Screening for depression in hospitalized elderly medical patients: taking a closer look.
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.


METHODS
Masked comparison of GDS and BCDRS with psychiatric interview.


METHODS
Durham VA Medical Center.


METHODS
109 consecutively admitted persons aged 70 or over.


METHODS
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.


CONCLUSIONS
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.
Koenig
H G
HG
Division of Geriatric Psychiatry, Duke University Medical Center, Durham, North Carolina.
Meador
K G
KG
Cohen
H J
HJ
Blazer
D G
DG
D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005069:Evaluation Studies as Topic; D015577:Geriatric Assessment; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D007406:Interview, Psychological / Q000592:standards; D016013:Likelihood Functions; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D009657:North Carolina / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity