title: Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis.
abstract: BACKGROUND
  The Geriatric Depression Scale (GDS) has been evaluated in individual studies, but its validity and added value in medical settings and nursing homes is uncertain. Therefore, the authors conducted a meta-analysis, analyzing the diagnostic accuracy of long, short, and ultrashort versions of the GDS and stratified this into those with and without cognitive impairment.
  
  
  METHODS
  A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semistructured psychiatric interview, and of these, 43 analyses (in 36 publications) took place inmedical settings. Twenty-one studies examined the GDS₃₀, 12 studies examined the GDS₁₅, and 3 examined the GDS₄(/)₅. For comparison, the authors also summarized studies examining unassisted clinical judgment. Heterogeneity was moderate to high; therefore, random effects meta-analysis was used.
  
  
  RESULTS
  Across all studies, the prevalence of late-life depression was 29.2% (95% confidence interval [CI] = 24.7%–33.9%), with no difference between inpatients, outpatients, and nursing homes. Diagnostic accuracy of the GDS₃₀ aftermeta-analytic weighting was given by a sensitivity of 81.9% (95% CI = 76.4%–86.9%) and a specificity of 77.7% (95% CI = 73.0%–82.1%). For the GDS₁₅, sensitivity was 84.3% (95% CI = 79.7%–88.4%) and specificity was 73.8% (95% CI = 68.0%–79.2%). For the GDS₄(/)₅, the sensitivity and specificity were 92.5% (95% CI = 85.5%–97.4%) and 77.2% (95% CI = 66.6%–86.3%), respectively. Results were not significantly influenced by the presence of dementia. Concerning added value, when identification using the GDS was compared with routine clinicians’ ability to diagnose late-life depressions, at a prevalence of 30%, of every 100 attendees, the GDS₃₀ would help correctly identify an additional 22 people as depressed but at a cost of 13 additional false positives. The GDS₁₅ performed the same as GDS₃₀ but with 15 false positives. The ultrashort form would help identify an additional 25 true positives with only 10 false positives. Thus, the best option when choosing between versions of the GDS seems to be the GDS₄(/)₅.
  
  
  CONCLUSIONS
  All versions of the GDS yield potential added value in medical settings, but the GDS₄(/)₅ is the most efficient. In nursing homes, given an absence of data on the GDS₄(/)₅, the GDS₁₅ may be preferred until more studies are reported.
authors.affiliation: Leicester General Hospital, Leicestershire Partnership Trust, UK. ajm80@le.ac.uk
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: Vicky
authors.initials: V
authors.lastname: Bird
authors.forename: Maria
authors.initials: M
authors.lastname: Rizzo
authors.forename: Nicholas
authors.initials: N
authors.lastname: Meader
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D009735:Nursing Homes; D010045:Outpatients / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity