PRACTICAL DEPRESSION SCREENING IN ASSISTED LIVING: FIVE METHODS COMPARED TO GOLD STANDARD DIAGNOSES

Purpose: The goal of the study was to test the accuracy of depression screening strategies in older adults that are practical to use in assisted living (AL), the fastest growing sector of long-term care.

Methods: Data were collected from 107 residents aged ≥ 65 from 4 AL facilities in North Carolina. Direct care staff completed the Cornell Scale for Depression in Dementia, modified for this study for use by long-term care staff (CSDD-M-LTCS). They also completed a one-item question ‘Do you believe the resident is often sad or depressed?’ Separately, a research assistant (RA) administered three well-validated depression measures: the Minimum Data Set Depression Rating Scale (DRS) to the direct care staff on behalf of each resident; the Geriatric Depression Scale 15-item version (GSD-15) and Personal Health Questionnaire, 2-item version (PHQ-2) directly to each resident. A geriatric psychiatrist performed gold standard interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), rendering a diagnosis (or not) of major or minor depression.

Results: Most residents were female (72%) with a mean age of 83. They had an average Mini Mental State Exam score of 20 (mild-moderate cognitive impairment) and needed assistance with a mean of 1.2 activities of daily living. Roughly one-third of residents scored positive for depression on any screening tool, and 14% were diagnosed with major or minor depression based on gold standard.

 Performance of screening measures compared to DSM-IV diagnoses of depression

Screening measure	Cut-point	Sensitivity (95% CI)	Specificity (95% CI)	LR positive (95% CI)
Caregiver completed CSDD-M-LTCS	≥8	0.47 (0.21-0.73)	0.65 (0.55-0.75)	1.3 (0.73-2.47)
One-item	-	0.47 (0.21-0.73)	0.74 (0.64-0.83)	1.8 (0.94-3.40)
RA administered DRS	≥3	0.47 (0.21-0.73)	0.85 (0.76-0.91)	3.1 (1.49-6.33)
GDS-15	≥5	0.60 (0.32-0.84)	0.75 (0.65-0.83)	2.4 (1.39-4.14)
PHQ-2	≥1	0.80 (0.52-0.96)	0.71 (0.60-0.80)	2.7 (1.82-4.13)

 Conclusions: Three methods of screening for depression in AL administered by research staff were found to be accurate: the PHQ-2, GDS-15 and DRS. Measures completed by caregivers were unable to adequately detect depression. The PHQ-2 appears to have the best mix of brevity, sensitivity, and ease of administration.