title: Improving the diagnostic accuracy of depression in older persons: the Depression in the Aged Female National Evaluation cluster randomized trial.
abstract: OBJECTIVE
  To evaluate whether a training intervention can improve the ability of geriatricians to recognize depression in older persons.
  
  
  METHODS
  Multicenter, cluster randomized clinical trial.
  
  
  METHODS
  Fourteen geriatric outpatient clinics in Italy, each representing the unit of randomization.
  
  
  METHODS
  After training, a total of 1,914 outpatients aged 65 years and older in both arms, not on antidepressant at entry, were blindly evaluated by the clinic geriatrician, in charge of routine clinical management, and by a field researcher, who formally diagnosed depression by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), taken as the criterion standard.
  
  
  METHODS
  After randomization, geriatricians belonging to the intervention arm were assigned to receive a residential 3-day educational program on depression. Those in the control arm received a generic course on disease management in elderly people.
  
  
  METHODS
  Sensitivity and specificity of the diagnosis of depression made by geriatricians, compared with the DSM-IV diagnosis.
  
  
  RESULTS
  Sensitivity and specificity were significantly higher in trained than in untrained geriatricians (49 vs 35% and 91 vs 88%, respectively; P=.002 in marginal regression models). Effectiveness of training was confirmed, adjusting for age, sex, and cognitive performance (P=.02).
  
  
  CONCLUSIONS
  The ability of geriatricians to diagnose depression in older outpatients can be improved with a specific training intervention. Improvement of diagnostic performance might translate into more-appropriate clinical management.
authors.affiliation: Research Department, Istituto Nazionale Riposo e Cura Anziani, Ancona, Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: Antonio
authors.initials: A
authors.lastname: Sgadari
authors.forename: Michela
authors.initials: M
authors.lastname: Baccini
authors.forename: Sara
authors.initials: S
authors.lastname: Ercolani
authors.forename: Franco
authors.initials: F
authors.lastname: Rengo
authors.forename: Umberto
authors.initials: U
authors.lastname: Senin
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D005853:Geriatrics / Q000193:education; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D018579:Patient Selection; D012680:Sensitivity and Specificity