Screening for depression in elderly primary care patients - A comparison of the center for epidemiologic studies depression scale and the geriatric depression scale
Screening for depression in elderly primary care patients - A comparison of the center for epidemiologic studies depression scale and the geriatric depression scale
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DOI：
10.1001/archinte.157.4.449
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发表时间：
1997-02-24
影响因子：
--
通讯作者：
Caine, ED
中科院分区：
文献类型：
--
作者：
Lyness, JM;Noel, TK;Caine, ED
背景：晚年抑郁症是初级保健环境中的一个主要公共卫生问题。一个有效的筛查工具可能有助于识别抑郁症。然而，从年轻患者的研究结果可能不会推广到老年人，和现有的研究筛选仪器在老年患者samples遭受了很大的methodological limitations.Methods：130例60岁或以上参加3初级保健内科医生的做法参加了这项研究。两个筛选量表：流行病学中心抑郁量表（CES-D）和老年抑郁量表（GDS）。精神疾病诊断和统计手册第三版修订版的结构化临床访谈被用来建立包括重度和轻度抑郁症在内的“金标准”诊断。结果：CES-D量表和GDS量表在抑郁症筛查中均具有良好的信度和效度。CES-D的最佳临界点为21，敏感性为92%，特异性为87%。GDS的最佳临界点为10，敏感性为100%，特异性为84%。较短版本的GDS的敏感性为92%，特异性为81%，使用截止点为5。所有的尺度失去了准确性时，用于检测轻度抑郁症或存在任何抑郁diagnosis.Conclusions：CES-D和GDS具有优良的性能作为筛选工具，在老年初级保健患者的抑郁症。因为GDS的是或否格式可能会简化管理，初级保健临床医生应该考虑在他们的实践中常规使用。
Background: Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument might aid in the recognition of depression. However, available findings from younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffered substantial methodological limitations.Methods: One hundred thirty patients 60 years or older attending 3 primary care internists' practices participated in the study. Two screening scales were used: the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Geriatric Depression Scale (GDS). The Structured Clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, was used to establish ''gold standard'' diagnoses including major and minor depressive disorders. Receiver operating curve analysis was used to determine each scale's operating characteristics.Results: Both the CES-D and the GDS had excellent properties in screening for major depression. The optimum cutoff point for the CES-D was 21, yielding a sensitivity of 92% and a specificity of 87%. The optimum cutoff point for the GDS was 10, yielding a sensitivity of 100% and a specificity of 84%. A shorter version of the GDS had a sensitivity of 92% and a specificity of 81% using a cutoff point of 5. All scales lost accuracy when used to detect minor depression or the presence of any depressive diagnosis.Conclusions: The CES-D and the GDS have excellent properties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease administration, primary care clinicians should consider its routine use in their practices.