Validity of the 30-item geriatric depression scale in patients with Parkinson's disease.

Depression in Parkinson's disease (dPD) is difficult to diagnose because depressive symptoms can overlap with symptoms of Parkinson's disease (PD). Subject-rated scales such as the 30-item Geriatric Depression Scale (GDS) may be useful in screening for dPD. There were 57 patients (33 men, 24 women; mean age, 58.6 years [SD +/- 8.4]) enrolled in a study of pallidotomy for intractable PD who were evaluated for depression before and after surgery. Subjects were evaluated using the 17-item Hamilton Depression Rating Scale (HDRS), Structured Clinical Interview for Diagnostic and Statistical Manual-III (SCID), and the GDS. SCID was used to diagnose major depression with confirmation by an expert geropsychiatrist. Receiver-operating curves (ROC) were used to identify cutoff points with maximal discriminant validity for diagnosing dPD. A total of 213 evaluation time points were included for the 52 patients with time points that included a valid SCID diagnosis, GDS, and HDRS. A ROC established points of maximum specificity/sensitivity for the GDS at a cutoff of 9/10 (sensitivity = 0.809, specificity = 0.837, positive predictive value [PPV] = 0.584, negative predictive value [NPV] = 0.939) and for the HDRS at a cutoff of 12/13 (sensitivity = 0.810, specificity = 0.821, PPV = 0.580, NPV = 0.934). The GDS was moderately correlated with the HDRS (Pearson's r = 0.54; P < 0.001). The GDS is useful in screening for dPD. A cutoff score of 9/10 has acceptable discriminant validity for dPD, and the GDS has a moderate correlation with the HDRS in PD patients.     

The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease.

PURPOSE: To evaluate the validity of the Beck Depression Inventory (BDI) as a screening and diagnostic scale for depression in Parkinson's disease (PD). PATIENTS AND METHODS: Fifty-three nondemented patients with PD were diagnosed according to a standardized protocol consisting of the depression module of the Structured Clinical Interview for DSM axis I disorders (SCID) and the BDI. A "receiver operating characteristics" (ROC) curve was obtained and the sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) were calculated for different cut-off points of the BDI. RESULTS: Maximum discrimination was obtained with a cut-off score of 13/14. High sensitivity and NPV were obtained with cut-off scores of 8/9 or lower; a high specificity and PPV were obtained with cut-off scores of 16/17 or higher. The area under the ROC curve was 85.67%. CONCLUSION: A single cut-off score on the BDI to distinguish nondepressed from depressed patients with PD is not feasible. If one accepts the low specificity, then the BDI can be used as a valid screening instrument for depression in PD with a cut-off of 8/9. With a cut-off score of 16/17, it can be used as a diagnostic scale, at the cost of a low sensitivity. The use of diagnostic criteria for depression remains necessary.     

Effect of age on geriatric depression scale performance in Parkinson's disease

The purpose of this study was to compare the validity of the 15‐item Geriatric Depression Scale (GDS‐15) in nonelderly (<65 years), young‐elderly (age, 65–75), and old‐elderly (>75 years) patients with Parkinson's disease (PD). 57 nonelderly, 88 young‐elderly, and 81 old‐elderly PD patients were administered the GDS‐15 and the Structured Clinical Interview for DSM‐IV depression module. Receiver‐operating characteristic (ROC) curves were plotted for GDS‐15 scores against a DSM‐IV diagnosis of major or minor depression. The discriminant validity of the GDS‐15 was high for nonelderly, young‐elderly, and old‐elderly subjects (ROC area under curve = 0.92, 0.91, and 0.95, respectively), with optimal dichotomization at a cut‐off of 4/5 (85% sensitivity and 84% specificity in nonelderly; 89% sensitivity and 82% specificity in young‐elderly) and 5/6 (90% sensitivity and 90% specificity in old‐elderly). In conclusion, the GDS‐15 has comparable validity in younger and older PD patients, suggesting its appropriateness as a depression screening instrument in PD patients of all ages. © 2007 Movement Disorder Society     

Validity, sensitivity and specificity of the mentation, behavior and mood subscale of the UPDRS

OBJECTIVE: The unified Parkinson's disease rating scale (UPDRS) is the most widely used tool to rate the severity and the stage of Parkinson's disease (PD). However, the mentation, behavior and mood (MBM) subscale of the UPDRS has received little investigation regarding its validity and sensitivity. Three items of this subscale were compared to criterion tests to examine validity, sensitivity and specificity. METHODS: Ninety-seven patients with idiopathic PD were assessed on the UPDRS. Scores on three items of the MBM subscale, intellectual impairment, thought disorder and depression, were compared to criterion tests, the telephone interview for cognition status (TICS), psychiatric assessment for psychosis and the geriatric depression scale (GDS). Non-parametric tests of association were performed to examine concurrent validity of the MBM items. The sensitivities, specificities and optimal cutoff scores for each MBM item were estimated by receiver operating characteristic (ROC) curve analysis. RESULTS: The MBM items demonstrated low to moderate correlation with the criterion tests, and the sensitivity and specificity were not strong. Even using a score of 1.0 on the items of the MBM demonstrated a sensitivity/specificity of only 0.19/0.48 for intellectual impairment, 0.60/0.72 for thought disorder and 0.61/0.87 for depression. Using a more appropriate cutoff of 2.0 revealed sensitivities of 0.01, 0.38 and 0.13 respectively. DISCUSSION: The MBM subscale items of intellectual impairment, thought disorder and depression are not appropriate for screening or diagnostic purposes. Tools such as the TICS and the GDS should be considered instead.     

Cut‐off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson's disease

The prevalence of dementia in Parkinson's disease (PD) is close to 30%, and its incidence is 4 to 6 times higher than in age‐matched general population. PD with dementia (PDD) is mainly characterized by a predominant and progressive frontal‐subcortical impairment. The Mattis Dementia Rating Scale (MDRS) is a commonly used screening test that sensitively measures the degree of frontal‐subcortical defects. Although the MDRS has been validated as a screening test of cognitive dysfunction in nondemented PD patients (PD‐ND), its utility for screening dementia in PD is unknown. In order to validate the MDRS for diagnosis of PDD it was prospectively administered to 92 PD patients (57 PD‐ND, 35 PDD) fulfilling UK‐PDSBB criteria. Dementia was diagnosed according to DSM‐IV‐TR and a Clinical Dementia Rating (CDR) scale score ≥1. Univariate, logistic regression, and ROC curve analysis were carried out to measure the discriminative power of MDRS in PDD. Regression analysis showed MDRS total scores to independently differentiate PD‐ND from PDD (P < 0.001). Age and education did not predict the presence of dementia. ROC curve analysis showed a cut‐off score of ≤123 on the MDRS total scores to yield high sensitivity (92.65%), specificity (91.4%), positive and negative predictive values (PPV 83.3%, NPV 96.4%). A brief version of the MDRS obtained by the addition of the memory, initiation/perseveration, and conceptualization subscores yielded similar discriminant properties. The MDRS has an excellent discriminant ability to diagnose dementia in PD and provides an objective measure to distinguish PD‐ND from PDD. © 2008 Movement Disorder Society     

Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects

BACKGROUND: Proper screening of depression among older adults depends on accurate cut-off scores. Recent articles have recommended the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) for this screening. However, there has been no investigation of the sensitivity and specificity of either scale using Japanese subjects. The purpose of the present study was to identify appropriate GDS and CSDD cut-offs for Japanese older adults. METHODS: The GDS and the CSDD were interview-administered to nondepressed Japanese older adults (n = 74) and to Japanese older adults with a SCID-IV diagnosis of major or minor depression (n = 37). Depressed subjects were also administered the Hamilton Depression Rating Scale (HDRS). Data were also collected on demographic variables, mental status, health status, and medication use. RESULTS: ROC curve analysis identified a cut-off score of 6 for the GDS which had a sensitivity of 0.973, a specificity of 0.959, a False Positive Rate (FPR) of 0.894, and a False Negative Rate (FNR) of 0. A cutoff score of 5 for the CSDD yielded a sensitivity of 1, a specificity of 0.919, a FPR of 0.942, and a FNR of 0. Comparisons indicate current HDRS cut-offs may overlook subthreshold depression. The GDS cut-off score identified among Japanese subjects was the same as that reported for Western subjects. CONCLUSIONS: Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.     

Validation of the Patient Health Questionnaire–9 and Patient Health Questionnaire–2 in the General Korean Population

ObjectiveThe Patient Health Questionnaire–9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population.MethodsWe used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d).ResultsOf the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the “anxiety/depression” score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18.ConclusionThe PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.     

The diagnostic validity of the Athens Insomnia Scale

OBJECTIVE: To provide documentation for the diagnostic validity of the Athens Insomnia Scale (AIS), a self-assessment psychometric tool which has previously shown high consistency, reliability and external validity for the evaluation of the intensity of sleep difficulty. METHODS: The AIS was administered to a total of 299 subjects (105 primary insomniacs, 100 psychiatric outpatients, 44 psychiatric inpatients and 50 nonpatient controls) who were also assessed for the ICD-10 diagnosis of "nonorganic insomnia" blindly in terms of the AIS scores. RESULTS: 176 subjects were identified as insomniacs and 123 as noninsomniacs. Logistic regression of AIS total score against the ICD-10 diagnosis of insomnia demonstrated that a score of 6 is the optimum cutoff based on the balance between sensitivity and specificity. When diagnosing individuals with a score of 6 or higher as insomniacs, the scale presents with 93% sensitivity and 85% specificity (90% overall correct case identification). For this cutoff score, in the general population, the scale has a positive predictive value (PPV) of 41% and a negative predictive value (NPV) of 99%. For the same cutoff score, among unselected psychiatric patients, the PPV was found to be 86% and the NPV 92%. Other cutoff scores can be also considered, however, depending on the importance of avoiding false positive or false negative results; for example, for a cutoff score of 10, the PPV in the general population reaches about 90% without the NPV becoming lower than 94%. CONCLUSION: The AIS can be utilized in clinical practice and research, not only as an instrument to measure the intensity of sleep-related problems, but also as a screening tool in reliably establishing the diagnosis of insomnia.     

Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease

Parkinson's disease (PD) frequently entails non‐motor symptoms, worsening the course of the disease. Apathy is one of the core neuropsychiatric symptoms that has been investigated in recent years; research is however hampered by the limited availability of well‐evaluated apathy scales for these patients. We evaluated the psychometric properties of the Apathy Evaluation Scale (AES) in a sample of PD patients. Psychometric properties, convergent and discriminant validity and sensitivity/specificity were evaluated in patients with (n = 582) or without dementia/depression (n = 339). Internal consistency was high in the entire sample as well as in patients without dementia/depression. Correlations were moderate for convergent validity (UPDRS I item 4: motivation). While apathy could be differentiated from cognitive decline, it was related to depression (Geriatric Depression Scale, GDS‐15). The overall classification accuracy based on the UPDRS I item 4 was comparable for AES and GDS scores. The AES exhibits good psychometric properties in PD patients with and without dementia and/or depression. Commonly used screenings on the presence of apathy had low detection rates compared to the AES and reflected both apathetic and depressive symptoms. Psychometric evaluation of available instruments will support further research on the clinical relevance of apathy for disease progression and treatment approaches in PD patients.     

Test characteristics of the 15-item geriatric depression scale and Hamilton depression rating scale in Parkinson disease.

OBJECTIVE: The objective of this study was to compare the sensitivity, specificity, and diagnostic accuracy of the 15-item Geriatric Depression Scale (GDS-15) and the Hamilton Depression Rating Scale (HDRS) in patients with Parkinson disease (PD). METHOD: A convenience sample of 148 outpatients with idiopathic PD receiving specialty care completed the GDS-15 and were administered the HDRS and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) depression module by a research psychiatrist or trained research assistant. Receiver-operating characteristic (ROC) curves were plotted for the GDS-15 and HDRS scores with a SCID diagnosis of a depressive disorder as the state variable. RESULTS: Thirty-two subjects (22%) were diagnosed with a depressive disorder. The discriminant validity of the GDS-15 and HDRS were both high (ROC area under the curve: 0.92 and 0.91, respectively), with greatest dichotomization for the GDS-15 at a cutoff of 4/5 (87% accuracy, 88% sensitivity, 85% specificity) and the HDRS at a cutoff of 9/10 (83% accuracy, 88% sensitivity, 78% specificity). CONCLUSIONS: The GDS-15 performs well as a screening instrument and in distinguishing depressed from nondepressed patients in PD. Its test characteristics are comparable to the HDRS. Because it is a brief instrument and can be self-administered, it is an excellent depression screening tool in this population.     

Validation and comparison of three brief depression scales in an elderly Chinese population

The study aimed to establish the diagnostic accuracy of the Geriatric Depression Scale (GDS), the Even Briefer Assessment Scale for Depression (EBAS DEP), and the single question test for depression in our elderly Chinese population, and to determine if any one instrument was to be preferred. Ninety-eight community-living, socially active and non-depressed elderly and 75 patients diagnosed with depression were administered the three depression scales. Receiver operating characteristics (ROC) were employed to determine the optimal cut-off scores for the GDS and EBAS DEP, and the diagnostic performance of all three instruments were then compared. ROC analysis indicated an optimal cut-off score of 4 and above for the 15-item GDS, with a sensitivity of 84.0% and a specificity of 85.7%, while the EBAS DEP had 77.3% sensitivity and 89.8% specificity at the optimal cut-off score of 3 and above. The sensitivity and specificity of the single question were 64.0% and 94.9%, respectively. The non-parametric test of the areas-under-the-curve showed no significant difference between the diagnostic performances of the GDS and the EBAS DEP; visually, however, the ROC plot of the GDS was superior. The GDS, the EBAS DEP, and the single question were all valid screening tools for depression in the elderly Chinese population. For busy physicians, there is rationale to first use the single-question test, supplemented where necessary with either the GDS or the EBAS DEP, as an efficient diagnostic strategy for identifying depression amongst older Chinese patients.     

The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson's disease

The concurrent validity of the Hamilton Rating Scale for Depression (HAMD-17) and the Montgomery-Asberg Depression Rating Scale (MADRS) against the DSM-IV diagnosis 'depressive disorder' was assessed in patients with Parkinson's disease (PD). Sixty-three non-demented Parkinson's Disease (PD) patients who attended the outpatient department of an academic hospital were diagnosed according to a standardised research protocol. This protocol consisted of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to establish the presence or absence of 'depressive disorder' according to the DSM-IV criteria, as well as the HAMD-17 and the MADRS. Receiver Operating Characteristics curves (ROC curves) were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut-off scores. Maximum discrimination between depressed and non-depressed patients was reached at a cut-off score of 13/14 for the HAMD-17, and at 14/15 for the MADRS. At lower cut-offs, like 11/12 for the HAMD-17 and 14/15 for the MADRS, the high sensitivity and NPV make these scales good screening instruments. At higher cut-offs, such as 16/17 for the HAMD-17 and 17/18 for the MADRS, the high specificity and PPV make these instruments good diagnostic instruments. The diagnostics performance of the HAMD-17 is slightly better than that of the MADRS. This study shows that it is justified to use the HAMD-17 and the MADRS to measure depressive symptoms in both non-depressed and depressed PD patients, to diagnose depressive disorder in PD, and to dichotomize patient samples into depressed and non-depressed groups.     

Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study

Objective

Two depression screening tools, Patient Health Questionnaire (PHQ)-9 and PHQ-2, have not had their validity examined in general internal medicine settings in Japan. We examined the validity of these screening tools.

Methods

A total of 598 outpatients of an internal medicine clinic in a rural general hospital were enrolled consecutively and stratified by PHQ-9 score. Seventy-five patients randomly selected and 29 patients whose results from the PHQ-9 were considered to be positive for depressive disorder were then interviewed with a semistructured interview, the Mini International Neuropsychiatric Interview. We calculated diagnostic accuracy of the PHQ-9 and PHQ-2 to detect major depression and that of the suicidality item of the PHQ-9 to detect suicidality using sampling weights with multiple imputations.

Results

Sensitivity and specificity for depression were 0.86 and 0.85, respectively, for the PHQ-9 with cutoff points of 4/5, and 0.77 and 0.95, respectively, for the PHQ-2 with cutoff points of 2/3. Sensitivity and specificity of the suicidality item of the PHQ-9 were 0.70 and 0.97, respectively.

Conclusion

In internal medicine clinics in Japanese rural hospitals, the PHQ-2 with an optimal cutoff point for each setting plus the suicidality item of the PHQ-9 can be recommended to detect depression without missing suicidality.     

Does the presence of anxiety affect the validity of a screening test for depression in the elderly?

INTRODUCTION: Depression in the elderly is frequently detected by screening instruments and often accompanied by anxiety. We set out to study if anxiety will affect the ability to detect depression by a screening instrument. OBJECTIVE: To validate the short Zung depression rating scale in Israeli elderly and to study the affect of anxiety on its validity. DESIGN: The short Zung was validated against a psychiatric evaluation, in a geriatric inpatient and outpatient service. The overall validity was determined, as well as for subgroups of sufferers and non-sufferers of anxiety. SETTING: An urban geriatric service in Israel. PATIENTS: 150 medical inpatients and outpatients, aged 70 years and older.MEASURES: Psychiatric evaluation of modified Anxiety Disorders Interview Schedule for DSM-IV as criterion standard for anxiety and depression and short Zung instrument for depression. RESULTS: By criterion validity, 60% suffered from depression. The overall validity of the short Zung was high (sensitivity 71.1%, specificity 88.3%, PPV 90.1%, NPV 67.1%). The validity for those not suffering from anxiety was good (sensitivity 71.1%, specificity 90.2%, PPV 84.4%, NPV 80.7%). In those with anxiety, sensitivity, specificity and PPV were high (71.2%, 77.8%, 94.9% respectively), although the specificity was less than in non-suffers. However major difference was in the NPV rate being much lower (31.8%). CONCLUSION: The short Zung, an easily administered instrument for detecting depression, is also valid in the Israeli elderly. However, anxiety limits the usefulness of this instrument in correctly ruling out depression. The clinician must be aware, therefore, that those suffering from anxiety may score negatively for depression on a screening instrument, such as the short Zung.     

Usefulness of Beck Depression Inventory (BDI) in the Korean elderly population

OBJECTIVES: This study aimed to evaluate the diagnostic validity of the Beck Depression Inventory (BDI) in the elderly and to suggest an optimal cut-off score in order to screen major depressive disorder. METHODS: The BDI and an elderly health questionnaire were administered to 2729 subjects over the age of 60 chosen by stratified random sampling in a Ansan City, South Korea. The BDI and geriatric depression scale (GDS) were examined at about a two-year interval. A reliability and validity test, a factor analysis and an ROC curve analysis were performed. RESULTS: Eighty-four subject had depression and 2645 subjects were rated as normal. The BDI showed significant positive internal consistency (r = 0.88) and test-retest reliability (r = 0.60). Convergent validity with GDS was significantly positive (r = 0.59), and an exploratory factor analysis revealed four factors. We suggest a score of 16 as the optimal cut-off point for the BDI when screening for major depression. CONCLUSION: The results of this study showed that the Korean version of the BDI is appropriate for screening for depression and 16 is the optimal cut-off score for the Korean elderly. Screening of elderly depression with BDI in the community would be valuable when comparing with younger adults and with their former BDI data which were taken when they were young.     

Validation of the Polish version of the Beck Depression Inventory in patients with epilepsy

BackgroundDespite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWE), such disorders often go unrecognized and untreated. In addition, the availability of validated screening instruments to detect depression in PWE is limited. The aim of the present study was thus to validate the Polish version of the Beck Depression Inventory (BDI) in adult PWE.MethodsA group of 118 outpatient PWE were invited to participate in the study. Ninety-six patients meeting the inclusion criteria completed the Polish Version of Beck Depression Inventory-I (BDI-I) and were examined by a trained psychiatrist using the Structured Clinical Interview (SICD-I) for Diagnostic and statistical manual of mental disorders - fourth edition (Text revision) (DSM-IV-TR). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for BDI.ResultsReceiver operating characteristic analysis showed the area under the curve to be approximately 84%. For major depressive disorder (MDD) diagnosis, the BDI demonstrated the best psychometric properties for a cut-off score to be 18, with a sensitivity of 90.5%, specificity of 70.7%, positive predictive value (PPV) of 46.3%, and negative predictive value (NPV) of 96.4%. For the ‘any depressive disorder’ group, the BDI optimum cut-off score was 11, with a sensitivity of 82.5%, specificity of 73.2%, PPV of 68.8%, and NPV of 85.4%.ConclusionsThe BDI score is a valid psychometric indicator for depressive disorders in PWE maintaining adequate sensitivity and specificity, high NPV, and acceptable PPV with an optimum cut-off score of 18 for MDD diagnosis.     

Development of a shorter version of the geriatric depression scale for visually impaired older patients

OBJECTIVE: To validate a shorter version of the Geriatric Depression Scale (GDS) for older, visually impaired patients. PARTICIPANTS: Subjects were 70 visually impaired adults over age 65 who were presenting for services at a low vision clinic. METHOD: Subjects were interviewed by a geriatric nurse practitioner. A structured clinical interview was used to ascertain major depression, and the 15-item GDS was used to assess depressive symptoms. A multiple logistic regression was performed in which the dependent variable was clinical diagnosis of major depression and the independent variables were the 15 GDS items. Four items were significant, and were used to form the GDS-Abbreviated (GDS-A) scale. Sensitivity and specificity analyses were performed on various combinations of these four items to generate an effective cutoff score. RESULTS: Endorsing any two or more of the following four items--a) dissatisfied with life, (b) feeling helpless, (c) reporting problems with memory, and (d) lost activities and interests-yielded the best results with a sensitivity of .71 and a specificity of .88. This GDS-A cutoff score better differentiates depressed from nondepressed individuals than the cutoff score of 5 that is recommended for the GDS-15. CONCLUSION: The GDS-A's short format and strong discriminating ability make it an effective, convenient tool for screening visually impaired, older patients for depression.     

Validation of the Hospital Anxiety and Depression Scale in patients with epilepsy

ObjectiveDespite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWEs), they often go unrecognized and untreated. The availability of validated screening instruments to detect depression in PWEs is limited. The aim of the present study was to validate the Hospital Anxiety and Depression Scale (HADS) in adult PWEs.Methods:A consecutive group of 118 outpatient PWEs was invited to participate in the study. Ninety-six patients met inclusion criteria, completed HADS, and were examined by a trained psychiatrist using Structured Clinical Interview (SCID-I) for DSM-IV-TR. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for the HADS depression subscale (HADS-D).ResultsReceiver operating characteristic analyses showed areas under the curve at approximately 84%. For diagnoses of MDD, the HADS-D demonstrated the best psychometric properties for a cutoff score ≥ 7 with sensitivity of 90.5%, specificity of 70.7%, positive predictive value of 46.3%, and negative predictive value of 96.4%. In the case of the group with ‘any depressive disorder’, the HADS-D optimum cutoff score was ≥ 6 with sensitivity of 82.5%, specificity of 73.2%, positive predictive value of 68.8%, and negative predictive value of 85.4%.ConclusionsThe HADS-D proved to be a valid and reliable psychometric instrument in terms of screening for depressive disorders in PWEs. In the epilepsy setting, HADS-D maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing MDD with an optimum cutoff score ≥ 7.     

Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients

OBJECTIVE: To investigate the criterion validity of the four-item Geriatric Depression Scale (GDS4) and the six-item Orientation-Memory-Concentration-test (OMC) against longer widely used screening instruments. METHOD: Participants were 153 patients (aged 65 or over) admitted to four acute medical wards of a northern UK town. The validity of the GDS4 was determined using the 30-item geriatric depression scale (GDS30) as the comparator; the validity of the OMC was determined using the standardised mini-mental state examination (MMSE) as the comparator. For both screens, the area under receiver operating characteristic (ROC) curve was calculated in addition to the number of true and false positives and the sensitivity and specificity for various cut-off points. RESULTS: The area under ROC curve was 0.80 for the GDS4 and 0.90 for the OMC. Using a cut-off of 0/1, the GDS4 correctly classified 78.2% of participants, using the GDS30 as the standard. This cut-off gave a sensitivity of 90.1% and specificity of 55.3%. With a cut-off of 1/2 the GDS4 correctly classified 76.8% of participants and had sensitivity and specificity of 78% and 74.5% respectively. The GDS4 and GDS30 were highly correlated (rho=0.63, p < 0.0005). A cut-off of 10/11 on the OMC gave optimum performance. With this cut-off, it correctly classified 85.9% of participants, and had 85.6% sensitivity and 86.8% specificity. There was a significant correlation between the OMC and the SMMSE (rho = -0.827, p < 0.0005). CONCLUSION: The GDS4 and OMC appear to be useful instruments for screening for depression and cognitive impairment among older medical inpatients.     

Reliability, validity and factor structure of the GDS-15 in Iranian elderly

OBJECTIVES: Depressive disorders are a public health problem even in developing countries. Access to valid and reliable screening instruments is needed for conducting community surveys. The main objective of this study is to provide the Iranian version of the Geriatric Depression Scale-15 (GDS). METHODS: The GDS-15 Farsi version was developed by translation and back translation. Two hundred and four subjects aged 59 years or older, who were chosen randomly from residents of the Ekbatan district of Tehran, the capital city of Iran, completed the GDS-15. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of major depressive disorders. RESULTS: The GDS was found to be an internally consistent measure. Alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Two factors were extracted by using factor analysis and the principle component analysis (varimax rotation): 'depression' and 'psychosocial activity'. The Depression factor (omitting items 2, 9, 10, 13), which could be considered as a short form of the scale (alpha = 0.92), has significant correlation with the main scale (r = 0.58). Using receiver operating curve (ROC) analysis, the optimum cutoff score for GDS-15 is 7/8, yielding a sensitivity of 0.9 and a specificity of 0.84. The optimum cutoff score for GDS-11 is 6, yielding a sensitivity of 0.9 and a specificity of 0.83. CONCLUSION: The long and short forms of the GDS have excellent properties as screening instruments for major depression in older dwellers in Iran, particularly in urban areas, as presented in our findings.