Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes.

OBJECTIVE: The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS: Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS: Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS: The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.

[Screening for depression in nursing homes: validity of the WHO (Five) Well-Being Index]. / Der WHO-5-Fragebogen zum Wohlbefinden als Screeninginstrument für Depression bei Altenheimbewohnern.

OBJECTIVE: Depression is common in nursing home residents, but is still underrecognized. Screening for depression could be a first step to increase recognition rates within this high-risk group. Therefore, we investigated the validity of the WHO (Five) Well-Being Index (WHO-5) for early detection of depression in nursing home residents. METHODS: The Structural Clinical Interview for DSM-IV (SCID) was used as the gold standard for the validation of the WHO-5. The diagnoses covered in this assessment were both current major depression as well as minor depression according to DSM-IV research criteria. RESULTS: In our sample of 92 nursing home residents in Munich aged 65-97 years, (73.9% female, 26.1% male) 14.1% fulfilled the criteria of major depression and again 14.1% fulfilled the criteria of minor depression in the SCID. Overall diagnostic validity (area under the ROC curve) of the WHO-5 was .90 (95% confidence interval: .84- .97). The best cut-off-point according to Youden's index yielded a sensitivity of .92 and a specificity of .79. CONCLUSIONS: The diagnostic accuracy of the WHO-5 in our study is promising. The WHO-5 might be an efficient screening tool for nursing home residents, but results have to be replicated in a larger sample.

[Validity of the geriatric depression scale in nursing home residents: comparison of GDS-15, GDS-8, and GDS-4]. / Validität der Geriatrischen Depressionsskala bei Altenheimbewohnern: Vergleich von GDS-15, GDS-8 und GDS-4.

OBJECTIVE: To assess and compare the validity of the German 15-item version and shortened versions of the Geriatric Depression Scale (GDS) for early detection of depression in nursing home residents with mild to moderate cognitive impairment (MMSE ≥ 15). METHODS: Data from 92 patients were analysed. The Structural Clinical Interview for DSM-IV (SCID) was used as the gold standard. The diagnoses covered in this assessment were current major depression (MD) and minor depression (MinD). The performance of the GDS scales was evaluated using receiver operating characteristics (ROC). Main outcome measures were AUC (area under curve) values, as well as sensitivity and specificity. RESULTS: Overall diagnostic validity of the GDS-15 was better for MD than for MinD (AUC: 89.7 % and 73.4 %, respectively). In assessing MD, AUC values as well as sensitivity and specificity were comparable for the GDS-15 and the GDS-8. A cut-off point ≥ 5 on the GDS-8 gave optimum performance (sensitivity: 76.9 %, specificity: 88.6 %). For the best cut-off point ≥ 2, the corresponding values of the GDS-4 were 53.8 % and 92.4 %. CONCLUSIONS: The GDS-8 appears to be a less time-consuming alternative for the nursing home setting. However, the GDS-4 is not suitable for this population.

Depression in nursing homes: prevalence, recognition, and treatment.

OBJECTIVE: Depression is very common in people above 65 years living in long-term care. However, little is known about how well depression is recognized and how adequately it is treated. Therefore, the present study aimed at assessing accuracy of the unaided clinical diagnosis of the attending physicians, and the medical treatment situation in nursing home residents. METHODS: A random sample of 97 residents of 10 nursing homes in Munich was examined with the Section A "Affective Syndrome" of the Structured Clinical Interview (SCID) for DSM-IV to detect depression. Information concerning clinical diagnosis and medication was obtained from the subjects' medical records. RESULTS: 14.4% suffered acutely from major depression, 14.4% suffered from minor depression, and 18.6% were diagnosed as depressive according to the physician and nursing records. In total, 27.8% received antidepressants. Merely 42.9% of the subjects with acute major depression were diagnosed by their attending physicians as depressive, and only half of them received an antidepressant; 17.5% received antidepressants without a diagnosis of depression in their physician and nursing records. In accordance with the guidelines, 73.3% of the antidepressants prescribed were SSRIs or newer antidepressants. Only 20.0% were tricyclic antidepressants. CONCLUSIONS: Findings show that depression is relatively frequent in residents of nursing homes. Moreover, it is insufficiently recognized by physicians and is even more seldom adequately treated. Also, a significant proportion of residents receive antidepressants without a documented associated indication. Therefore, the recognition and guideline-based treatment of depression should be improved in this high-risk group.