Comparing three clinical screening tools in identification of geriatric depression in a rural community setting
Comparing three clinical screening tools in identification of geriatric depression in a rural community setting
Eman M Mahfouz*& Mahmoud M Mahfouz**
Abstract[عدل]
Background[عدل]
With the demographic transition, the elderly population is growing all over the world. Depression, currently considered as the ‘disease of the century’ ranks among the most significant health problems in older adults causing substantial morbidity, disability, functional decline, and mortality. Depression is reported in 13% of elderly community dwelling, and 24% of older medical outpatients, but there is a consensus that geriatric depression is underestimated. This is because older people in the community may not have contact with health services and because physicians may not screen for depression using the too lengthy tools leading to compounding of the depression problem. Efforts are needed to locate and identify those at risk and to provide care relevant to their needs. The Geriatric Depression Scale (GDS) is a screening instrument for depression in the elderly. Using a shortened GDS can greatly facilitate identification and assessment of depression in clinical and community settings.
Aim of the study[عدل]
Determining the toll of depression among geriatric rural population in El Minia as well as to assess the value of application of the shorter version of geriatric depression scale and two-questions from PRIME-MD for screening of depression.
Methodology[عدل]
The 15-item GDS, 5items GDS and two-questions from PRIME-MD completed by all participants during community visit. Subjects: 165 community dwellers aged 60 years and older were chosen randomly to be participated in the study and subjected to interview questionnaire administered to them at their household in Tehna Elgabal village, El Minia Governorate.
Results[عدل]
ROC curve analyses showed good agreement between 15-GDS, five-GDS and two-items PRIME-MD screener. Using GDS 15, it was found that nearly 30% of the participated geriatric rural populations in El Minia were moderately to severely depressed, while as 37.6% of them were categorized as so using GDS 5. Two items PRIMEMD screening categorized 24.2% as moderately- to- severely depressed. GDS was found to have a good specificity (0.85)in a representative sample of community-dwelling oldest old for the presence of major depression. This scale was developed as a basic screening measure for depression in older adults. 15-GDS is correlated to 5-GDS and Two items-PRIME-MD screener (r = 0.53, P < .000, r = 0.44, P =0.000) respectively. ROC curve analyses showed good agreement between 15-GDS and the 5-GDS as well as the Two-items PRIME-MD screener. It was found that 2 items (measuring depressed mood and anhedonia over the past month) demonstrated good sensitivity (88%) but only modest specificity (60%) compared with the 15-GDS. It was found that 5-GDS demonstrated excellent sensitivity (92%) but only fair specificity (50%) compared with the 15-GDS Interview Schedule.
Conclusion[عدل]
Nearly one fourth of community geriatric participated in the this study were found to be moderately to severely depressed using the 2-item PRIME-MD depression screening questionnaire which was found to be an efficient and effective way of separating patients with milder levels of depression from those with moderate to severe impairment. It was found that the short forms were adequate substitute for the long form and tends to be more suitable to be incorporated and widely used in primary care and community setting.
Key word[عدل]
Geriatric depression, screening, GDS
