title: Identifying psychological distress in elderly seeking health care.
abstract: BACKGROUND
  Psychological distress in the elderly with various illness conditions often goes unrecognized. Since psychological distress is treatable, it is important to recognize it at the earliest to enhance recovery. This is an interim analysis of screening data of the elderly seeking health care in a hospital in India, with a focus on the 12-item General Health Questionnaire (GHQ-12), a screening instrument for psychological distress and a rationale for a higher cutoff score in help seeking elderly.
  
  
  METHODS
  A retrospective analysis of screening data of psychological distress using GHQ-12 in the elderly seeking care for neuropsychiatric conditions was carried out. Traditionally, ≥2 is considered positive for distress by GHQ-12. Receiver Operating Characteristic (ROC) curve was used to define new cutoff points for psychological distress.
  
  
  RESULTS
  At ≥2, 2443 (50%) of the elderly screened were recognized to be psychologically distressed. Using an ROC and optimum sensitivity and specificity measures, a cutoff score of ≥4 was observed to detect 30% of the elderly who had diagnosable mental health disorders. Female sex, illiteracy, and multiple co-morbidities were the factors that were associated with higher cutoff scores on GHQ-12 proposed here and psychiatric morbidity thereof.
  
  
  CONCLUSIONS
  There is greater psychological distress among the elderly seeking health care. Hence, it is important to screen them and identify those at higher risk. Using a higher cutoff score with a standardized instrument like GHQ-12 indicated that it was statistically valid to identify those elderly with higher distress in a busy out-patient setting.
authors.forename: Prafulla
authors.initials: P
authors.lastname: Shivakumar
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sadanand
authors.affiliation: Professor of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Srikala
authors.initials: S
authors.lastname: Bharath
authors.forename: N
authors.initials: N
authors.lastname: Girish
authors.forename: Mariamma
authors.initials: M
authors.lastname: Philip
authors.forename: Mathew
authors.initials: M
authors.lastname: Varghese
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012372:ROC Curve; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology*