The theoretical basis behind the BDI-II is to assess for symptoms of depression. More specifically the BDI-II was revised to improve the scale so that it matched the DSM (Ward, 2006). Professionals acknowledged that the original BDI was in need of a major revision for the assessment to remain current and valid for clinical use. Beck, Steer, Ball & Renieri (1996) states that Beck wanted to modify the assessment where it matched up with the DSM (Beck, Steer, Ball, & Ranieri, 1996). Another premise behind the BDI-II is that it is quick and easy to administer. It is not meant to be used as a primary diagnostic tool and it will not be the learner’s job to diagnose mental health disorders. The BDI-II is meant to give the clinician a better picture of where the clients’ symptoms are at and how severe they are.
The BDI-II was revised to allow clients to self-report on symptoms from the last 2 weeks. This assessment sought to improve on the original BDI by making adjustments to the instrument. There are numerous Beck assessments that are commonly used: Beck Anxiety Inventory (BAI), Beck Cognitive Insight Scale (BCIS), and the Beck Hopelessness Scale (BHS). The BDI-II has 21 questions or items, which is excellent in that it does not take too much time to administer. Kjergaard, Wang, Waterloo, & Jorde (2014) declares that the BDI-II was validated by using college students (Kjergaard, Wang, Waterloo, & Jorde, 2014). It is also translated in different languages. When the learner researched the Capella Library she did not find many studies analyzing the Spanish translation or other translations. The BDI-II might be used in clinical or hospital settings as well as community mental health settings. Another interesting aspect of the BDI-II is the questions can be read to the client if they have difficulty reading.
Ethical Considerations with Administering the BDI-II
We use the BDI-II to gain more information about the client, particularly in regards to depression symptoms. It is important to be qualified to administer the BDI-II and other assessments. Remley & Herlihy (2010) mandates that counselors should only give assessments that they are qualified to administer and should always make sure to not use the test as the only measure to make clinical decisions (Remley & Herlihy, 2010). The BDI-II is a Level B assessment that counselors with a Master’s Degree can administer. It would be unethical for the learner to administer Level C assessments because those are doctorate’s level assessments. We must also be sure that we are trained in the proper assessment as well because otherwise we could harm the client. If we use an assessment without proper training, a client could get misdiagnosed which could have a negative effect on their life. It is important that we always work with the client’s best interest in mind.
The BDI-II is a self-report assessment that uses a Likert-scale. One of the issues with the BDI-II (and other self-report assessments as well) is that clients might display response bias. They can either over report or underreport their symptoms depending on the situation. Counselors need to take this into account when they interpret the results of this test. That is why we should not use the BDI-II as the only method to assess depression symptoms. However, this instrument is excellent for use in conjunction with other assessments. Remley (2010) says that it is crucial that we regulate ourselves in using assessments and applying the results to clinical situations (Remley & Herlihy, 2010). The learner knows the impact that counseling and assessment can have on a client’s life. It is important to not jump to conclusions with the BDI-II because it is not intended to be used for diagnostic purposes. It is a solid instrument that can give the clinician an idea of where the client is at though.
Reviewers Analysis of BDI-II and Appropriateness with Diverse Populations
Paul Arbisi and Richard Farmer reviewed the BDI-II. Arbisi (2001) gave a very positive review stating that the BDI-II was improved and discussed different positive aspects of the instrument (Arbisi, 2001). Arbisi made no mention of whether the BDI-II is appropriate for diverse populations. However, he did mention that the BDI-II has improved its validity (Arbisi, 2001). That should be expected because the original BDI was used for a long period of time without having a revision made. The Farmer review appeared to be more neutral, and it was difficult for the learner to assess how he felt about the BDI-II. Farmer (2001) states that the questions on the BDI-II were written at a sixth-grade reading level (Farmer, 2001). The only mention of cultural diversity that the learner noticed was that he said the sample was composed mainly of Caucasian individuals (Farmer, 2001). There was also discussion about reliability and validity in the review. In fact, Farmer’s review had more detail on reliability and validity than Arbisi’s review. The learner did not fully understand everything that was said in both reviews but she took away the fact that the BDI-II is a respected instrument within the counseling field regardless of the negative aspects that comes with it being a self-report instrument.
Not accounting for cultural diversity can be very damaging for clients. Sashidaran, Pawlow, & Pettibone (2012) says that when we utilize assessments that are not proven to be effective with diverse populations, that it can be pathologizing for clients (Sashidaran, Pawlow, & Pettibone, 2012). Sashidaran and the other authors conducted a study to see if the BDI-II would be appropriate to be used with African-American clients. Sashidaran (2012) found that the BDI-II can be a valid instrument to assess for depression in African-Americans (Sashidaran et al., 2012). This is not to say that it will be effective for all minority groups because there are cultural differences within each group. However, more research studies needs to be done with other ethnic minorities to assess the effectiveness of the BDI-II with those groups.
The purpose of using the BDI-II is to assess symptoms of depression. The ACA Code of Ethics (2014) is adamant that counselors do not misuse assessments or withhold the results from clients unless there is a legitimate reason to withhold the results (ACA, 2014). An example of when it would be legitimate to withhold the results would be if the results of the test would negatively impact the client (ex. Diagnosing them with schizophrenia or another potentially stigmatizing disorder). This assessment does not diagnose mental disorders but the learner thought it was important to emphasize the importance of using the assessment for its intended purpose. It is important to recognize that depression can present differently in different cultures. Dere, Yu, Ryder, Watters, Bagby, & Harkness (2015) says that depression symptoms vary between cultures (Dere, Ryder, Watters, Bagby, & Harkness, 2015). Therefore continuing studies needs to be conducted on depression assessments to ensure that they are culturally appropriate. Both of the reviews made the learner question whether the BDI-II would be culturally appropriate for diverse population, and she was happy to read about studies where the BDI-II was culturally appropriate.
In conclusion, the learner had the opportunity to learn about the BDI-II. This was particularly intriguing for her because this is an assessment that she will be able to administer in the future. Tying in the ACA Code of Ethics reminded the learner the importance of maintaining proper boundaries when giving assessments. She appreciated receiving the opportunity to learn more about the BDI-II…
(2014). ACA Code of Ethics. . Retrieved from Capella
Arbisi, P. (2001). Review of the Beck Depression Inventory-II. Mental Measurements Yearbook. Retrieved from Capella Library
Beck, A., Steer, R., Ball, R., & Ranieri, W. (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment. Retrieved from Capella Library
Dere, J., Ryder, A., Watters, C., Bagby, R., & Harkness, K. (2015). Cross-cultural examination of measurement invariance of the Beck Depression Inventory-II. Psychological Assessment. Retrieved from Capella Library
Farmer, R. (2001). Review of the Beck Depression Inventory-II. Mental Measurements Yearbook. Retrieved from Capella
Kjergaard, M., Wang, C., 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. Retrieved from Capella Library
Remley, T. J., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed ed.). Upper Saddle River, NJ: Merrill/Pearson Education.
Sashidaran, T., Pawlow, L., & Pettibone, J. (2012). An examination of racial bias in the Beck Depression Inventory-II. Cultural Diversity and Ethnic Minority Psychology. Retrieved from Capella Library