THE USE OF THE SELFCARE(D) AS A SCREENING TOOL FOR DEPRESSION IN THE CLIENTS OF LOCAL-AUTHORITY HOME CARE SERVICES - A PRELIMINARY-STUDY

Background. The home care population has high levels of depressive dis order which is unrecognized and untreated. In the UK, social services are charged with a full assessment of need but there appears to be lit tle systematic assessment of depressed mood in their assessment and re view procedures. The performance of the SelfCARE(D), a 12-item self-ad ministered depression rating scale, was tested in this population. Met hod. Home care recipients in Lewisham East were invited to complete th e SelfCARE(D). Random samples of groups scoring at different levels on the SelfCARE(D) were then interviewed using the GMS/AGECAT system in order to make a standardized psychiatric diagnosis. The sensitivity an d specificity, and positive and negative predictive values (PPV and NP V) of the tests were calculated along with the area under ROC curves f or different SelfCARE(D) cutpoints and definitions of disorder. Result s. 75% Of the target population completed the SelfCARE(D). The data su ggest that the most efficient cutpoint to use in this population appea rs to be 7/8, since this gave an NPV of 0.90, a PPV of 0.50 and a yiel d of 83% of cases of depression. This was achieved with having to comp lete a second-stage assessment on 17% less of the total population whe n compared with the 5/6 cutpoint and 9% less than the 6/7 cutpoint. Co nclusions. This study suggests that the SelfCARE(D) may be an acceptab le and effective tool for the screening of depression in the home carl population. The data presented here support an evaluation of its inco rporation into social service assessment and review packages for their elderly home care clients. (C) 1998 John Wiley & Sons, Ltd.