Factor Structure of the Beck Depression Inventory Second Edition (BDI-II) in a Student Sample

Mark A. Whisman, John E. Perez, Wiveka Ramel

Yale University
A confirmatory factor analysis was performed to evaluate the factorial validity of the Beck Depression InventorySecond Edition (BDI-II) in a large sample of undergraduates ( N 576). Results suggest that the revised measure is internally consistent and consists of two underlying factors assessing cognitive-affective and somatic symptoms of depression. Results support the use of the BDI-II as a severity measure of symptoms of depression. 2000 John Wiley & Sons, Inc. J Clin Psychol 56: 545551, 2000. Keywords: depression; symptoms; factor analysis; assessment; Beck Depression Inventory

Since it was introduced in 1961, the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) has become one of the most widely used instruments for evaluating the severity of depressive symptoms in psychiatric patients and in normal populations (as reviewed by Beck, Steer, & Garbin, 1988). Although the original scale was amended once before (BDI-IA; Beck, Rush, Shaw, & Emery, 1979), more recently the Beck Depression InventorySecond Edition (BDI-II; Beck, Steer, & Brown, 1996) was developed in order to adhere more closely with the diagnostic criteria for major depressive episode in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Like the BDI, the BDI-II has 21 items, each of which consists of four self-evaluative statements scored 0 to 3, with increasing scores indicating greater depression severity. Responses are summed to yield a total score that ranges from 0 to 63. In the revision process for the BDI-II
four items (Weight Loss, Body Image Change, Somatic Preoccupation, and Work Difficulty) were dropped and replaced by four new items (Agitation, Worthlessness, Concentration Difficulty, and Loss of Energy) in order to index symptoms typical of severe depression or depression warranting hospitalization. Two items were changed to allow for increases as well as decreases in appetite and sleep. Many of the statements (or alternatives) used in rating the other symptoms were reworded (Beck et al., 1996, p. 1).
This study was supported by grant MH54372 from the National Institute of Mental Health, awarded to Mark A. Whisman. We would like to thank Todd Little for his consultation regarding the statistical analyses. Correspondence concerning this article should be addressed to Mark A. Whisman, University of Colorado at Boulder, Department of Psychology, Campus Box 345, Boulder, CO 80309; e-mail: whisman@psych. colorado.edu.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 56(4), 545551 (2000) 2000 John Wiley & Sons, Inc.

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In addition, the time frame of the BDI-II was extended to two weeks (versus the past week, including today in the BDI) in order to be consistent with DSM-IV criteria for major depressive episode. Because the BDI-II constitutes a substantial revision (Beck et al., 1996, p. 1) of the original BDI, studies are needed to evaluate the psychometric properties of the BDI-II, including the factorial validity of the measure. Psychometric studies conducted on the original BDI have found that the factor structure represents one underlying general syndrome of depression, which can be subdivided into three highly interrelated factors reflecting Negative Attitudes Toward Self, Performance Impairment, and Somatic Disturbance (as reviewed by Beck et al., 1988). To date, few studies have been published on the factor structure of the BDI-II. Results from an outpatient sample ( N 500) with mixed psychiatric disorders yielded two factors, which were labeled Somatic-Affective and Cognitive (Beck et al., 1996). Similarly, results from a student sample yielded two factors, labeled Cognitive-Affective and Somatic symptoms (Beck et al., 1996). The student sample, however, included only 120 individuals, which generally is considered inadequate for the application of factor-analytic techniques (Comrey & Lee, 1992). Because self-report measures like the BDI (and BDI-II) often are used as measures of depressive symptoms in studies of nonclinical samples, including college students, the present study was conducted to provide normative information on, and evaluate the factor structure of, the BDI-II in a large sample of undergraduates. Method Participants The original sample was composed of 606 undergraduate students who participated for course extra credit. There was one age outlier and 29 respondents who had missing data (27 cases with omission of one or more items on the BDI-II and two cases where gender was not indicated). These cases were eliminated, and the analyses were conducted on the remaining 576 students. There were 333 (57.8%) women and 243 (42.2%) men. The mean age was 18.64 (SD 1.12) years old. The ethnic background of the sample consisted of 350 (60.8%) Caucasian, 36 (6.3%) African American, 36 (6.3%) Hispanic, 120 (20.8%) Asian / Pacific Islander, and 23 (3.8%) other ethnic participants; 11 participants (1.9%) did not indicate their ethnic background. Analysis A maximum-likelihood confirmatory factor analysis was performed on the 21 items of the BDI-II using LISREL 8 (Jreskog & Srbom, 1996). The hypothesized model was based on a principal-axis exploratory factor analysis of the BDI-II presented by Beck et al. (1996) with a small student sample ( N 120). The hypothesized model is presented in Figure 1, where circles represent latent variables and rectangles represent measured or manifest variables.Absence of a line-connecting variables implies no hypothesized direct effect. Standardized regression coefficients of the manifest variables on the latent constructs are represented by the symbol lambda (). Standardized error variances of the manifest variables are represented by the symbol epsilon (E). The variances of the latent constructs were fixed at 1 to identify the solution and establish the scale of measurement. Thus, the double-headed arrow between the latent variables, denoted by the symbol phi (), represents a correlation. Based on the initial factor analysis, a two-factor model of depression, CognitiveAffective and Somatic, was hypothesized. The following items served as indicators of the

Factor Structure of the BDI-II

547

Figure 1.

Hypothesized two-factor model of the BDI-II.

Cognitive-Affective factor: Sadness, Past Failure, Loss of Pleasure, Guilty Feelings, Punishment Feelings, Self-Dislike, Self-Criticalness, Suicidal Thoughts or Wishes, Crying, Agitation, Loss of Interest, Indecisiveness, Worthlessness, and Irritability. The following items served as indicators of the Somatic factor: Loss of Energy, Changes in Sleeping Pattern, Changes in Appetite, Concentration Difficulty, and Tiredness or Fatigue. Two items with loadings less than .35 on both factors in the initial analysis, Pessimism and Loss of Interest in Sex, were not estimated as indicators of either factor. However, error variances and modification indices were estimated for these items.

Results The mean BDI-II total score for the entire sample was 8.36 (SD 7.16; range 0 49). According to the cut scores and interpretive labels provided by Beck et al. (1996), 462 (80.2%) participants scored in the minimal range (013), 72 (12.5%) participants scored in the mild range (1419), 33 (5.7%) participants scored in the moderate range (20 28), and 9 (1.6%) scored in the severe range (29 63). Table 1 presents the means, standard deviations, and percentages of individuals who were symptomatic (i.e., the

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Table 1 Means, Standard Deviations, Percentages Symptomatic, and Corrected ItemTotal Correlations
BDI-II Item and Label 1. Sadness 2. Pessimism 3. Past Failure 4. Loss of Pleasure 5. Guilty Feelings 6. Punishment Feelings 7. Self-Dislike 8. Self-Criticalness 9. Suicidal Thoughts 10. Crying 11. Agitation 12. Loss of Interest 13. Indecisiveness 14. Worthlessness 15. Loss of Energy 16. Changes in Sleep a. Increase b. Decrease 17. Irritability 18. Changes in Appetite a. Increase b. Decrease 19. Concentration Difficulty 20. Tiredness or Fatigue 21. Loss of Interest in Sex Mean .35 .36 .34 .35 .41 .18 .36 .41 .16 .38 .46 .28 .33 .26 .49 .98 SD .57 .55 .59 .59 .61 .53 .68 .66 .40 .83 .59 .55 .65 .59 .60 .73 % 31 34 28 30 35 13 27 33 15 22 42 24 26 18 44 74 14 60 26 56 24 32 47 44 13 r .59 .51 .45 .62 .49 .49 .63 .58 .52 .43 .43 .45 .53 .60 .54 .32

.30 .70

.56 .76

.47 .43

.59 .50 .16

.72 .62 .46

.50 .53 .28

Note. % Percentage endorsing response choices 1, 2, or 3. r corrected itemtotal correlation.

percentages of individuals who endorsed a non-zero response option) on each of the 21 items of the BDI-II. Coefficient alpha for the total scale was .89, which, although less than the alpha of .93 reported by Beck et al. (1996), suggests that the BDI-II exhibited a high level of internal consistency. Table 1 also provides the corrected itemtotal correlations of the 21 BDI-II items. As can be seen in Table 1, these correlations ranged from .28 (Loss of Interest in Sex) to .63 (Self-Dislike), with 19 of the 21 items exhibiting a corrected itemtotal correlation of .40. The correlation matrix of the 21 BDI-II items is presented in Table 2. The independence model that tests the hypothesis that all variables are uncorrelated was easily rejected, 2 (210, N 576) 3,645.71, p .01. The hypothesized model was tested next. Although there was a significant improvement in fit between the independence model and the hypothesized model, 2 (190, N 576) 870.56, p .01, the fit indices of the hypothesized model were unacceptable: Goodness of Fit Index (GFI) .88, Adjusted Goodness of Fit Index (AGFI) .85, Comparative Fit Index (CFI) .80, Incremental Fit Index (IFI) .80, and Root Mean Square Error of Approximation (RMSEA) .08. Post hoc modifications were performed in an attempt to develop a better-fitting model. Two very large modification indices suggested that a substantial improvement in model fit could be achieved by allowing Pessimism and Loss of Interest in Sex to load on the

Table 2 Intercorrelations Among Items From the BDI-II

5 .33 .26 .36 .37 .38 .29 .33 .31 .43 .40 .42 .46 .41 .34 .30 .34 .37 .32 .37 .39 .33 .53 .37 .30 .38 .39 .31 .39 .36 .35 .44 .20 .10 .27 .25 .28 .29 .27 .37 .32 .22 .17 .32 .29 .26 .28 .27 .22 .20 .39 .30 .17 .44 .21 .29 .28 .19 .24 .24 .19 .30 .31 .24 .35 .33 .29 .35 .38 .34 .24 .25 .24 .34 .44 .43 .44 .34 .36 .53 .43 .40 .29 .28 .34 .37 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

BDI-II Item and Label

.38

.24 .41

1. Sadness 2. Pessimism 3. Past Failure 4. Loss of Pleasure 5. Guilty Feelings 6. Punishment Feelings 7. Self-Dislike 8. Self-Criticalness 9. Suicidal Thoughts 10. Crying 11. Agitation 12. Loss of Interest 13. Indecisiveness 14. Worthlessness 15. Loss of Energy 16. Changes in Sleep 17. Irritability 18. Changes in Appetite 19. Concentration Difficulty 20. Tiredness or Fatigue 21. Loss of Interest in Sex

.44 .38 .30

Factor Structure of the BDI-II

.33 .29 .30 .41 .20 .22 .36 .27 .32 .30 .19 .37 .29 .25

.13 .08 .11 .20 .14 .09 .24 .23 .10 .19 .16 .05 .16 .17 .26

.37 .23 .18 .39 .22 .28 .31 .26 .22 .23 .33 .28 .31 .24 .34 .18

.28 .17 .16 .26 .17 .17 .26 .29 .21 .23 .21 .22 .28 .22 .32 .28 .24

.25 .31 .27 .35 .21 .23 .32 .31 .21 .21 .26 .21 .38 .32 .36 .30 .25 .28

.31 .29 .22 .37 .24 .18 .33 .31 .19 .19 .20 .27 .27 .28 .51 .37 .31 .35 .46

.19 .13 .06 .22 .14 .20 .24 .20 .12 .04 .19 .22 .22 .23 .13 .09 .18 .18 .07 .14

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Figure 2. Final modified two-factor model of the BDI-II with significant coefficients presented in standardized form. (Note: Variance explained in each manifest variable is the square of the loadings. The .71 correlation indicates a 50% overlap of the reliable variance in the two latent constructs.)

Cognitive-Affective factor. In addition, several residuals were correlated. Consequently, after allowing Pessimism and Loss of Interest in Sex to be estimated as indicators of the Cognitive-Affective factor, three pairs of theoretically meaningful correlated residuals were estimated in order to achieve a satisfactory fit of the model to the data. A chi-square difference test indicated a significant improvement in fit of the final model over the original hypothesized model, 2 (5, N 576) 325.98, p .01. Moreover, the final model showed a good fit to the data: GFI .92, AGFI .90, CFI .90, IFI .90, and RMSEA .06. The final model,1 with standardized coefficients, is presented in Figure 2. The Somatic and (modified) Cognitive-Affective factors had alpha coefficients of .72 and .87, respectively, suggesting that they both showed high levels of internal consistency.

1 In order to control for the positively skewed raw data (i.e., most scores centered on zero), a square root transformation of the data was employed. Running the confirmatory factor analysis with the transformed data yielded an equivalent two-factor solution. The factor loadings of the manifest variables were essentially the same and the fit indices were within one hundredth of a point. Thus, results of the confirmatory factor analysis presented in this article are based on the raw data. Finally, the test for a single factor showed a significantly worse fit to the data, 2 (1) 124.83, p .001.

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Discussion With some slight modification (i.e., allowing Pessimism and Loss of Interest in Sex to load on the Cognitive-Affective factor), the current confirmatory factor analysis replicated, in a large sample of undergraduates, the two-factor solution of the BDI-II obtained by Beck et al. (1996). Therefore, the scale appears to represent two highly correlated factors, measuring cognitive-affective and somatic symptoms. Furthermore, we found that the internal consistency of the BDI-II total and factor scores was very good, supporting the reliability of the total and factor scores. Given that only three of the 21 items from the BDI-IA were not revised in the BDI-II, and given that the BDI-II yields two factors whereas the BDI has tended to yield three factors (see Beck et al., 1988 for a review), it would appear that the BDI-II does, indeed, represent a substantial revision of the original BDI (Beck et al., 1996, p. 1). Future research is needed to determine ideal cut scores for the BDI-II for identifying clinical depression (i.e., case detection), as research with the BDI has shown that not all individuals with elevated scores meet diagnostic criteria for major depression in students (e.g., Deardorff & Funabiki, 1985) or community samples (e.g., Oliver & Simmons, 1984). However, given that the BDI-II was constructed to measure more closely the DSM-IV symptoms of major depressive episode, it may be that the scale will be a more sensitive measure than was its predecessor. The results from the current study support the continued use of the BDI-II as an indicator of the presence and degree of depressive symptoms (Beck et al., 1996, p. 6), insofar as they suggest that it is a reliable measure that appears to consist of two underlying factors measuring cognitive-affective and somatic symptoms. The current findings, combined with the results reported by Beck et al. (1996), suggest that although cognitiveaffective and somatic dimensions were observed in the BDI-II in both clinical and nonclinical (i.e., student) samples, individual affective items may load on different factors depending upon the nature of the sample studied. References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press. Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression InventorySecond Edition manual. San Antonio, TX: The Psychological Corporation. Beck, A.T., Steer, R.A., & Garbin, M.G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77100. Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571. Comrey, A.L., & Lee, H.B. (1992). A first course in factor analysis (2nd ed.). Hillsdale, NJ: Erlbaum. Deardorff, W.W., & Funabiki, D. (1985). A diagnostic caution in screening for depressed college students. Cognitive Therapy and Research, 9, 277284. Jreskog, K.G., & Srbom, D. (1996). LISREL 8: Users reference guide. Chicago: Scientific Software International. Oliver, J.M., & Simmons, M.E. (1984). Depression as measured by the DSM-III and the Beck Depression Inventory in an unselected adult population. Journal of Consulting and Clinical Psychology, 52, 892898.