Objective. To determine the validity of short Geriatric Depression Scale (GDS) versions for the detection of a major depressive episode according to ICD-10 criteria for research and DSM-IV. Design. Cross-sectional evaluation of depressive symptoms in a sample of elderly subjects with short GDS versions. DiAerent GDS cutoA points were used to estimate the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of major depressive episode. Internal consistency of the scales was estimated with the Cronbach's alpha coeAcient. Setting. Mental Health Unit for the Elderly of 'Santa Casa' Medical School in Sao Paulo, Brazil. Participants. Sixty-four consecutive outpatients aged 60 or over who met criteria for depressive disorder (current or in remission). Subjects with severe sensory impairment, aphasia or Mini-Mental State score lower than 10 were excluded from the study. Measurements. ICD-10 Checklist of Symptoms, GDS with 15, 10, 4 and 1 items, Montgomery-Asberg Depression Rating Scale (MADRS), ICD-10 diagnostic criteria for research and DSM-IV diagnostic criteria. Results. The use of the cutoA point 4/5 for the GDS-15 produced sensitivity and specificity rates of 92.7% and 65.2% respectively, and positive and negative predictive values of 82.6% and 83.3% respectively when ICD-10 diagnostic criteria for major depressive episode were used as the 'gold standard'. Similarly, rates of 97.0%, 54.8%, 69.6% and 94.4% were found when DSM-IV was the comparing diagnostic criteria. Sensitivity, specificity and positive and negative predictive values for the cutoA point 6/7 were 80.5%, 78.3%, 86.8% and 69.2% according to ICD-10, and 84.8%, 67.7%, 73.7% and 80.8% respectively according to DSM-IV. Intermediate values were found for the cutoA point 5/6. The best fit for GDS-10 was the cutoA point 4/5, which produced a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86.8% and negative predictive value of 60.2% according to ICD-10 diagnosis of a major depressive episode. Similarly, rates of 84.8%, 67.7%, 73.7% and 80.8% were found when DSM- IV criteria for major depression were used. GDS-4 cutoA point of 2/3 was associated with a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86.8% and negative predictive value of 69.2% when compared to ICD-10. Again, rates of 84.8%, 67.7%, 73.7% and 80.8% respectively were found when the criteria used were based on DSM-IV. GDS-1 had low sensitivity (61.0% and 63.6% for ICD-10 and DSM-IV respectively) and negative predictive value (56.7% and 67.6% for ICD-10 and DSM-IV respectively), suggesting that this question is of limited clinical utility in screening for depression. GDS-15 (rhoa 0.82), GDS-10 (rhoa 0.82) and GDS-4 (rhoa 0.81) scores were highly correlated with subjects' scores on the MADRS. Reliability coeAcients were 0.81 for GDS-15, 0.75 for GDS-10 and 0.41 for GDS-4. Conclusion. GDS-15, GDS-10 and GDS-4 are good screening instruments for major depression as defined by both the ICD-10 and DSM-IV. The shorter four- and one-item versions are of limited clinical value due to low reliability and failure to monitor the severity of the depressive episode. General practitioners may benefit from the systematic use of short GDS versions to increase detection rates of depression among the elderly. Copyright # 1999 John Wiley & Sons, Ltd. KEY WORDS—depression; GDS; short versions; assessment; screening; diagnosis; ICD-10; DSM-IV; validity; reliability

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

Statistical Methods in Medical Research.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)60879-5.pdf

Clinical diagnosis of depression in primary care: a meta-analysis

#### Summary points

Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030.w1 Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes from physical illness. Most clinicians will encounter older patients with depression in their day to day practice, but although treatment is as effective for older patients as for younger adults, the condition is often under-recognised and under-treated. According to WHO data, proportionately more people aged over 65 commit suicide than any other age group, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults.1

With a progressively ageing population worldwide, identification and treatment of depression in older adults becomes increasingly important, especially as older patients may have different presentations and needs than younger ones. We consider recent systematic reviews, meta-analyses, and randomised controlled trials to …

Depression in older adults

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.

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Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses

The Netherlands Study of Depression and Anxiety (NESDA) is a multi-site naturalistic cohort study to: (1) describe the long-term course and consequences of depressive and anxiety disorders, and (2) to integrate biological and psychosocial research paradigms within an epidemiological approach in order to examine (interaction between) predictors of the long-term course and consequences. Its design is an eight-year longitudinal cohort study among 2981 participants aged 18 through 65 years. The sample consists of 1701 persons with a current (six-month recency) diagnosis of depression and/or anxiety disorder, 907 persons with life-time diagnoses or at risk because of a family history or subthreshold depressive or anxiety symptoms, and 373 healthy controls. Recruitment took place in the general population, in general practices (through a three-stage screening procedure), and in mental health organizations in order to recruit persons reflecting various settings and developmental stages of psychopathology. During a four-hour baseline assessment including written questionnaires, interviews, a medical examination, a cognitive computer task and collection of blood and saliva samples, extensive information was gathered about key (mental) health outcomes and demographic, psychosocial, clinical, biological and genetic determinants. Detailed assessments will be repeated after one, two, four and eight years of follow-up. The findings of NESDA are expected to provide more detailed insight into (predictors of) the long-term course of depressive and anxiety disorders in adults. Besides its scientific relevance, this may contribute to more effective prevention and treatment of depressive and anxiety disorders.

/pdf/the-netherlands-study-of-depression-and-anxiety-nesda-4gh7bchgot.pdf

The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods.

BACKGROUND. Many scales have been developed to assess depression, but they are often too lengthy to be of practical use in general practice consultations. AIM. A study was undertaken to investigate the feasibility, reliability and diagnostic value of the geriatric depression scale and its shorter versions for screening in general practice. METHOD. A total of 586 consecutive consulting patients aged 65 years and over were studied in nine general practices in the west of the Netherlands (13 doctors). The 30-item version of the geriatric depression value was compared with the diagnostic interview schedule as a reference test. RESULTS. The reference test indicated a major depression in six patients while 27 patients had a dysthymic disorder (that is, a chronic mild depression). Five per cent of patients required help for 50% of the questions on the geriatric depression scale. The diagnostic value of the 30-item, 15-item, 10-item and four-item versions did not differ significantly, but the one-item version performed no better than chance. Two items discriminated best between patients who were and who were not depressed (P < 0.05), only one of which was included in a previously proposed four-item version of the scale. The reliability of the proposed four-item version was 0.64, the reliability of the other versions ranging from 0.70 to 0.87. CONCLUSION. The results for the different versions of the geriatric depression scale suggest the use of a 10-item or a four-item version. For practical purposes, the smallest subset would be the most desirable: the four-item version. These scales may be better suited for exclusion rather than inclusion purposes. The feasibility of screening for depression in elderly people in a general practice setting is discussed in the light of the results of the study.

Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (≥55 years) in primary care.

Design Longitudinal cohort study, with three years’ follow-up.

Setting 32 general practices in West Friesland, the Netherlands.

Participants 234 patients aged 55 years or more with a prevalent major depressive disorder.

Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Asberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis.

Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered.

Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.

https://www.bmj.com/content/bmj/338/bmj.a3079.full.pdf

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

Medical Education 2010:44: 156–164



Context  This study aimed to assess if an additional patient feedback training programme leads to better consultation skills in general practice trainees (GPTs) than regular communication skills training, and whether process measurements (intensity of participation in the programme) predict the effect of the intervention.



Methods  We carried out a controlled trial in which two sub-cohorts of GPTs were allocated to an intervention group (n = 23) or a control group (n = 30), respectively. In 2006, allocated first-year GPTs in the VU University Medical Centre attended a patient feedback training programme in addition to the regular communication skills training. The control group attended only regular communication skills training. Trainees were assessed by simulated patients who visited the practices and videotaped the consultations at baseline and after 3 months. The videotapes were randomly assigned to eight trained staff members. The MAAS-Global Instrument (range 0–6) was used to assess (a change in) trainee consultation skills. Results were analysed using a multi-level, linear mixed-model analysis.



Results  Data on 50 GPTs were available for the follow-up analysis. Both intervention group and control group GPTs improved their consultation skills: mean MAAS-Global scores for all participants were 3.29 (standard deviation [SD] 0.75) at baseline and 3.54 (SD 0.66) at follow-up (P = 0.047). The improvement in MAAS-Global scores in the intervention group did not differ significantly from the improvement in the control group. The analysis showed a trend for intensity of participation in the patient feedback programme to predict greater improvement in MAAS-Global scores.



Discussion  Although the baseline scores were already in the high range, consultation skills in both groups improved significantly. This is reassuring for current teaching methods. The patient feedback programme did not improve consultation skills more than regular communication skills training. However, a subgroup of GPTs who participated intensively in the programme did improve their consultation skills further in comparison with the less motivated subgroup.

H.W.J. van Marwijk

Papers

The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods.

Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

Does patient feedback improve the consultation skills of general practice trainees? A controlled trial

Controlled Interventions to Reduce Burnout in Physicians