Validation and factor structure of the Thai version of the EURO-D scale for depression among older psychiatric patients.
OBJECTIVE
To assess the concurrent and the construct validity of the Euro-D in older Thai persons.


METHODS
Eight local psychiatrists used the major depressive episode section of the Mini International Neuropsychiatric Interview to interview 150 consecutive psychiatric clinic attendees. A trained interviewer administered the Euro-D. We used receiver operating characteristic (ROC) analysis to assess the overall discriminability of the Euro-D scale and principal components factor analysis to assess its construct validity.


RESULTS
The area under the ROC curve for the Euro-D with respect to major depressive episode was 0.78 [95% confidence interval (CI) 0.70-0.90] indicating moderately good discriminability. At a cut-point of 5/6 the sensitivity for major depressive episodes is 84.3%, specificity 58.6%, and kappa 0.37 (95% CI 0.22-0.52) indicating fair concordance. However, at the 3/4 cut-point recommended from European studies there is high sensitivity (94%) but poor specificity (34%). The principal components analysis suggested four factors. The first two factors conformed to affective suffering (depression, suicidality and tearfulness) and motivation (interest, concentration and enjoyment). Sleep and appetite constituted a separate factor, whereas pessimism loaded on its own factor.


CONCLUSIONS
Among Thai psychiatric clinic attendees Euro-D is moderately valid for major depression. A much higher cut-point may be required than that which is usually advocated. The Thai version also shares two common factors as reported from most of previous studies.
Jirapramukpitak
Tawanchai
T
Department of Psychiatry, Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani, Thailand. tawanchaij@gmail.com
Darawuttimaprakorn
Niphon
N
Punpuing
Sureeporn
S
Abas
Melanie
M
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005060:Europe; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D025341:Principal Component Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013785:Thailand