Screening for depression in African-Caribbean elders.
BACKGROUND
There are increasing numbers of older African-Caribbeans in the UK. Primary care staff often feel less confident about diagnosing depression in this group. Screening instruments may assist in making diagnoses in cross-cultural consultations.


OBJECTIVE
We aimed to determine the sensitivity and specificity of screening instruments for depression in older African-Caribbean people in Manchester, UK.


METHODS
We carried out a two-stage study to compare three screening instruments for depression (Geriatric Depression Scale, Brief Assessment Schedule Depression Cards, Caribbean Culture Specific Screen), with a computerized diagnostic interview for mental health disorders in older adults (Geriatric Mental State). The study was set in inner-city Manchester. The subjects were community-resident African-Caribbeans aged 60 years and over; 227 subjects were approached. Of the 160 people screened, 130 agreed to diagnostic interview. The main outcome measures were Spearman correlation coefficients; these were calculated between each screening instrument and the diagnostic interview. Receiver-operating characteristic (ROC) curve analysis was used to determine appropriate sensitivity and specificity for each instrument.


RESULTS
The results for the largest subgroup, the Jamaicans (n = 96/130), demonstrated highly significant correlations between screening instruments and diagnostic interview (P < 0.001). Each instrument had a high sensitivity: Brief Assessment Schedule depression cards (cut-off > or =6; sensitivity 90.9% (95% CI 58.8-99.8), specificity 82.1% (95% CI 74.0-90.3)), Caribbean Culture Specific Screen (cut-off > or =6; sensitivity 90.9% (95% CI 58.8-99.8), specificity 74.1% (95% CI 64.8-83.4)), and Geriatric Depression Scale (cut-off > or =4; sensitivity 100% (95% CI 97.1-100), specificity 69.1% (95% CI 59.6-79.2)).


CONCLUSIONS
These screening instruments demonstrate high sensitivity levels, if an appropriate cut-off point is used. The culture-specific instrument did not perform better than the traditional instruments. Health professionals should approach the consultation in a culturally sensitive manner and use the validated instrument they are most familiar with.
Rait
G
G
Department of Primary Care & Population Sciences, University College London and Royal Free Medical Schools, Whittington Hospital.
Burns
A
A
Baldwin
R
R
Morley
M
M
Chew-Graham
C
C
St Leger
A S
AS
Abas
M
M
D017677:Age Distribution; D000368:Aged; D044383:Black People / Q000235:genetics*; D017691:Caribbean Region / Q000208:ethnology; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D012372:ROC Curve; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology