Accuracy in detecting major depressive episodes in older adults using the Swedish versions of the GDS-15 and PHQ-9
Abstract
Objectives: The purpose of this study was to evaluate the diagnostic accuracy at different cut-off values for the Swedish versions of the 15-item Geriatric Depression Scale (GDS-15) and Patient Health Questionnaire (PHQ-9) compared with a structured clinical psychiatric interview in older adults.
Methods: Community-dwelling participants (N = 113) aged 65 years or older completed the Swedish versions of the GDS-15 and PHQ-9 and were then interviewed using the Mini International Neuropsychiatric Interview (MINI) to establish the presence or absence of current major depressive episodes (MDEs). Areas under the curve (AUC) were calculated for each scale, as well as the sensitivity, specificity, and Youden’s index for different cut-off values.
Results: Seventeen participants met the criteria for MDEs. The AUC was 0.97 for the GDS-15 and 0.95 for the PHQ-9. A cut-off of ≥6 on the GDS-15 yielded a sensitivity of 94%, a specificity of 88%, and a Youden’s index of 0.82. A cut-off of ≥5 on the PHQ-9 yielded a sensitivity of 100%, a specificity of 81%, and a Youden’s index of 0.81. The proposed cut-off of ≥10 on the PHQ-9 produced excellent specificity of 95% but a lower sensitivity of 71%.
Conclusions: This study indicates that the Swedish versions of the GDS-15 and PHQ-9 have comparable accuracy as screening instruments for older adults with MDEs. However, the proposed cut-off of 10 on the PHQ-9 might be too high when applied to older individuals in Sweden, and further investigations in larger samples in different healthcare settings are warranted.
Downloads
References
- Karlsson B, Johnell K, Sigström R, Sjöberg L, Fratiglioni L. Depression and depression treatment in a population-based study of individuals over 60 years old without dementia. Am J Geriatr Psychiatry. 2016;24:615–23. doi: 10.1016/j.jagp.2016.03.009
- Magnil M, Gunnarsson R, Björkstedt K, Björkstedt C. Prevalence of depressive symptoms and associated factors in elderly primary care patients: a descriptive study: CME. Prim Care Companion J Clin Psychiatry. 2008;10:462–8. doi: 10.4088/PCC.v10n0607
- Schulz R, Beach SR, Ives DG, Martire LM, Ariyo AA, Kop WJ. Association between depression and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med. 2000;160:1761–8. doi: 10.1001/archinte.160.12.1761
- Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48:445–69. doi: 10.1016/S0277-9536(98)00370-0
- Pyne JM, Patterson TL, Kaplan RM, Gillin JC, Koch WL, Grant I. Assessment of the quality of life of patients with major depression. Psychiatr Serv. 1997;48:224–30. doi: 10.1176/ps.48.2.224
- Samples H, Stuart EA, Saloner B, Barry CL, Mojtabai R. The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits. J Gen Intern Med. 2020;35:12–20. doi: 10.1007/s11606-019-05192-3
- Ekselius L. Diagnostik och uppföljning av förstämningssyndrom : en systematisk litteraturöversikt. Stockholm: Statens beredning för medicinskt utvärdering (SBU); 2012.
- Statens beredning för medicinsk och social utvärdering. Behandling av depression hos äldre: en systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2015. Available from: http://www.sbu.se/sv/publikationer/SBU-utvarderar/behandling-av-depression-hos-aldre-/ [cited 20 April 2021].
- Pettersson A, Boström KB, Gustavsson P, Ekselius L. Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review. Nord J Psychiatry. 2015;69:497–508. doi: 10.3109/08039488.2015.1008568
- Statens beredning för medicinsk och social utvärdering. Patient Health Questionnaire-9 (PHQ-9) som stöd för diagnostik och bedömning av svårighetsgrad av depression. Stockholm: Statens beredning för medicinskt utvärdering (SBU); 2018. Available from: https://www.sbu.se/contentassets/f8d620e0134c4277aff8f4d8245057d5/phq_9_stod_diagnostik_bedomning_svarighetsgrad_depression.pdf [cited 20 April 2021].
- Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–73. doi: 10.1300/J018v05n01_09
- Pocklington C, Gilbody S, Manea L, McMillan D. The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2016;31:837–57. doi: 10.1002/gps.4407
- Gottfries GG, Noltorp S, Nørgaard N. Experience with a Swedish version of the Geriatric Depression Scale in primary care centres. Int J Geriatr Psychiatry. 1997;12:1029–34. doi: 10.1002/(SICI)1099-1166(199710)12:10<1029::AID-GPS683>3.0.CO;2-D
- Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17:638–45. doi: 10.1080/13607863.2012.758231
- Sacuiu S, Seidu NM, Sigström R, Rydberg Sterner T, Johansson L, Wiktorsson S, et al. Accuracy of 12 short versions of the Geriatric Depression Scale to detect depression in a prospective study of a high-risk population with different levels of cognition. Int Psychogeriatr. 2019:1–10. doi: 10.1017/S1041610219001650
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13. doi: 10.1046/j.1525-1497.2001.016009606.x
- Hansson M, Chotai J, Nordstöm A, Bodlund O. Comparison of two self-rating scales to detect depression: HADS and PHQ-9. Br J Gen Pract. 2009;59:e283–8. doi: 10.3399/bjgp09X454070
- Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22–33;quiz 4–57.
- Aslan J, Cova F, Saldivia S, Bustos C, Inostroza C, Rincón P, et al. Psychometric properties of the Patient Health Questionnaire-9 in elderly chilean primary care users. Front Psychiatry. 2020;11:1259. doi: 10.3389/fpsyt.2020.555011
- Chen IP, Liu S-I, Huang H-C, Sun F-J, Huang C-R, Sung M-R, et al. Validation of the Patient Health Questionnaire for depression screening among the elderly patients in Taiwan. Int J Gerontol. 2016;10:193–7. doi: 10.1016/j.ijge.2016.05.002
- Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476. doi: 10.1136/bmj.l1476
- Conwell Y, Simning A, Driffill N, Xia Y, Tu X, Messing SP, et al. Validation of telephone-based behavioral assessments in aging services clients. Int Psychogeriatr. 2018;30:95–102. doi: 10.1017/S1041610217001752
- Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression among older adults: a 20-year update on five common myths and misconceptions. Am J Geriatr Psychiatry. 2018;26:107–22. doi: 10.1016/j.jagp.2017.06.011
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Upsala Medical Society. Read the full Copyright- and Licensing Statement.
