title: The Kimberley assessment of depression of older Indigenous Australians: prevalence of depressive disorders, risk factors and validation of the KICA-dep scale.
abstract: OBJECTIVE
  This study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population.
  
  
  METHODS
  Cross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from 'never' to 'all the time' (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history.
  
  
  RESULTS
  The study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8).
  
  
  CONCLUSIONS
  The KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities.
authors.affiliation: School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
authors.affiliation: Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fenner
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Smith
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Hyde
authors.affiliation: Rural Clinical School, University of Western Australia, Perth, Australia; Kimberley Aboriginal Medical Services, Broome, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Skeaf
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Malay
authors.affiliation: WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia; Aged Care, Melbourne Health, Melbourne, Australia.
authors.forename: Dina
authors.initials: D
authors.lastname: LoGiudice
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014904:Western Australia / Q000453:epidemiology
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