University of Oulu

Seppänen, M., Lankila, T., Auvinen, J., Miettunen, J., Korpelainen, R., & Timonen, M. (2022). Cross-cultural comparison of depressive symptoms on the Beck Depression Inventory-II, across six population samples. BJPsych Open, 8(2), E46. doi:10.1192/bjo.2022.13

Cross-cultural comparison of depressive symptoms on the Beck Depression Inventory-II, across six population samples

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Author: Seppänen, Marjo1,2,3; Lankila, Tiina1,3; Auvinen, Juha2,4;
Organizations: 1Geography Research Unit, University of Oulu, Finland
2Center for Life Course Health Research, University of Oulu, Finland
3Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Finland
4Medical Research Center, Oulu University Hospital and University of Oulu, Finland
5Unit of General Practice, Oulu University Hospital, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Cambridge University Press, 2022
Publish Date: 2022-04-27


Background: The Beck Depression Inventory (BDI) and BDI-II (revised version) are some of the most widely used and comparable self-report scales for assessing the presence and severity of depressive symptoms in many countries. However, although the relative mean score of each symptom in different countries may vary, the cultural differences of BDI-II symptoms for each item have not been previously studied.

Aims: To examine the overall picture of the magnitude of the symptoms in the Finnish population, and compare the relative mean score of each symptom between all published population-based samples from different countries fulfilling the search criteria.

Method: We conducted a search for population-based studies reporting BDI-II item, using Scopus, PsycINFO and PubMed, and five population-based samples were identified. Relative average scores for each item of the scale were calculated for the Finnish population and five populations from other countries. Meta-regression methods were used to test the differences in the relative score of each symptom between each country separately, and results were then visually compared with spider charts.

Results: We found significant differences in several BDI-II item scores between countries: lower indecisiveness, higher changes in sleep pattern and higher irritability in Finland; higher loss of pleasure in Norway; higher loss of interest in the Dominic Republic; higher self-criticalness and feelings of punishment in Mexico; and higher sadness in Japan.

Conclusions: Based on the study fundings and including all currently published population-based samples with BDI-II scores, cultural differences in depressive symptoms should be considered when interpreting BDI-II item scores.

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Series: BJPsych open
ISSN: 2056-4724
ISSN-E: 2056-4724
ISSN-L: 2056-4724
Volume: 8
Issue: 2
Article number: E46
DOI: 10.1192/bjo.2022.13
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
515 Psychology
Funding: The NFBC received financial support from the University of Oulu (grant number 24000692), Oulu University Hospital (grant number 24301140) and European Regional Development Fund (grant number 539/2010 A31592). The study was financially supported by the Ministry of Education and Culture in Finland (grant numbers OKM/86/626/2014, OKM/43/626/2015, OKM/17/626/2016, OKM2017, OKM2018 and OKM2019), and Juho Vainio Foundation, Finland. The funders of the study did not have any role in the design of the study, data collection, analysis, interpretation or writing of the manuscript.
Copyright information: © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.