Validating the GDS Depression Screen in the Nursing Home

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Abstract
The GDS (Geriatric Depression Scale) has demonstrated validity among ambulatory elderly but is less useful in nursing home (NH) populations, probably because of high rates of cognitive impairment. We, therefore, sought the lowest level of Mini-Mental Status Exam (MMSE) score for which the GDS would remain valid. Validation Study. Nursing Homes in New York City. A total of 66 of 168 newly admitted residents to the NH were able to complete psychiatric assessment, undergo an MMSE, and complete the GDS. The psychiatrists and testers (all non-MDs) were blinded to each others' results. Using a cutoff of 10 or greater on the GDS to indicate depression, the GDS's validity (when compared with the psychiatric diagnoses) was sought at ever decreasing levels of cognitive function as measured by the MMSE. The results of all participants (n = 66) revealed a sensitivity of 63% and a specificity of 83%. When only those with an MMSE score > or = 15 (the best cutoff score) were included, 44 (64%) participants were selected, with a sensitivity and specificity of 84% and 91%, respectively. The two-step procedure of first selecting those with MMSE scores > or = 15 and then giving the GDS significantly increases the utility of the GDS in detecting depression in NH residents and should improve the diagnostic process for this widely underdetected problem.