Bigger Dragon, Better Weapon

“A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.”

– Elizabeth Wurtzel, Prozac Nation

Depression sucks.

It literally sucks the hope, the will and the joy from people. In the end, if untreated, that dark lumbering dragon of depression is a deadly beast.

Depression is also everywhere. As reported by the Centers for Disease Control, Major Depression is the leading cause of disability for Americans between the ages of 15 and 44, characterized by debilitating “feelings of hopelessness, despondency, and/or guilt.” Even if it does not rise to the degree of major depression “the key take-away is that depression is a powerful condition” hurting over 18 million people and costing over $80,000,000,000 per year “due to lost productivity and health care” (Iliades, 2013, Holms, 2015).

According to Dr. Chris Illades (2013) “the earlier you start treatment, the more likely you are to get a handle on the condition. The best defense against depression may very well be knowledge and awareness.” Treatment and awareness are both achieved through diagnosis, the earlier the better. Overwhelmingly most often that treatment starts with the Beck Depression Inventory II.

Back in 1990 the BDI (from the 60s) had some problems with certain items failing to discriminate adequately across the range of depression and other items showing gender bias,” said Pr. Arbisi (2006) of the Buros Institute of Mental Measurements, “Hence the time had come for a conceptual reassessment and psychometrically informed revision of the instrument” which was completed in 1996.

That was twenty years ago. Counselors, myself included, use the BDI-II all across the world, every day. In our more diverse America of 2016, fighting a disorder so rampant that the World Health Organization calls it an epidemic, with rates that have “risen dramatically in the past 50 years” the time has come for counselors to sharpen our assessment tools and increase their scope.

A Universal Weapon in a Universal Fight

“I’ll never forget how the depression and loneliness felt good and bad at the same time. Still does.”

– Henry Rollins, The Portable Henry Rollins

The ACA code states that counselors are to “select and use with caution” any “assessment techniques normed on populations other than the client” because an un-normed test can skew results (2016).

In terms of the Beck Depression Inventory II, both Arbisi and Farmer (2001) observe that there’s something about the BDI that has withstood the last fifty years, for it to be still one of the most—if not the most—widely used depression assessment tool in the world. This is because it “is presented as a user-friendly self-report measure” which can work for anyone “13 years of age and older” and be “completed within 5 to 10 minutes” (Farmer, 2006).

But there are some significant holes in that world-wide net. According to Farmer (2006) “Despite the many impressive features of this measure, one may wonder why the test developers were not…more rigorous in the evaluation of its effectiveness. The clinical sample used…seems unrepresentative in many respects (e.g., racial make-up, patient setting, geographic distribution), and other aspects of this sample (e.g., education level, family income) go unmentioned. The student sample is relatively small and, unfortunately, drawn from a single university.”

Age and race “make a difference in the prevalence of depression” according to Pr. Arbisi, but in counselors’ offices all across the world, a measure is being used to assess depression which may not be normed on the most affected populations. The American Journal of Psychiatry found that “major depression rates for American adults increased from…from 1991 through 2002” and have continued that trend until more than “5 percent of the global population [is] suffering from the condition” today (Iliades, 2013).

With 350,000,000 people of all races affected by some form of depression and “women being 70% more likely than men to experience depression in their lifetime” it seems crucial that counselors have a measure to help fight the disorder which once again reflects the climate of the times, as was the reason for the BDI revision twenty years ago (Holms, 2015).

Returning to the Master

“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.”

– Stephen Fry, British Actor

Arbisi (2006) said that, the Beck II was developed because, though none could refute “the demonstrated utility of the Beck, times had changed and the diagnostic context within which the instrument was developed had altered considerably over the years” and merited a “retooling of the content to reflect diagnostic sensibilities of the 1990s.” Despite the race and gender issues noted, the psychological community in the 90s and 2000s overwhelmingly said the revision was sound, reliable and such an improvement that “the BDI-II deserves to replace the BDI as the single most widely used clinically administered instrument for the assessment of depression” and so it has been for the last twenty years (Farmer, 2006).

But depression continues to rise and steal the lives and hope of millions around the world. It’s time to go back to the master—not seek other resources—to improve the assessment which remains the counselor’s “old faithful” weapon in the fight against depression; aiding treatment and awareness with the Beck.

It’s been twenty years since the Beck Depression Inventory II was retooled. It is still used as pervasively, but again the times have changed and the culture has shifted context. It’s time for the Beck III.

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American Counseling Association Code of Ethics, 2016.

Arbisi, P. A. (2001). Review of the Beck Depression Inventory-II. In B. S. Plake & J. C. Impara (Eds.), The fourteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements.

Farmer, R. F. (2001). Review of the Beck Depression Inventory-II. In B. S. Plake & J. C. Impara (Eds.), The fourteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements.

Holms, L. (2015) 11 Statistics That Will Change The Way You Think About Depression Retrieved from: http://www.huffingtonpost.com/2015/01/20/depression-statistics_n_6480412.html

Iliades, C. (2013) Stats and Facts About Depression in America. Everyday Health. Retrieved from: http://www.everydayhealth.com/hs/major-depression/depression-statistics/