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Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions.

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journal contribution
posted on 12.07.2016, 11:46 by Collin Esiwe, Sarah Baillon, Aniruddha Rajkonwar, James Lindesay, Nelson Lo, Michael Dennis
BACKGROUND: depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). METHODS: one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). RESULTS: a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. CONCLUSION: the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases.

History

Citation

Age Ageing, 2015, 44 (5), pp. 771-775

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

Age Ageing

Publisher

Oxford University Press (OUP) for British Geriatrics Society

issn

0002-0729

eissn

1468-2834

Acceptance date

10/12/2014

Copyright date

2015

Available date

12/07/2016

Publisher version

http://ageing.oxfordjournals.org/content/44/5/771

Language

en