Reflexões sobre o uso da escala de depressão geriátrica (GDS-15) em idosos hospitalizados / Reflections about using the geriatric depression scale (GDS-15) in hospitalized aged people

A desordem mental mais comum na terceira idade é a depressão. Os sintomas depressivos nem sempre se apresentam de maneira típica. Nos idosos as queixas somáticas são frequentes e podem ser reforçadas pela hospitalização, tornando os idosos mais suscetíveis ainda a sintomas depressivos. Isso se avigora numa ala geriátrica, onde os pacientes lá internados são muitas vezes mais frágeis, poliqueixosos, e com múltiplas comorbidades. Fundamentado a partir deste contexto, o presente trabalho teve como objetivo buscar reflexões críticas sobre o uso da Escala de Depressão Geriátrica (na versão reduzida - GDS-15), amplamente utilizada, como método para avaliar o quadro depressivo em idosos internados numa enfermaria de geriatria. Este estudo é, sobretudo, qualitativo, cuja coleta de informações envolveu a aplicação da escala proposta. Os resultados incitaram discussões acerca da necessidade de reavaliação da confiabilidade da Escala, podendo ser esta pouco suficiente/adequada para medir os sintomas depressivos destes pacientes específicos.

The most common mental disorder in the elderly is depression. Depressive symptoms are not always presented in a typical way. In depressed aged people multiple somatic complaints are frequently and can be reinforced by hospitalization, making the elderly more susceptible to depressive symptoms. This happens quite frequently in a geriatric ward, where patients admitted there are often more fragile, sensitive to pain and soreness, and with multiple comorbidities. Based on this context, this study aimed to look for critical reflections about the use of the Geriatric Depression Scale (reduced version - GDS-15), widely used as an evaluation method for assessing depression in elderly patients in a geriatric ward. This study is especially qualitative, in which the information gathered has involved application of the required scale. The results have prompted discussions about the need to reassess the reliability of the scale, making it not sufficient or appropriated to measure the depressive symptoms of these specific patients.

Consistencia interna, estructura factorial y confiabilidad del constructo de la Escala de Yesavage para depresión geriátrica (GDS-15) en Cartagena (Colombia) / Internal consistency and exploratory factorial analysis of the Yesavage Geriatric Depression Scale (GDS-15) in Cartagena (Colombia)

Objetivo: Determinar la consistencia interna, la estructura factorial y la confiabilidad del constructo de la escala de Yesavage para depresión geriátrica (GDS-15) en adultos mayores asistentes a centros comunitarios de Cartagena (Colombia). Materiales y métodos: Estudio de validación de una escala para tamizaje sin criterio de referencia. Participaron 185 adultos mayores sin deterioro cognoscitivo, entre 65 y 95 años, con media de 75,6 (DT=6,9); y 57,3% mujeres. Se determinó consistencia interna mediante la fórmula 20 de Kuder-Richardson (KR-20) y se realizó análisis factorial exploratorio con el método de componentes principales. Resultados: La consistencia interna fue 0,783, la solución factorial mostró dos factores (estado de ánimo deprimido y capacidad de disfrute) que explicaban el 37,3% de la varianza y la confiabilidad del constructo fue 0,700. Conclusiones: La GDS - 15 muestra una aceptable consistencia interna y confiabilidad del constructo. No obstante, la estructura factorial bidimensional no es completamente satisfactoria. Es posible que la utilidad de la GDS-15 en personas de baja escolaridad sea limitada.

Objective: To determine the internal consistency, factor structure and construct reliability of the Yesavage Geriatric Depression Scale (GDS-15) among older people a ending community centers in Cartagena (Colombia). Materials and method: Validation study of a screening scale without a gold standard. A group of 185 adults participated in this research. Ages were between 65 and 95 years (Mean = 75.6, SD=6.9); and 57.3% were women. Internal consistency was determined by Kuder-Richardson’s formula 20, factor structure was explored by factor analysis with principal component method, and construct reliability was computed by Anderson-Gerbing’s formula. Results: Internal consistency was 0,783 and the factor solution showed two factors (depressed mood and life enjoy) that explained 37.3% of the variance, and construct reliability was 0,700. Conclusions: The GDS-15 showed acceptable internal consistency and construct reliability. However, its two-dimensional factor structure is not satisfactory. It is possible that the GDS- 15 exhibits low ability to identify depressive episodes in elders with low scholarship...

Agreement in Depression Determination among Four Self-Rating Depression Scales Applied to Japanese Community-Dwelling Elderly

Objective: In this study, we examined the characteristics of depression determination using four representative self-rating depression scales (Geriatric Depression Scale, GDS; Self-rating Depression Scale, SDS; Center for Epidemiologic Studies Depression Scale, CES-D; and Carroll Rating Scale, CRS) applied to Japanese community-dwelling elderly. Methods: Subjects were 563 community-dwelling independent elderly living in twelve prefectures (330 males, 68.9±6.3 yr; 233 females, 68.1±5.8 yr). Results: Depression rates determined using SDS (45.8%) and CES-D (68.6%) were higher than those determined using GDS (5.7%) and CRS (14.7%). Although correlations of depression scale scores among the four scales were significant and comparable (r: 0.61 (GDS vs. SDS, p<0.01) to 0.78 (SDS vs. CES-D, p<0.01)), the agreement in depression determination varied among scales (kappa coefficients: 0.05 (GDS vs. CES-D, p>0.05) to 0.46 (SDS vs. CES-D, p<0.01)). Conclusions: Similarities in depression determination were found between GDS and CRS, and between CES-D and SDS. Depression rates determined on the basis of cut-off point for each scale were higher for CES-D and SDS than for GDS and CRS. Depression determination using a four-point rating scale may overestimate a slightly depressive symptom, compared with that using a two-point scale.

Agreement in depression determination among four self-rating depression scales applied to Japanese community-dwelling elderly

<p><b>OBJECTIVE</b>In this study, we examined the characteristics of depression determination using four representative self-rating depression scales (Geriatric Depression Scale, GDS; Self-rating Depression Scale, SDS; Center for Epidermiologic Studies Depression Scale, CES-D; and Carroll Rating Scale, CRS) applied to Japanese community-dwelling elderly.</p><p><b>METHODS</b>Subjects were 563 community-dwelling independent elderly living in twelve prefectures (330 males, 68,9±6.3 yr; 233 females, 68.1±5.8 yr).</p><p><b>RESULTS</b>Depression rates determined using SDS (45.8%) and CES-D (68.6%) were higher than those determined using GDS (5.7%) and CRS (14.7%). Although correlations of depression scale scores among the four scales were significant and comparable (r: 0.61 (GDS vs. SDS, p<0.01) to 0.78 (SDS vs. CES-D, p<0.01)), the agreement in depression determination varied among scales (kappa coefficients: 0.05 (GDS vs. CES-D, p>0.05) to 0.46 (SDS vs. CES-D, p<0.01)).</p><p><b>CONCLUSIONS</b>Similarities in depression determination were found between GDS and CRS, and between CES-D and SDS. Depression rates determined on the basis of cut-off point for each scale were higher for CES-D and SDS than for GDS and CRS. Depression determination using a four-point rating scale may overestimate a slightly depressive symptom, compared with that using a two-point scale.</p>

Problems with the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly: an examination of the factor structure

<p><b>PURPOSE</b>The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.</p><p><b>METHODS</b>The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.</p><p><b>RESULTS</b>From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.</p><p><b>CONCLUSION</b>An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.</p>

Problems with the Japanese Version of the Center for Epidemiologic Studies Depression (CES-D) Scale when Applied to Japanese Independent Community-Dwelling Elderly: an Examination of the Factor Structure

Purpose: The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure. Methods: The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly. Results: From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted. These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-of-fit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale. Conclusion: An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

Depressive Symptoms in Elderly Patients with Physical Illness

OBJECTIVES: This study aimed to evaluate the effects of severity of functional disability, caused by physical illness, on the depressive symptoms and depressive disorders of the elderly patients (above 65 year-old) with physical illness. METHOD: Complete medical and psychiatric evaluations were achieved on 138 patients, except the 12 patients, who were severely cognitively impaired (MMSE-K score;below 19), of the 150 elderly patients (above 65 year-old) with physical illness. Sociodemographic data and health characteristic data were systematically collected, and the severity of functional disability caused by physical illness was evaluated. Depression scales (KGDS, GDS, MADRS) on 138 elderly patients were executed. In addition, based on the 61 patients of the 65 elderly patients (above 65 years old) with physical illness, except 4 patients who were severely cognitively impaired (MMSE-K score;below 19), sociodemographic data and health characteristic data were collected. The clinical diagnosis by DSM-IV diagnostic criteria and KGDS on 61 elderly patients were performed, and their functional disability caused by physical illness was evaluated. RESULTS: The frequency of depressive symptoms showed 50.0%, 36.2%, and 35.5%, respectively in KGDS, GDS, and MADRS. The patients with severe functional disability caused by physical illness-compared with those with mild functional disability-had significantly higher score on the depression scales (KGDS, GDS, MADRS). The correlation between severity of functional disability caused by physical illness and depression scales was highly positive. Severity of functional disability caused by physical illness was the strongest contributor to the depression scales. In the additional study, 19.7% of patients were diagnosed as major depressive disorder, 18% of them as dysthymic disorder, and depressive disorder (major depressive disorder & dysthymic disorder) group-compared with nondepressive disorder group-showed significantly higher score on the FDRPT and KGDS. CONCLUSION: The frequency of depressive symptoms and depressive disorder in elderly patients with physical illness was higher, compared with those in general elderly people. Functional disability caused by physical illness most highly influenced on depressive symptoms. Thus, it is important to discriminate whether the elderly patients with physical illness have depressive symptoms or not. In addition, we assumed that KGDS was not only highly correlated with other depression scales (GDS, MADRS), but also had the high diagnostic power of dis-crimination for depressive symptoms and depressive disorder. This study suggested that KGDS was available in screening depression in the elderly patients with physical illness. It was necessary to study systematically the availability of KGDS in the future.

A Reliability and Validity Study of Geriatric Depression Scale / 신경정신의학

OBJECTS: The purpose of this study was to examine the reliability and validity of Geriatric Depression Scale(GDS). METHODS: GDS, BDI, SDS, MMPI-D, K-CES-D were administered to 81 depressed elderlies and 75 nondepressed elderlies. Those who obtained the 'definite impairment' score in MMSE-K were excluded in the final analyses. RESULTS: The values of Cronbach's alpha and test-retest correlation coefficient were 0.88 and 0.66(p< .001) respectively, The GDS was highly correlated with BDI(r= .72), SDS(r= .78), K-CES-D(r= .75), and MMPI-D(r= .65). The result of the factor analysis showed that GDS had seven factors. They could be labeled as core depressive feature(factor 1), loss of interest/pleasure(factor 2), feeling of unhappiness(factor 3), agitation(factor 4), cognitive inefficiency (factor 5), social withdrawal tendency(factor 6), and lack of motivation(factor 7), which represent important characteristics (emotional, cognitive, and behavioral aspects) of depression in the elderly. The total percent of variance of 7 factors was 53.4%. finally, the result of discrimination analysis showed that the hit ratio of GDS was 64%. CONCLUSION: Although GDS had the reasonable reliability and validity, it seemed to have some limitations in relation to absolute discrimination power. It is necessary to investigate the cultural differences in geriatric depressive symptoms and to develope a new depression scale for elderly people with consideration of the cultural differences.