BDI-II: 21 items, four bands, one caveat worth reading twice
BDI-II is the 1996 revision of Aaron Beck's depression inventory. Twenty-one items, each with four statements arranged by increasing severity and scored 0 to 3, for a total between 0 and 63. The reference window is the past two weeks, which is one of the things this revision changed: it was rebuilt around the DSM-IV criteria for a major depressive episode.
Four items were replaced in the process. Weight loss, body image distortion, somatic preoccupation and inability to work gave way to agitation, worthlessness, concentration difficulty and loss of energy. Two items, 16 on sleep and 18 on appetite, carry seven options so they can register either an increase or a decrease.
The four bands
| Total | Band |
|---|---|
| 0-13 | Minimal |
| 14-19 | Mild |
| 20-28 | Moderate |
| 29-63 | Severe |
The original BDI used different boundaries (0-10, 10-18, 19-29, 30-63), so a score quoted from a 1970s paper is not directly comparable to one from the BDI-II.
Reliability and accuracy
Internal consistency in the manual is .92 to .94, and one-week retest was .93. A reliability generalisation over 40 studies put alpha at about .92, and a review of 118 studies reported a range of .83 to .96. Pooled across four studies against structured clinical interviews, sensitivity was .85 and specificity .83.
The factor structure is usually reported as two: a cognitive-affective factor and a somatic one. Chinese validation work shows it is not fixed across populations. A national sample of 4,672 middle school teachers supported a bifactor model (CFI .983, RMSEA .037, with measurement invariance across sex and school location), while 466 Yi ethnic minority middle schoolers in Liangshan produced a three-factor solution and a total alpha of .925.
Medical populations: adjust the cutoff
This is where BDI-II gets misused. Its somatic items overlap with the symptoms of physical illness, so totals inflate in medical samples and the usual band boundaries stop doing what they were calibrated to do. Best cutoffs reported in the literature run from 7 to 20 depending on the group: 14/15 in Parkinson's disease, 18.5 in multiple sclerosis, 14 in coronary heart disease, 16 in haemodialysis, 19 in brain injury. In stroke patients, roughly 31% of positive screens are false positives. If you live with a chronic illness, read your score with that in mind.
Two other constraints are worth knowing. A change of more than 5 points is the threshold for a clinically meaningful shift, which matters if you are tracking a score over time. And the items assume a fifth to sixth grade reading level; the scale should not be used with people who have significant cognitive impairment or aphasia.
Copyright, and what this page is
BDI-II is commercially copyrighted and sold by Pearson, which is why you will not find the item wording here. What the test on this site measures is the same symptom-severity construct, using the published bands above. A total is a severity estimate, not a diagnosis, and depression is diagnosed through a clinical interview. If your score sits in the moderate band or higher, or if you are having thoughts of harming yourself, that is a reason to talk to a clinician or a crisis line now rather than later. This page is not a diagnosis and does not replace one.