 73(3), 157-162.
Dunlop, B. W., Scheinberg, K., & Dunlop, A. L. (2013). Ten ways to improve the treatment of
depression and anxiety in adults. Mental Health in Family Medicine, 10(3), 175-181.
Edwards, S. D. (2000). Critical review of R. R. Parse’s The Human Becoming School of Thought.
A Perspective for Nurses and Other Health Professionals. Journal of Advanced Nursing,
31(1), 190-196.
Kjaergaard, M., Arfwedson Wang, C. E., Waterloo, K., & Jorde, R. (2014). A study of the
psychometric properties of the Beck Depression Inventory-II, the Montgomery and
Asberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale in a
sample from a healthy population. Scandinavian Journal of Psychology, 55(1), 83-89.
Lahlou-Laforet, K., Ledru, F., Niarra, R., & Consoli, S. M. (2015). Validity of Beck Depression
Inventory for the assessment of depressive mood in chronic heart failure patients. Journal
of Affective Disorders, 184(15), 256-260.
Beck Depression Inventory in Primary Care
McPherson, A. & Martin, C. R. (2010). A narrative review of the Beck Depression Inventory
(BDI) and implications for its use in an alcohol-dependent population. Journal of
Psychiatric and Mental Health Nursing, 17(1), 19-30.
Pilkington, F. B. (1999). An ethical framework for nursing practice: Parse’s Human Becoming
Theory. Nursing Science Quarterly, 12(1), 21-25.
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