The use of the SelfCARE(D) as a screening tool for depression in the clients of local authority home care services--a preliminary study.
BACKGROUND
The home care population has high levels of depressive disorder which is unrecognized and untreated. In the UK, social services are charged with a full assessment of need but there appears to be little systematic assessment of depressed mood in their assessment and review procedures. The performance of the SelfCARE(D), a 12-item self-administered depression rating scale, was tested in this population.


METHODS
Home care recipients in Lewisham East were invited to complete the SelfCARE(D). Random samples of groups scoring at different levels on the SelfCARE(D) were then interviewed using the GMS/AGECAT system in order to make a standardized psychiatric diagnosis. The sensitivity and specificity, and positive and negative predictive values (PPV and NPV) of the tests were calculated along with the area under ROC curves for different SelfCARE(D) cutpoints and definitions of disorder.


RESULTS
75% of the target population completed the SelfCARE(D). The data suggest that the most efficient cutpoint to use in this population appears to be 7/8, since this gave an NPV of 0.90, a PPV of 0.50 and a yield of 83% of cases of depression. This was achieved with having to complete a second-stage assessment on 17% less of the total population when compared with the 5/6 cutpoint and 9% less than the 6/7 cutpoint.


CONCLUSIONS
This study suggests that the SelfCARE(D) may be an acceptable and effective tool for the screening of depression in the home care population. The data presented here support an evaluation of its incorporation into social service assessment and review packages for their elderly home care clients.
Banerjee
S
S
Section of Old Age Psychiatry, Institute of Psychiatry, London, UK. spjussb@iop.bpmf.ac.uk
Shamash
K
K
MacDonald
A J
AJ
Mann
A H
AH
D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis*; D006699:Home Care Services; D006801:Humans; D008403:Mass Screening; D011237:Predictive Value of Tests; D011594:Psychometrics; D012372:ROC Curve; D018709:Statistics, Nonparametric