Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions.
BACKGROUND
depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE).


METHODS
one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15).


RESULTS
a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%.


CONCLUSIONS
the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases.
Lincolnshire Partnership NHS Foundation Trust, Sleaford, Lincolnshire, UK.
Collins
C
Esiwe
Department of Health Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
Sarah
S
Baillon
Tees, Esk and Wear Valley NHS Trust, County Durham, UK.
Aniruddha
A
Rajkonwar
Department of Health Sciences, University of Leicester, Leicester, UK.
James
J
Lindesay
Department of Geriatric Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Nelson
N
Lo
College of Medicine, Swansea University, Swansea, UK.
Michael
M
Dennis
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D004739:England; D005260:Female; D015577:Geriatric Assessment; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards
acute medical wards; depression; older people; screening