SCREENING FOR DEPRESSION IN ELDERLY PRIMARY-CARE PATIENTS - A COMPARISON OF THE CENTER FOR EPIDEMIOLOGIC STUDIES DEPRESSION SCALE AND THE GERIATRIC DEPRESSION SCALE

Background: Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument mig ht aid in the recognition of depression. However, available findings f rom younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffer ed substantial methodological limitations. Methods: One hundred thirty patients 60 years or older attending 3 primary care internists' pract ices participated in the study. Two screening scales were used: the Ce nter for Epidemiologic Studies-Depression Scale (CES-D) and the Geriat ric 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 m ajor 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, yiel ding 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 specif icity of 84%. A shorter version of the GDS had a sensitivity of 92% an d a specificity of 81% using a cutoff point of 5. All scales lost accu racy when used to detect minor depression or the presence of any depre ssive diagnosis. Conclusions: The CES-D and the GDS have excellent pro perties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease ad ministration, primary care clinicians should consider its routine use in their practices.