AGS: Faster, More Accurate Tool Evaluates Depression in Nursing Home Residents

By Peggy Peck
WASHINGTON, 04 may 2008-- An assessment tool that closely tracks the DSM-IV, was more accurate and took only about half the time to complete as the more widely used Geriatric Depression Scale (GDS) for evaluating mood disorders in nursing home patients, researchers reported here.
The nine-question Patient Health Questionnaire-9 (PHQ-9) is even more useful when it is administered using "an unfolding technique," in which the patient is first asked queue questions, such as "have you been feeling sad" before being asked to estimate frequency and severity of symptoms, said Debra Saliba, M.D., M.P.H., of the University of California Los Angeles School of Medicine, in a plenary presentation at the American Geriatrics Society meeting.
Dr. Saliba and colleagues enrolled 418 residents from 70 nursing homes in eight states. Participants included only residents who were scheduled for a regular Minimum Data Set (MDS) assessment and were capable of communication.
Assessments were conducted by 16 nurses who were specially trained for the study and worked in pairs.
Participants were evaluated using the 15-question GDS, and the PHQ-9, as well as the MDS. They were also assessed using the modified Standard for Affective Disorders Scale, which was considered the gold standard. One nurse conducted the GDS, PHQ-9, and MDS and another nurse, working on a different day, conducted the affective disorders scale. The nurses then switched tasks for the next set of evaluations. Interview order was reversed for half the sample.
Completion rates were similar for each instrument -- 84% completed the PHQ-9 versus 78% for the GDS. But on average, it took eight minutes to complete the GDS, and only four minutes to complete the PHQ-9.
Correlation with the modified Standard for Affective Disorders Scale was greatest for the PHG-9 (0.83), versus 0.71 with GDS and 0.23 with MDS (P<0.001),>