ABSTRACT
CONTEXT: Though common, depressive disorders often remain undetected in late life. AIM: To examine the usefulness of Center for Epidemiologic Studies Depression (CES-D) for identifying depression among older people. SETTINGS AND DESIGN: Community resident older people (aged 65 years or more), were evaluated by clinicians trained in psychiatry, as part of a cross-sectional study of late-life depression. Assessments were done in the community. METHODS AND MATERIAL: The participants were assigned ICD-10 diagnoses and assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and CES-D. A short version of CES-D with 10 items, translated to the local language Malayalam, was used. STATISTICAL ANALYSIS: The sensitivity and specificity of CES-D was evaluated against ICD-10 clinical diagnosis of depression. The correlation of CES-D and MADRS was assessed using Pearson correlation coefficient. RESULTS: 220 consenting adults from 3 wards of the Panchayath were assessed. On analysis of the Receiver Operating Characteristic (ROC) curve of CES-D scores in relation to clinical diagnosis, the large Area Under Curve (AUC) showed efficient screening and a cut off score of 4 in CES-D had a sensitivity of 97.7% and a specificity of 79.1% for depression. There was also good correlation between the MADRS and CES-D scores (0.838). CONCLUSION: CES-D is a short simple scale which can be used by health care professionals for detecting depression in older people in primary care settings.
ABSTRACT
BACKGROUND: Depression is the most common mental health problem in late-life. We need more information about the incidence and prevalence of major and minor syndromes of depression in older people. This will help in service development. AIMS: To estimate the prevalence of depressive disorders among community resident older people in Kerala, India and to identify factors associated with late-life depression. MATERIALS AND METHODS: Two hundred and twenty community resident older subjects were assessed for depression by clinicians trained in psychiatry. They used a symptom checklist based on International Classification of Diseases Tenth Revision (ICD-10) Diagnostic criteria for research for Depression and Montgomery Asberg Depression Rating Scale for assessment of symptoms. A structured proforma was used to assess sociodemographic characteristics and medical history. The point prevalence of depression was estimated. Univariate analysis and subsequent binary logistic regression were carried out to identify factors associated with depression. RESULTS: Prevalence of any ICD-10 (World Health Organization, 1992) depressive episode was 39.1% (95% confidence interval [CI] 32.6-45.9). There was significant correlation between depression and female gender (odds ratio [OR] 2.33; 95% CI 1.07-5.06) and history of a significant life event in the previous year (OR 2.39; 95% CI 1.27-4.49). CONCLUSION: High prevalence rate of late-life depression is indicative of high burden due to depression among older people in the community. Better awareness among primary care clinicians can result in better detection and management of late-life depression.
