Structured self-reports, such as Beck's Depression Inventory (BDI) are widely used in assessing adolescents’ psychological wellbeing.

To investigate what factors are associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population.

To recognize what factors may contribute to high BDI scores besides depressive symptoms.

The study population consisted of 206 adolescents (13–17 years old) who were hospitalised for the first time in adolescent psychiatry and 203 age and gender matched adolescents recruited from schools in the same region. Study subjects filled self-reports on depression symptoms (BDI-21), substance misuse (AUDIT), psychiatric symptoms (SCL-90), defense styles (DSQ-40) and self-image (OSIQ). Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. Information on background and life events was gathered from study subjects.

We compared subjects who scored in BDI-21 either 0–15 points or 16–63 points firstly among subjects who did not fill diagnostic criteria for current unipolar depression and secondly among those who did fulfill the diagnostic criteria. High BDI-21 scores in subjects without depression diagnosis were associated with female sex, older age, several adverse life events, higher psychiatric co-morbidity, worse self-image and more immature, neurotic and image-distorting defense styles (and less mature defense style). Low BDI-21 scores among subjects with depression diagnosis were associated with male sex, more positive self-image and less immature defense style.

High BDI-21 scores may reflect a broad range of challenges in an adolescent's psychological development even in the absence of depression.

The authors have not supplied their declaration of competing interest.