Screening accuracy for late-life depression in primary care: A systematic review

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Applied Evidence

Screening accuracy for late-life depression in primary care: A systematic review

J Fam Pract. 2003 December;52(12):956-964

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References

1. Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 1999;60(suppl 20):9-15.

2. US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, Va: International Medical Publishing; 1996.

3. Pignone MP, Gaynes BN, Rushton JL, et al. Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;136:765-776.

4. Lijmer JG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999;282:1061-1066.

5. D’Ath P, Katona P, Mullan E, Evans S, Katona C. Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract 1994;11:260-266.

6. Gerety MB, Williams JW, Jr, Mulrow CD, et al. Performance of case-finding tools for depression in the nursing home: influence of clinical and functional characteristics and selection of optimal threshold scores. J Am Geriatr Soc 1994;42:1103-1109.

7. Neal R, Baldwin R. Screening for anxiety and depression in elderly medical outpatients. Age and Ageing 1994;23:461-464.

8. van Marwijk HV, Wallace P, de Bock GD, Hermans J, Kapteinaa Mulder JD. Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Prac 1995;45:195-199.

9. Arthur A, Jagger C, Lindesay J, Graham C, Clarke M. Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice. Int J Geriatr Psychiatry 1999;14:431-439.

10. Hoyl MT, Alessi CA, Harker JO, et al. Development and testing of a five-item version of the Geriatric Depression Scale. J Am Geriatr Soc 1999;47:873-878.

11. Rait G, Burns A, Baldwin R, et al. Screening for depression in African-Caribbean elders. Fam Pract 1999;16:591-595.

12. Abas MA, Phillips C, Carter J, Walter S, Banerjee S, Levy R. Culturally sensitive validation of screening questionnaires for depression in older African-Caribbean people living in south London. Br J Psychiatry 1998;173:249-254.

13. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, de Vries MR, Van Tillburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med 1997;27:231-235.

14. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 1997;12:277-287.

15. Lyness JM, Noel TK, Cox C, et al. Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med 1997;157:449-454.

16. Papassotiropoulos A, Heun R, Maier W. The impact of dementia on the detection of depression in elderly subjects from the general population. Psychol Med 1999;29:113-120.

17. Papassotiropoulos A, Heun R. Detection of subthreshold depression and subthreshold anxiety in the elderly. Int J Geriatr Psychiatry 1999;14:643-650.

18. Bird A, Macdonald A, Mann A, et al. Preliminary experience with the SelfCARE(D): a self-rating depression questionnaire for use in elderly, non-institutionalized subjects. Int J Geriatr Psychiatry 1987;2.

19. Upadhyaya AK, Stanley I. Detection of depression in primary care comparison of two self. administered scales. Int J Geriatr Psychiatry 1997;12:35-37.

20. Banerjee S, Shamash K, MacDonald AJ, et al. The use of the SelfCARE(D) as a screening tool for depression in the clients of local authority home care services-a preliminary study. Int J Geriatr Psychiatry 1998;13:695-699.

21. Howe A, Bath P, Goudie F, et al. Getting the questions right: an example of loss of validity during transfer of a brief screening approach for depression in the elderly. Int J Geriatr Psychiatry 2000;15:650-655.

22. Vida S, Des Rosiers P, Carrier L, Gauthier S. Depression in Alzheimer’s disease: receiver operating characteristic analysis of the Cornell Scale for Depression in Dementia and the Hamilton Depression Scale. J Geriatr Psychiatry Neur 1994;7:159-162.

23. Sheik J, Yesavage J. Geriatric Depression Scale (GDS): recent findings and development of a shorter version. New York, NY: Howarth Press; 1986.

24. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17:37-49.

25. Fountoulakis KN, Tsolaki M, Iacovides A, et al. The validation of the short form of the Geriatric Depression Scale (GDS) in Greece. Aging (Milano) 1999;11:367-372.

26. Lim PP, Ng LL, Chiam PC, Ong PS, Ngui FT, Sahadevan S. Validation and comparison of three brief depression scales in an elderly Chinese population. Int J Geriatr Psychiatry 2000;15:824-830.

27. Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999;14:858-865.

28. Mulrow CD, Williams JW, Jr, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med 1995;122:913-921.

29. Alexopoulos G, Abrams R, Young R, Shamoian CA. Use of the Cornell Scale in Nondemented Patients. J Am Geriatr Soc 1988;36:230-236.

30. Alexopoulos G, Abrams R, Young R, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.

31. Harwood D, Ownby R, Barker W, Duara R. The factor structure of the Cornell Scale for Depression in Dementia among probable Alzheimer’s disease patients. Am J Geriatr Psychiatry 1998;6:212-220.

32. Weyerer S, Killmann U, Ames D, Allen N. The Even Briefer Assessment Scale for Depression (EBAS DEP): its suitability for the elderly in geriatric care in English-and German- speaking countries. Int J Geriatr Psychiatry 1999;14:473-480.

33. Pomeroy IM, Clark CR, Philp I. The effectiveness of very short scales for depression screening in elderly medical patients. Int J Geriatr Psychiatry 2001;16:321-326.

34. Howe A, Bath P, Goudie F, et al. Getting the questions right: an example of loss of validity during transfer of a brief screening approach for depression in the elderly. Int J Geriatr Psychiatry 2000;15:650-655.

35. Lyketsos G, Baker L, Warren A, et al. Major and minor depression in Alzheimer’s disease: prevalence and impact. J Neuropsychiatry Clin Neurosci 1997;9:556-561.

36. Lyness JM, King DA, Cox C, Yoediono Z, Caine ED. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. J Am Geriatr Soc 1999;47:647-652.

37. Hendrie H, Callahan C, Levitt E. Prevalence rates of major depressive disorders: the effect of varying diagnostic criteria in an older primary care population. Am J Geriatr Psychiatry 1995;3:119-131.

38. Unutzer J, Patrick D, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. JAMA 1997;277:1618-1623.

39. Lavretsky H, Kumar A. Clinically significant non-major depression: old concepts, new insights. Am J Geriatr Psychiatry 2002;10:239-255.

40. Lebowitz BD, Pearson JL, Schneider LS, et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997;278:1186-1190.

This review also reveals a lack of screening accuracy for nonmajor depressive disorders using 3 common instruments. Lyness and colleagues³⁶ showed that there is considerable functional disability in subsyndromal depression, which is more prevalent than major depression. Others show similar findings, supporting the significant morbidity caused by depressive symptoms not severe enough to cross threshold for a major disorder.^37,38 As the characterization of nonmajor depressive disorders evolves, screening instruments should be developed and validated specifically for these syndromes.³⁹

Late-life depressive disorders have a convincing burden of suffering, often go undetected, and have known effective treatments.⁴⁰ Our systematic review reveals that accurate screening instruments are available to detect major depression in older primary care patients. Based on format and length ( Table 2 ), several could easily be self-administered or administered by nonclinicians in the waiting room. We recommend the 15-item GDS ( Figure ) because of its yes/no format and ease of scoring. Future work should include tests of depression screening accuracy for demented populations, and for nonmajor depressive disorders. Investigators should also evaluate the accuracy of very short instruments, such as the 5-item version of the GDS¹⁰ in the primary care setting. Acceptable administration times and ease of use is likely to determine the realistic application of proven instruments.

TABLE 2
Selected screening instruments and their characteristics

Instrument	Format	Item	Time to administer	Sn (%)	Sp (%)
GDS-15	Yes/no questions about current symptoms	15	2–3 minutes	82–100	72–82
CES-D	Rates frequency of selected symptoms over last week	20	2–3 minutes	74–93	70–87
SelfCareD	Multiple choice responses regarding symptoms over last month	12	2–3 minutes	77–95	53–98
GDS-15: Geriatric Depression Scale, 15-item; CES-D: Center for Epidemiologic Study-Depression; Sn, sensitivity; Sp, specificity. Sensitivity and specificity values represent the range reported from the eligible studies in our review.

FIGURE
Geriatric Depression Scale, 15-item

Acknowledgments

The authors would like to thank Dr. Carmen Lewis for her thoughtful review of this manuscript. The authors report no competing interests. Funding sources: Robert Wood Johnson Clinical Scholars Program; Agency for Healthcare Research and Quality contract # 290-97-0011.

Corresponding author
Lea C. Watson MD, MPH, Geriatric Psychiatry, Box 3903, Duke University Medical Center, Durham, NC 27710. E-mail: watso069@mc.duke.edu.