PERFORMANCE OF CASE-FINDING TOOLS FOR DEPRESSION IN THE NURSING-HOME - INFLUENCE OF CLINICAL AND FUNCTIONAL-CHARACTERISTICS AND SELECTION OF OPTIMAL THRESHOLD SCORES

OBJECTIVE: To compare case-finding tools for depression in the nursing home setting and to evaluate effects of subject function, cognition, and disease number on test performance. DESIGN: Cross-sectional survey . SETTING: One academic and four community homes. SUBJECTS: One hundre d thirty-four randomly selected, mildly cognitively impaired, function ally dependent residents. METHODS AND MEASURES: The Geriatric Depressi on Scale (GDS), Short Geriatric Depression Scale (SGDS), Center for Ep idemiologic Studies Depression Scale (CES-D), and Brief Carrol Depress ion Rating Scale (BCDRS) were administered. The Structured Clinical In terview for DSM-III-R diagnoses was administered independently,. Opera ting characteristics and the effects of subject characteristics on tes t performance were evaluated using McNemar's test and logistic regress ion. Selection of ''optimal'' threshold scores was guided by Kraemer's quality indices and clinical judgment. RESULTS: Thirty-five subjects (26%) had major depression. No differences were found among the instru ments in sensitivity (range 0.74-0.89), specificity (range 0.62-0.77), or area under the receiver operating curve (ROC) (range 0.85-0.91). R esident characteristics did not affect test performance. Quality indic es showed the GDS and BCDRS met criteria for moderate to substantial a greement with the criterion standard, whereas the SGDS and the CES-D a chieved only fair agreement. No change in threshold scores was warrant ed. CONCLUSIONS: The GDS and BCDRS performed well in the nursing home. As the GDS can serve as a both a case-finding and severity instrument , it is preferred. Use of brief, interviewer-administered tools may im prove detection of depression in the nursing home.