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.1997.00440250107012
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发表时间：
1997-02
影响因子：
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通讯作者：
J. Lyness;Tamson Kelly Noel;C. Cox;D. King;Y. Conwell;E. Caine
中科院分区：
文献类型：
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作者：
J. Lyness;Tamson Kelly Noel;C. Cox;D. King;Y. Conwell;E. Caine
老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，现有的研究结果，从年轻患者可能无法推广到老年人，现有的研究筛选工具在老年患者样本遭受了很大的方法上的限制。方法130例60岁或以上的患者参加了3个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）。精神障碍诊断和统计手册的结构化临床访谈。第三版，修订，被用来建立“金标准”的诊断，包括重大和轻微的抑郁症。受试者工作曲线分析用于确定每个量表的工作特性。结果CES-D和GDS在抑郁症筛查中均具有良好的应用价值。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。所有量表在用于检测轻度抑郁症或任何抑郁症诊断的存在时都失去了准确性。结论：CES-D和GDS具有优良的性能，可用作筛选工具，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.