October 1, 1992
View Full PaperScreening for Depression in Hospitalized Elderly Medical Patients: Taking a Closer Look
Key Result
The Geriatric Depression Scale and Brief Carroll Depression Rating Scale demonstrated sensitivities of 82% and 73%, and specificities of 76% and 79%, for detecting major depressive disorder.
Study Design
Type
Cross-Sectional (n=109)
Blinding
Masked
Multicenter
No
Structured PICO
What are the test characteristics of the GDS and BCDRS for detecting major depressive disorder in hospitalized elderly medical patients?
P
Population
109 consecutively admitted medical inpatients aged 70 or over evaluated for major depressive disorder using the GDS and BCDRS.
E
Exposure
Screening for depression using the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS)
C
Comparator
Structured psychiatric interview to determine the presence of major depressive disorder (MDD)
O
Outcome
Sensitivity and specificity of the GDS and BCDRS for detecting major depressive disordersurrogate
The diagnostic accuracy of the GDS and BCDRS in hospitalized elderly medical patients is lower than previously reported, which may impact their clinical utility for depression screening.
Main Result
Absolute Event Rate: 82% vs 73%
Abstract
OBJECTIVE: To re-examine the test characteristics of the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS) in elderly medical inpatients, simulating the procedure followed by clinicians when using screening instruments. DESIGN: Masked comparison of GDS and BCDRS with psychiatric interview. SETTING: Durham VA Medical Center. PARTICIPANTS: 109 consecutively admitted persons aged 70 or over. MEASUREMENTS: Screening by a social worker using GDS and BCDRS on day one, followed the next day by an investigator's structured psychiatric interview to determine the presence of major depressive disorder (MDD). RESULTS: By this method, the sensitivity and specificity of the GDS (cutoff 11) were 82% and 76%, respectively; for the BCDRS (cutoff 6), they were 73% and 79%. Among those with a negative test, the likelihood of MDD dropped from an a priori probability of 10% to an a posteriori probability of 3% with the GDS and 4% with the BCDRS. Among those with a positive test, the likelihood of MDD was 27% for the GDS and 28% for the BCDRS. Excluding patients with cognitive impairment (MMSE < or = 25) only slightly improved test characteristics. CONCLUSION: These estimates are considerably below those reported in earlier studies where concordant screening, two-stage screening, or other methods have been utilized and may impact the decision whether or not to screen for depression using these instruments.