Keywords
Adolescent Depression
Cross-Cultural Validation
Low- and Middle-Income Countries (LMICs)
Measurement Invariance
How to Cite
Abstract
Background: The Beck Depression Inventory (BDI-I/II) versions are widely used for identifying depression among adolescents in low- and middle-income countries (LMICs). Nevertheless, their global usage depends on the questionable assumption that symptoms are expressed the same way in different cultures.
Methods: This comprehensive review used narrative synthesis to explore the psychometric, conceptual, and ethical aspects of the BDI studies done on adolescents in LMICs. We purposively selected 8 case exemplars from the literature based on a pre-specified framework to illustrate key cross-cultural and methodological issues. A custom rubric was used to weight studies by methodological quality. Invariance evidence was defined as explicit reporting of multi-group confirmatory factor analysis (MGCFA) for configural, metric, or scalar invariance.
Results: Although the BDI showed high internal consistency across the 8 exemplar studies (Cronbach’s α: 0.79–0.96), it revealed significant psychometric variation across cultures. Somatic items showed substantial overlap with medical comorbidities (e.g., HIV, malnutrition) in vulnerable populations, confounding diagnostic specificity. Factor structures were inconsistent, and rigorous measurement invariance testing was largely absent.
Discussion: The widespread absence of scalar invariance suggests that current cross-cultural score comparisons may reflect measurement artifacts rather than true differences in depression severity. Beyond psychometrics, BDI presents ethical challenges regarding developmentally inappropriate items, particularly concerning sexuality and suicidality, that limit its validity in conservative or resource-limited contexts.
Conclusion: Investigations into this issue should focus more on the use of invariance-testing frameworks, the implementation of a mixed-methods strategy, and the recognition of the need for sensitive translation and culturally appropriate assessment techniques.
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