Improving the diagnostic accuracy of depression in older persons: the Depression in the Aged Female National Evaluation cluster randomized trial.
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.
Lattanzio
Fabrizia
F
Research Department, Istituto Nazionale Riposo e Cura Anziani, Ancona, Italy.
Di Bari
Mauro
M
Sgadari
Antonio
A
Baccini
Michela
M
Ercolani
Sara
S
Rengo
Franco
F
Senin
Umberto
U
Bernabei
Roberto
R
Marchionni
Niccolò
N
Cherubini
Antonio
A
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