Beck Depression Inventory Vs Hamilton Depression Scale

The revised Beck Depression Inventory ( BDI-II ) , published in 1996 was authored by Aaron Beck, Robert A. Steer, and Gregory K. Brown. Similar to its predecessor, it consists of 21multiple pick inquiries that assist in finding the badness of depression. Each point consists of four statements arranged in order to determine the badness of a certain symptom of depression. BDI-II conforms to the DSM-IV standards for depression. Clients who are presented with the BDI-II are asked to reply each inquiry based upon the manner they have felt for the past two hebdomads in order to accurately conform to the DSM-IV standards. The BDI-II is intended for striplings and grownups and should non be administered to those under the age of 13.


The BDI-II consists of 20 one inquiries, all of which correspond to a peculiar symptom of depression. Each point consists of a four point graduated table runing from 0-3. Items 16 and 18 consist of seven points which are used to bespeak an addition or lessening in both sleep forms and appetency. A entire mark of 0-13 is considered minimum scope, 14- 19 is considered mild, 20-28 is considered moderate, while 20-63 is considered to be terrible ( Beck, Steer and Brown, 1961 ) . The BDI-II may be scored by manus or by utilizing a package plan such as Q Local, where the tonss may be recorded and monitored by the clinician. The trial may be administered often, as it is intended to supervise symptoms that have occurred within a two hebdomad scope.


Beck ‘s Depression Inventory II has been used for many old ages with great success. Its dependability is still questioned by some. Sprinkle, Lurie, Insko, Atkinson, Jones, Logan and Bassada ( 2002 ) province that “ Although the BDI-II manual ( Beck, Steer, & A ; Brown, 1996 ) and assorted other studies ( e.g. , Dozois et al. , 1998, and Steer, Kumar, Ranieri, & A ; Beck, 1998 ) have offered significant grounds for the instrument ‘s applaudable “ split-half ” internal consistence ( with reported coefficient alphas of.91 and somewhat higher ) , there are merely two published studies to day of the month on the instrument ‘s test- retest dependability ( par.6 ) . Sprinkle et al. , ( 2002 ) further study “ Beck, Steer, and Brown ( 1996 ) reported on 26 outpatients ( no diagnostic information is offered ) who were administered the BDI-II at the times of their first and 2nd therapy Sessionss ( about one hebdomad apart ) , bring forthing a test-retest correlativity of.93 ” ( par 6 ) .


Cogency of the BDI-II appears to be favourable. A survey conducted by Storch, Roberti and Roth ( 2002 ) examined the psychometric belongingss of the BDI-II. 414 pupils from two separate universities participated in the survey. Their consequences “ supported BDI-II two-factor construction mensurating cognitive-affective and bodily depressive symptoms ” ( par.1 ) . They concluded that the cogency of the BDI-II was supported by favourable consequences “ with self-report steps of depression and anxiousness ” ( par.1 ) . The consequences of this survey double past research of a college sample which supported the dependability and cogency of the BDI-II.

Arnau, Meager, Norris, and Bramson ( 2001 ) besides conducted a psychometric rating of the BDI-II utilizing primary attention patients. The survey consisted of 340 primary attention patients ( 7 of which were eliminated due to incomplete responses ) . 68.8 % of the participants were female and the age group tested ranged from ages 18-54 ( M = 36.5, SD = 10.1, Arnau et al. , 2001 ) . The mean mark from the participants was 8.4 ( SD = 9.7 ) . They reported that “ tonss of 14 or higher, proposing at least a mild degree of depression ( Beck et al. , 1996 as cited in Arnau et al. , 2001 ) were observed in 23.2 % of the sample ” ( p.3 ) . Arnau et al. , ( 2001 ) besides found an alpha coefficient of.94, which they considered to be first-class internal consistence. They concluded that the BDI-II “ yielded strong grounds for the factorial cogency of the BDI-II in a primary attention puting ” ( p.6 ) . They found that the BDI-II could easy be implemented into the primary attention puting without interrupting patient flow.

BDI-II Reappraisals

Arbisi and Farmer, referees of BDI-II indicate that the BDI-II is easy to administrate and requires about five to ten proceedingss to finish. Arbisi provinces concern nevertheless, that “ there are no cogency indexs contained on the BDI or the BDI-II and the easiness of disposal of a self-report lends itself to the deliberate tailoring of self-report and deformation of the consequences ” ( Beck, Steeler & A ; Brown, 1961 par. 5 ) .

Arbisi and Farmer concur that the manual BDI-II was good written and provides a battalion of supportive information sing “ norms, factor construction, and notably, nonparametric item-option characteristic curves for each point ” ( Beck, Steer & A ; Brown, 1961 par. 4 ) . They contend that the BDI-II “ has improved upon the original by updating the points to reflect modern-day diagnostic standards for depression and utilizing state-of-the-art psychometric techniques to better the discriminatory belongingss of the instrument ” ( Beck, Steer & A ; Brown, 1961 par. 10 ) . Although the referees have noted their concern sing the deficiency of room for diverseness, Arbisi and Farmer appear to O.K. of its usage as a depression appraisal tool.

Hamilton Depression Scale

The Hamilton Depression Scale ( abbreviated as HDS, HAMD or HAD ) is used to mensurate the badness of symptoms of depression. For many old ages it was considered to be the “ gilded criterion ” . It was developed by Max Hamilton in the late fiftiess and was used to measure the public presentation of the first antidepressants. It was released in 1960. Upon its release, Hamilton acknowledged that it had “ room for betterment ” ( p. 56 ) . He revised the HDS in 1967. The HDS consists of 21 multiple pick inquiries. The first 17 inquiries determine the badness of the depression symptoms, while the extra four inquiries address the countries of paranoia and compulsion and their relation to depression.The HDS can be administered to both kids and grownups. It is considered to be easy to read and construe ; it is recommended that the HDS be administered merely by a accredited professional.


The HDS was intended to be administered by an experient clinician by carry oning a clinical interview.A Scoring and administering the graduated table may be considered cumbrous as Hamilton did non supply structured guidelines for this intent. “ No standardised investigation inquiries were provided to arouse information from patients and no behaviorally specific guidelines were developed for finding each point ‘s evaluation ” ( Health Care Technology Systems, 2010 ) . Seventeen points are rated on a 5-point ( 0-4 ) or a 3-point ( 0-2 ) graduated table. Overall tonss of 0-6 are considered normal. Tonss from 7-17 are declarative of mild depression. Tonss from 18-24 represent moderate depression. Tonss that are greater than 24 are representative of terrible depression.


Bagby, Ryder, Schuller, and Marshall ( 2004 ) province that “ Clinician-rated instruments should show three types of dependability: 1 ) internal dependability, 2 ) retest dependability, and 3 ) interrater dependability ” ( par.4 ) . They contend that the internal dependability of the HDS estimations ranged from “ 0.46 to 0.97, and 10 surveies reported estimations 0.70 ” ( par.5 ) . They further contend that the bulk of points contained in the HDS indicate sufficient dependability.Per their testing, the undermentioned points were met in each sample: ” ( Guilt, in-between insomnia, psychic anxiousness, bodily anxiousness, GI, general somatic ) and an extra five points met the standards in all but one sample ( down temper, self-destruction, early insomnia, late insomnia, work and involvements, hypochondriasis ) ” ( par.6 ) . A possible job was suggested with loss of penetration, as it had the greatest figure of variables. Interrater dependability was considered to be hapless. Cicchetti and Prusoff ( 1983, as cited in Reynolds and Kobak, 1995 ) province “ in a survey of interrater dependability of a 22-item version of the HDRS found low degrees of dependability for single points, with 14 of the 22 points showing intraclass correlativity coefficients of less than.40 ” ( par. 4 ) .

Retest Dependability

Tonss for the retest dependability of the HDS ranged from 0.81 to 0.98. Williams ( 1998 at cited in Bagby et al. , 2004 ) “ argued in favour of utilizing structured interview ushers to hike point and entire graduated table dependability and developed the Structured Interview Guide for the Hamilton Depression Rating Scale ” ( par.8 ) . Making so increased the retest dependability to 0.54 in malice of the fact that merely four points met the necessary standards for dependability ; i.e. : “ depressed temper, early insomnia, psychic anxiousness, and loss of libido ” ( par.8 ) .


The Hamilton Depression Scale is comprised of 1 ) Content, 2 ) Convergent, 3 ) Discriminant, 4 Factorial, and 5 ) Predicative Validity. Content cogency is determined by “ analyzing scale points to find correspondence with known characteristics of a syndrome ” ( Bagby et al. , 2004 par. 9 ) . Convergent cogency is sufficient when a graduated table indicates Pearson ‘s R values of a lower limit of 0.50 in concurrence with steps of the same syndrome. Discriminant cogency is determined by bespeaking that groups that differ in diagnostic position may be separated through the usage of the graduated table. “ Predictive cogency of symptom badness steps such as the Hamilton depression graduated table is determined by a statistically important ( p & lt ; 0.05 ) capacity to foretell alteration with intervention ” Bagby et al. , 2004 par. 9 ) . Factorial cogency may be established by utilizing factor analysis or principal-component analysis to bespeak that a positive illustration can be found in several samples.

HDS Reviews

Bernard Carroll wrote a missive to the editor of the American Journal of Psychiatry in December, 2005 entitled: “ Why the Hamilton Depression Scale Endures. ” He offers three grounds why the HDS remains the gilded criterion. First of wholly, he contends that Hamilton ‘s HDS “ focused on patient ‘s load of unwellness ” ( par.1 ) . He suggests that this is the ground why the HDS contains illustrations of anxiousness that are present in depressive episodes, but are non portion of the diagnosing for depression. He farther contends that Hamilton intended the usage of this graduated table for client ‘s that are good known by the clinician. In this visible radiation, the HDS displays a scope “ from mild to extreme unwellness ” ( par. 1 ) .

Second, Carroll contends that the demand for a revised graduated table based upon modern standards of major depression is non realistic. Carroll believes that “ Current definitions of major depression, instantiated in DSM-IV, for case, are intentionally atheoretical nominalist conventions that lack consolidative concepts, prognostic cogency, and explanatory power ” ( par.2 ) . He believes that this is the ground why those who are diagnosed with DSM-IV standards for major depression are so contrastive. He adds: “ In the hereafter, we might add biomarkers or endophenotypes to clinical symptoms in measuring depression, but that twenty-four hours is non here ” ( par.2 ) .

Third, Carroll does non believe that the HDS has been outmatched in public presentation. He does non believe that the HDS is insensitive to alterations in the badness of depression symptoms. When compared to the Montgomery-Asberg Depression Rating Scale, he believes that the Hamilton Depression Scale is superior in its “ sensitiveness to alter and in observing early alteration with intervention while holding the advantage of far more comprehensive symptom coverage ” ( par.3 ) .

Carroll concludes his missive by saying ” The endurance of the Hamilton depression graduated table is singular, sing how many unauthorised, nonvalidated, mutant versions now circulate ( Hamilton ‘s original 17 points have expanded to 28 at my last count ) . This is non progress, nevertheless, because the text versions and procedural usage in many modern-day intervention tests are corrupted ” ( par 4 ) .

Paul C Burnett, a referee of the HDS contends that the manual is “ extended and comprehensive ” ( par.2 ) . The instructions for administrating the trial are clear and contain illustrations of the marking procedure. All of the symptoms contained in the trial are described and supply illustrations to be used in the interviewing procedure. He believes that the symptoms contained in the trial conform to the standards listed in the DSM-IV.

The manual, which contains a sample of 202 down patients, is comprised of 76 % inmates, 24 % outpatients, and 69 % female ( par.3 ) . The manual contends that the demographics are just, despite the fact that no information is provided to back up this. He contends that the manual did non include informations to back up the process that was utilized to choose this demographic.

Burnett states that “ Internal consistence estimations were found to be.79 and.81 for the clinical and self-report signifiers severally, bespeaking moderate dependability ” ( par. 4 ) . Other surveies suggest that the internal consistence scope from.45 to.95, which is stated in the manual as “ consistent with the consequences from the confirmation sample ” ( par.4 ) . Burnett does non see a scope of.45 to.81 as acceptable internal consistence.

Burnett concludes that the HDS consists of a well written and concise manual, which clearly describes the disposal and hiting procedure. He finds that the two graduated tables have “ moderate internal consistence, sound coincident cogency, and comparatively consistent and stable factor constructions ” ( par. 7 ) . His lone ailment is that the confirmation sample is minimum and does non sufficiently describe the mode in which it was selected.

The Stronger Assessment Tool

Both Aaron Beck and Max Hamilton have created an assessment tool to find the badness of the symptoms of depression. While Hamilton ‘s Depression Scale was considered to be the gilded criterion, and may be administered to both kids and grownups, one would hold to reason that Beck ‘s Depression Inventory-II is the stronger of the two appraisals. It appears that the BDI-II can be administered with easiness and does non necessitate an interviewing procedure. The BDI-II has been revised to supervise the badness of symptoms of depression for the last two hebdomads, while Hamilton ‘s HDS does non province such rigorous guidelines. It besides appears as though the BDI-II contains a stronger internal consistence with an alpha coefficient of.95 as opposed to the HDS internal coefficiency of.79 and.81.

Another ground for this decision was the original purpose of usage of the graduated tables. Hamilton ‘s HDS was developed to measure the public presentation of the first coevals of antidepressants, while Beck ‘s Depression Inventory was developed to find the nature of the badness of symptoms of depression without the usage of medicine. Beck ‘s BDI-II appears to hold surpassed the HDS as referees have considered this assessment tool as “ utilizing state-of-the-art psychometric techniques to better the discriminatory belongingss of the instrument ” ( Beck, Steer & A ; Brown, 1961 par. 10 ) . It appears as though Beck ‘s BDI-II is the preferable pick among today ‘s clinicians.