Recognising depression in residential facilities: an Australian challenge.
BACKGROUND
Depression in aged care facilities (ACFs) is reportedly under-recognised and under-treated. Observer-rated and self-rated depression rating scales can help identify cases of depression, and could be used to estimate the prevalence of depression in ACFs.


METHODS
Direct care staff in 168 ACFs used a survey form and administered the Cornell Scale for Depression in Dementia (CSDD) and (in those able to be tested) the 15-item Geriatric Depression Scale (GDS-15) to every fourth resident. In seven facilities the same subjects were clinically assessed and (where appropriate) diagnosed by a psychiatrist.


RESULTS
Survey forms and CSDD ratings were completed by staff concerning 91.6% of the one-in-four selected subjects. Their mean age was 82.1 years. CSDD scores of 8 or more, indicating depression, were recorded for 34.7% of the ACF residents, comprising 40.5% of the 1,084 high care (nursing home level) residents, and 25.4% of the 674 low care residents. Of 1,250 residents tested with the GDS-15, 41.1% scored 6 or more, indicating depression. The correlation between GDS-15 and CSDD scores was 0.6. Use of the survey tool allowed staff to identify which factors were most strongly associated with depression, the strongest being grief over loss of abilities and opportunities to participate in valued activities.


CONCLUSIONS
The CSDD (and the GDS-15 in those without severe cognitive impairment) proved useful in identifying residents who were depressed. Survey questions helped draw attention to factors of importance in development or persistence of these depressions, and hence to strategies for intervention.
Snowdon
John
J
Discipline of Psychological Medicine, University of Sydney, Sydney, Australia. jsnowdon@mail.usyd.edu.au
Fleming
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009726:Nurses / Q000592:standards; D009735:Nursing Homes; D011569:Psychiatric Status Rating Scales