Age and Ageing 2000; 29: 511-515
© 2000, British Geriatrics Society
Research papers |
Development and validation of a brief observer-rated screening scale for depression in elderly medical patients
Geriatric Medicine, University Clinical Department, The Duncan Building, Daulby Street, Liverpool L69 3GA, UK
1 Department of Geriatric Medicine, St Michael's Hospital, Dun Laoghaire, County Dublin, Republic of Ireland
2 Department of Clinical Geriatric Medicine, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, County Durham NE9 65X, UK
Abstract
Objective: to develop a depression screening scale that does not rely on verbal communication.
Setting: an acute geriatric unit in a teaching hospital.
Subjects: 96 patients (mean age 81 years, range 68–92, 59 women); 40% of the initial study group of 50 and 22% of the validation group of 46 were diagnosed as depressed.
Methods: we devised a scale using nine items which could be rated by an observer; we determined inter-rater reliability, sensitivity, specificity and predictive values for each item compared with a Geriatric Mental State-AGECAT diagnosis of depression; we validated a final scale of six items.
Results: inter-rater reliability was poor for two items (irritability and sleep disturbance) while two items (sleep disturbance and night sedation) had poor sensitivity; we omitted these items in a revised scale. Re-analysis of data from the initial study showed that a cut-off of 
3 on the revised scale gave a sensitivity of 83%, a specificity of 95%, a positive predictive value of 0.89 and a negative predictive value of 0.90. Spearman's correlation coefficient between the six-item questionnaire and the Hamilton rating scale was 0.79. In the validation study, the cut-off score of 3 on the revised six-item scale had a sensitivity of 90%, specificity of 72%, a positive predictive value of 0.69 and a negative predictive value of 0.96.
Conclusions: this simple, short, observation-based screening scale completed by nurses is sensitive and specific in identifying depression in elderly medically ill patients, and may be a useful addition to clinical practice.
Keywords: depression, older people, screening scales
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