Minimal clinically important difference on the Beck Depression Inventory - II according to the patient's perspective

Katherine S Button*, Daphne-Zacharenia Kounali, Leonie B Thomas, Nicola J Wiles, Tim Peters, Nicky J Welton, A E Ades, G Lewis

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

197 Citations (Scopus)
35 Downloads (Pure)


BACKGROUND: The Beck Depression Inventory, 2nd edition (BDI-II) is widely used in research on depression. However, the minimal clinically important difference (MCID) is unknown. MCID can be estimated in several ways. Here we take a patient-centred approach, anchoring the change on the BDI-II to the patient's global report of improvement.

METHOD: We used data collected (n = 1039) from three randomized controlled trials for the management of depression. Improvement on a 'global rating of change' question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency, assessing whether MCID is best measured in absolute terms (i.e. difference) or as percent reduction in scores from baseline (i.e. ratio), and receiver operator characteristics (ROC) to estimate MCID according to the optimal threshold above which individuals report feeling 'better'.

RESULTS: Improvement in BDI-II scores associated with reporting feeling 'better' depended on initial depression severity, and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score. We estimated a MCID of a 17.5% reduction in scores from baseline from ROC analyses. The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32%.

CONCLUSIONS: MCID on the BDI-II is dependent on baseline severity, is best measured on a ratio scale, and the MCID for treatment-resistant depression is larger than that for more typical depression. This has important implications for clinical trials and practice.

Original languageEnglish
Pages (from-to)3269-3279
Number of pages11
JournalPsychological Medicine
Issue number15
Early online date13 Jul 2015
Publication statusPublished - 1 Nov 2015

Structured keywords

  • ConDuCT-II
  • Brain and Behaviour
  • Tobacco and Alcohol


  • 2nd edition (BDI-II)
  • Beck Depression Inventory
  • depression
  • minimal clinically important difference
  • outcome assessment
  • primary care


Dive into the research topics of 'Minimal clinically important difference on the Beck Depression Inventory - II according to the patient's perspective'. Together they form a unique fingerprint.
  • ConDuCT-II

    Blazeby, J.


    Project: Research


    Welton, N. J.


    Project: Research

Cite this