BECK'S INVENTORY

TO EVALUATE DEPRESSION
 BECK INVENTORY TO ASSESS DEPRESSION

The Depression Inventory was created by Beck in 1967, with the

objective of measuring depression, since it would offer, according to the
author, some advantages: It would avoid the variability of clinical diagnosis,
it would provide a standard measure not affected by theoretical orientation or
Inconsistency of the person who administers it, in addition, because it is
administered, it would reduce the costs of training and time of the
professional, and finally it would facilitate comparisons with other data.

INSTRUMENT DESCRIPTION. The inventory is made up of 21 categories of

symptoms or attitudes, each of them is a manifestation, in some categories
there are two alternative answers and they are divided into a and b to
indicate that it is at the same level, each item presents a score that It goes
from zero (0) to three (3).

In the event that the patient expresses that there are two or more
statements that agree with his mood, the highest value will be recorded, and
if the patient feels that he is between two statements, being more in two than
in three, the It will then register the value two because it is closest.
The instrument is based on two assumptions:

a. First: According to the more severe depression, the greater the number
of symptoms, this progression allows us to differentiate between healthy
people and patients who have mild, moderate and/or severe depression.

b. Second: As the patient is more depressed, each symptom is felt more

intensely or frequently, which is why its design includes all the
comprehensive symptoms of which it is classified into five areas:
 1. Affective Area
(A)
(E) Sadness
(J) Feelings of Guilt Predisposition to cry Irritability
(K)
2.
(D)
Motivational Area Dissatisfaction Suicidal Ideas
(Y
O)
3.
(B)
(C) Cognitive Area
(F) Pessimism About the future Feeling of Failure Expectation of
(G) Punishment Self-disgust
(M) Indecision
(N) Deformed self image Somatic concerns Self accusations
(T)
(F)
4.
(L)
(EI Behavioral Area Social Withdrawal Delay in working Fatigue
TH
ER)
(Q)
5. Physical area
(P) Loss of sleep
(R) Loss of appetite
(S) Weightloss
(U) Loss of sexual desire

This prevalence of subjective, psychic affectivity is consistent with

the cognitive theory of depression maintained by the same author, according
to which the affective response is determined by the way in which the
individual structures his or her experience. In Beck's theory, he mentions: “It
is possible that depressive episodes are precipitated by an external event;
the individual's evaluation of the event and the way they think about it, rather
than the event itself, may be what produces the Depression".
ADMINISTRATION. The Beck Depression Inventory was developed to be
administered individually or in groups. To be administered individually, a
double copy of the response protocol is used, one is given to the patient and
the other is read aloud by the interviewer.
After announcing their statements that correspond to each item, the
interviewee is asked to indicate “Which of the statements best defines your
state of mind, how you feel at that moment.” At no time should the answer be
suggested, and if the interviewee indicates that there are two statements
that correspond to the way he or she feels, then the higher number should
be recorded. The depression score is the sum of the answers ranging from A
to U. The application time has no time limit and generally does not require
more than fifteen minutes to answer.

QUALIFICATION. The coding system takes into account the number of

symptoms reported by the patient since each of them has a numerical score,
the intensity of each symptom has been recorded by assigning graduated
numerical values to each of the twenty-one categories, or a zero. indicates
that the symptom was not present, while increasing severity is graded by
one, two, and three, such that the patient's total score represents a
combination of the number of symptom categories and the severity of the
particular symptoms.
However, a total score from zero to ten indicates that there is no depression.
Eleven to twenty indicates that there is mild depression; the score ranging
from twenty-one to thirty; it means that there is moderate depression; But if it
goes from thirty-one or more, it shows that there is severe depression.

VALIDITY. In reviewing the validity of the Beck Depression Inventory, we

began by briefly discussing an experimental study before moving on to other
methods. In 1977, Beck, Kovaes & Hollan, studied forty-four outpatients who
came for consultation on their own initiative and met established criteria for
the diagnosis of Depressive Neurosis (DSM III). These patients presented
moderate to moderate depression. intense, (according to Beck's inventory).
The group was divided into two parts: The first group was made up of
eighteen patients assigned to cognitive therapy and the second was made
up of twenty-four patients assigned to pharmacological therapy. After the
treatment, both groups showed a significant reduction in depressive
symptoms.
Regarding the correlation with other tests, in Peru Novara, Sotillo & Wharton
(1985, cited by Pimentel, 1996), carried out a study on a sample of one
hundred and seventy-eight patients diagnosed with depression, using the
Zung scales. & Hamilton and Beck's inventory; They used a control group of
forty-nine patients and correlated the three tests with each other, the
correlation between Beck and the Hamilton scale was 0.72 and that of Beck
with the Zung scale was 0.76; highly significant coefficients.
 At the Central Military Hospital, a correlation study was carried out
between both Beck and Zung scales in a sample of fifteen patients with a
diagnosis of depression, finding a correlation between both scales of 0.78.
Beck's correlation with psychiatric diagnosis was also carried out by Novara,
Sotillo and Wharton (1985, cited by Pimentel, 1996), finding a correlation of
0.75. The results of the studies cited allow us to say that the Beck inventory
has satisfactory validity and is useful for the purposes for which it was
developed.

RELIABILITY. The reliability estimates are in relation to the respect that is

assumed to cause measurement error, which is why we find the following
types of reliability.
a. Stability and Consistency of scores over time.
b. Equivalence. Consistency in scores on two equivalent forms of the test.
c. Internal consistency evaluates the degree to which the items of a test are
related to the total score Brown (1980, cited by Pimentel, 1996), this last
form is characterized by being obtained through a single application of the
test calculated with the techniques separation by halves (Holt Split Method),
or homogeneity estimates (formulas: Kuder, Richardson or Cronbach's
Alpha Coefficient).

On the other hand, a Reliability study was carried out at the Central
Military Hospital, which, although it is done in a small sample and does not
allow generalization, does shed light on the reliability of this Instrument, the
Inventory of Reliability was administered. Beck in fifteen patients with a
depressive diagnosis and then. performed a retest with an interval of one
week, obtaining a coefficient of 0.80. Likewise, with the data from the first
administration, internal consistency was calculated with Cronbach's Alpha
coefficient, obtaining a coefficient of 0.81.

The glossed results make it possible to say that the Beck Inventory
has quite acceptable reliability.

RELIABILITY STUDY
Sample: 15 Patients _____________ Diagnosis: Depression
TEST LAPSE RE-TEST
1RA. BECK'S SEVEN DAYS 2DA. BECK'S
APPRECIATION APPRECIATION
42 40
35 36
38 35
 32 28
40 39
38 40
30 31
28 26
31 34
30 30
29 30
27 32
35 29
55 36
31 33
X = 33.27 X = 33.26
S = 4.74 S = 4.38
rxx = 0.78

TYPES OF DEPRESSION
Patients know someone who has depression and think they have the same
symptoms. However, symptoms of depression vary greatly from person to
person. They vary so much that two depressed people may have very little in
common, beyond a depressed mood.

There is a good reason to feel this way, such as after the death of a loved
one, the loss of a job, or a fight with a friend. These symptoms are logical
under these circumstances. However, if the symptoms are interfering with
your daily life or you feel like you can't get rid of them, then seek help.
Although it is common for depression to begin after a stressful event,
sometimes it happens just because, without an apparent cause. If you
recognize the symptoms mentioned above, then it is depression, no matter
how it started or what caused it.
Depression can be reactive (from outside) or endogenous (from within). In
the first case, it constitutes the response to an external stimulus that causes
grief - the death of a loved one or the loss of a job; However, when this
cannot be overcome, it transforms into depression and loses relationship
with the initial stimulus. In the second case, these are processes that have
nothing to do with reality, the person simply becomes depressed without a
real cause. A third position is the one that considers that both factors, both
endogenous and exogenous, may be involved in depression in different
proportions in different patients. It is really difficult to find a physical
alteration that does not affect the mood and vice versa. Mood and body can
only be break off
theoretically.
The biochemical and neurophysiological basis of both types, however, is the
same, and the pharmacological treatment is similar for both cases. Although
there is no antidepressant that achieves effects before three weeks, and this
seems to be due to the plasticity of the brain. It is necessary for the drug to
act for some time for the neurons to modify the activity of the membrane
receptors, and sometimes the patient cannot wait. Some types of depression
tend to affect members of the same family, which would suggest that a
biological predisposition can be inherited. This seems to occur in the case of
bipolar disorder. Studies of families with members who suffer from bipolar
disorder in each generation have found that those who become ill have a
somewhat different genetic makeup from those who do not become ill.

However, not everyone who has the genetic predisposition for bipolar
disorder suffers from it. Apparently, there are other additional factors that
contribute to triggering the disease: possibly stresses in life, family, work or
study problems.

In some families, severe depression occurs generation after generation.

However, severe depression can also affect people who do not have a
family history of depression. Whether hereditary or not, severe depressive
disorder is often associated with changes in brain structures or functions:
Decreased metabolism of the left prefrontal area of the brain. Situation that
normalizes after different treatments.

People with low self-esteem perceive themselves and the world in a

pessimistic way. People with low self-esteem and who are easily
overwhelmed by stress are predisposed to depression. It is not known with
certainty whether this represents a psychological predisposition or an early
stage of the disease.

DEPRESSION IN MEN
In recent decades, depressive illness has increased proportionally more in
men than in women. In the female population, more risk factors converge,
such as hormonal factors in the menstrual cycle, postpartum and
perimenopause, and personality factors, because women are more prone to
self-criticism and low self-esteem. However, the great social changes of
recent decades have benefited women and, on the other hand, they have
not been well assimilated by some men. All the events surrounding women's
liberation have created in certain types of men the feeling that Their chair
has been moved, that they have begun to lose ground and power. Some of
us have accepted it very well and it seems totally fair to us, but others do not
accept it, thus the relationship between depression and abuse at home
arises to a large extent.

admits Alonso-Fernández Although there is clinical evidence that undetected

depressed patients attend primary care consultations more than six times a
year, depression is an underdiagnosed disease.

In 80% of cases, depression has a progressive and gradual onset,

sometimes so silent and non-specific that it can go unnoticed even by the
patient themselves. Often sleep delay syndrome, whereby the person
usually goes to bed at very late hours, and behavioral disorders, such as
sexual promiscuity or violent behavior, are masking a depressive condition.
This is observed especially in adolescents and young people. The
symptoms of depression, according to Alonso-Fernández, transcend the
scope of mood disorders:

'Many patients do not present sadness or hopelessness or attachment to

suicidal ideas. However, they may have symptoms of apathy, lack of energy,
sexual dysfunctions; symptoms of lack of communication, such as social
withdrawal, bad mood, neglect of personal grooming, and symptoms of
rhythmopathies, such as sleep disturbances and great fluctuation of
symptoms over time. throughout the day or notable differences between
morning and afternoon'.

Some epidemiological data reveal that only 25% of patients correctly

attribute their suffering to depression. Another 25% maintain that their
disease is an organic or functional disorder (attributable to somatic
symptoms, such as headaches, digestive disorders, inhibition of sexual
desire). 10% are convinced that they suffer from a pure psychic disorder, of
a neurotic or anxious type. And the remaining 40% do not consider
themselves sick and attribute their symptoms to life incidents (problems,
worries) or to their own way of being.

Men are less likely to suffer from depression than women. Men tend to be
more reluctant to admit that they have depression. Therefore, the diagnosis
of depression may be more difficult to make. Men are diagnosed less than
women. The suicide rate in men is four times higher than in women.
However, suicide attempts are more common in women than in men.
Alcohol and drugs mask depression in men more commonly than in women.
Likewise, the socially acceptable habit of overworking can mask depression.
In men, it is not uncommon for depression to manifest with irritability, anger
and discouragement, rather than feelings of hopelessness or helplessness.
Therefore, it may be difficult to recognize. Even when men realize that they
are depressed, compared to women, they are less likely to seek help. Family
support is generally an important help. Some companies offer mental health
programs for their employees. These can be of great help to man. It is
important for the depressed man to understand and accept the idea that
depression is a real illness that requires treatment. _____________________