Screening for depression in African-Caribbean elders

Background. There are increasing numbers of older African-Caribbeans in the UK. Primary care staff often feel less confident about diagnosing depressi on in this group. Screening instruments may assist in making diagnoses in c ross-cultural consultations. Objective. We aimed to determine the sensitivity and specificity of screeni ng instruments for depression in older African-Caribbean people in Manchest er, UK. Methods. We carried out a two-stage study to compare three screening instru ments for depression (Geriatric Depression Scale, Brief Assessment Schedule Depression Cards, Caribbean Culture Specific Screen), with a computerized diagnostic interview for mental health disorders in older adults (Geriatric Mental State). The study was set in inner-city Manchester. The subjects we re community-resident African-Caribbeans aged 60 years and over; 227 subjec ts were approached. Of the 160 people screened, 130 agreed to diagnostic in terview. The main outcome measures were Spearman correlation coefficients; these were calculated between each screening instrument and the diagnostic interview. Receiver-operating characteristic (ROC) curve analysis was used to determine appropriate sensitivity and specificity for each instrument. Results. The results for the largest subgroup, the Jamaicans (n = 96/130), demonstrated highly significant correlations between screening instruments and diagnostic interview (P < 0.001). Each instrument had a high sensitivit y: Brief Assessment Schedule depression cards (cut-off greater than or equa l to 6; sensitivity 90.9% (95% Cl 58.8-99.8), specificity 82.1% (95% Cl 74. 0-90.3)), Caribbean Culture Specific Screen (cut-off greater than or equal to 6; sensitivity 90.9% (95% CI 58.8-99.8), specificity 74.1% (95% CI 64.8- 83.4)), and Geriatric Depression Scale (cut-off greater than or equal to 4; sensitivity 100% (95% Cl 97.1-100), specificity 69.1% (95% Cl 59.6-79.2)). Conclusions. These screening instruments demonstrate high sensitivity level s, if an appropriate cut-off point is used. The culture-specific instrument did not perform better than the traditional instruments. Health profession als should approach the consultation in a culturally sensitive manner and u se the validated instrument they are most familiar with.