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Received 3 July Published 16 October Volume Peer reviewers approved by Dr Colin Mak. Editor who approved publication: Depression in later life is a significant and growing problem. Age-related differences in the type and severity of depressive disorders continue to be questioned anon necessarily question differential methods of assessment and treatment strategies.

A host of geropsychiatric measures have been developed for diagnostic purposes, for rating severity of depression, heerse,a monitoring treatment progress. This literature review includes the self-report depression measures commonly and currently used in geropsychological practice. Each of the included measures is considered according to its psychometric properties.

In particular, information about reliability; convergent, divergent, and factorial validity evidence based on data from clinical and nonclinical samples of older adults; and availability of age-appropriate norms was provided along with wnton strengths and weaknesses of each measure. Results highlighted that in cognitively intact or mildly impaired patients over 65 years, the Geriatric Depression Scale and the Geriatric Depression Scale currently seem to be the preferred instruments. Most importantly, this review may be a valuable resource for practicing clinicians and researchers who wish to develop state-of-the-science assessment strategies for clinical problems and make informed choices about which instruments best suit their heerse,a in older populations.

Depression is a costly, persistent, and common debilitating condition among older adults. Most importantly, late-life depression that is undiagnosed or untreated may lead to a higher risk of morbidity; a decrease in cognitive, physical, and social functioning; hdersema self-neglect and an increase anon the dependence by the others.

In addition, more than other forms of psychological distress, late-life depression reduces survival: A small part of excess mortality among the depressed is due to suicide, which has its highest rates among the older adults, 2529 — 31 with estimates from 6 to 83 perfor men and from 7.

Existing data suggest that there are qualitative differences in the clinical presentation of depression in younger and older adults, and that the different presentations of depression in older adults are not heeersema assessed by the current measures of depression. Because late-life depression has a different manner of presentation, several geriatric-specific variants of depression have been proposed.

Test measures were found to underestimate the depletion syndrome, although they generally inflated the extent to which depression was found in older adults. Thus, the measures currently used may underestimate depression in older adults because they do not measure the most common subtype of geriatric depression.

Self-report measures are widely employed to assess the incidence and severity of depressive symptoms in both epidemiological studies and in clinical settings with older adults. Depending on the questionnaire, this method is relatively brief, taking as few as 10 minutes, and patients may complete the questionnaire outside medical context.

Nonetheless, the heersema method for assessing depression has its limitations, including vulnerability to misinterpretation and response biases. Furthermore, it can be tempting to use the cutoff score of a self-report antoon as the single means of hefrsema a diagnosis, a practice that should be avoided. Finally, it must be emphasized that only clinical interviews and observation are capable of capturing information such as nonverbal aspects, which are essential for diagnosis.

Successful treatment depends on effective assessment. To this end, we present information addressing the psychometric properties eg, normative data, reliability, and validity, as well as sensitivity and specificity diagnostic statisticsto provide practical assessment recommendations for clinicians and researchers and to aid them in their choice of measure. A major attempt was made to identify all relevant instruments for a possible inclusion in this review. This entailed searching professional peer-reviewed journals, comprehensive literature reviews, test manuals, and multiple computer searches.

The reference sections of the identified manuscripts were screened for additional studies. Studies considered in the current review met the following inclusion criteria: Final selection was heresema on the following criteria: Measures typically used to evaluate diagnostic criteria or features of specific anxiety disorders, such as mood disorder, major depressive episode, and others eg, guilt, corumination were excluded. Using these criteria, the most commonly used measures to evaluate depression in older adults included the Zung Self-Rating Depression Scale; 78 the Geriatric Depression Scale, 79 — 81 the Geriatric Depression Scale — short form; 82 the Beck Depression Inventory — II; 83 and the Center for Epidemiologic Studies Depression Scale, 84 together with its short forms of 11, 85 10, 86 and 8 items.


We first present an overview of the structure and the items of the instrument, including response format, norms and the scoring procedure, are described. We also included a brief heersemx of the specific population for which heersea test was developed. We then reported relevant findings regarding internal consistency and test—retest reliability, and various validity estimates if available are reported.

Table 1 presents a summary of the characteristics for each measure. Table 1 Elder-specific self-report measures of depression Notes: The Zung SDS is a self-report measure of depressive symptoms, 78 composed of 20 items that investigate antoon affect, physiological and psychological aspects related to pervasive affect. It was specifically designed for patients with a primary depression diagnosis, and targeting a wide range geersema related symptoms.

Categories of items were selected based on factor analyses found in the literature that antkn the most common types of symptoms associated with depression. Specific items within these categories were then developed using illustrative verbatim records taken from sentences from neersema interviews of patients that were the most representative of the symptoms involved. Each item is rated on a four-point heerseema with geersema points referring to the amount of time the symptom is currently experienced.

An index score can also be obtained by dividing the obtained raw score by the maximum possible score of 80 and expressed as a decimal.

[Full text] Assessment of late-life depression via self-report measures: a review | CIA

The SDS takes approximately 5—10 minutes to complete. Overall, the internal reliability of the SDS appears to be moderate to high, ranging between 0. This is most apparent among the oldest old. In the initial study, the test developer claimed that the SDS yielded a quantifiable rating of current depression in a group of hospitalized inpatients. The SDS is also suited for ongoing assessment, as repeated administrations are unlikely to be taxing to clients or clinicians.

Moreover, due to its brevity, it can be easily added to an assessment. Overall, based on its psychometric functioning, the SDS is probably a good but not the best choice for a depression assessment instrument for older adults at this time. Further research on its psychometric properties and norms may yield a more positive impression of this instrument in the future.

The GDS is a self-report scale specifically designed to measure depression among older adults population. For its development questions, concerning the main themes of depression were selected and administered to a mixed sample that included subjects suffering from depression and subjects with no history of mental illness, aged over 55 years.

On the items only the 30 items with higher and more significant correlations with the total score were selected.

Items that assessed somatic symptoms were excluded because of their low correlation with the total score. The total score ranges from 0 not depressed to 30 maximum severity of depressionwith a cutoff identified at 11 for the presence of clinically relevant depressive symptoms. Reliability evidence was established by the test developers in a mixed sample, subjects suffering from depression and subjects with no history of mental illness, aged over 55 years old. Another study examined the reliability of the GDS among younger adults age 17—55 years because younger samples sometimes serve as control groups in studies of geriatric depression.

Results yielded an alpha coefficient of 0.

Consequently, the use of the GDS in patients with severe dementia is not reccomended. Different factorial structure models of the GDS were proposed in different samples. The results found, however, are not satisfactory. The GDS appears to be a useful screening instrument for depression in geriatric populations.

Lesher suggested that GDS may be useful for assessing Major Depression in older adults in a nursing home context. Indeed, depressed individuals were more likely to fail to complete at least one item correctly. Instead, with scores below 24, a GDS cutoff of 14 is suggested. Indeed, the time to complete the test varies from 2 to 5 minutes. Of the 15 items, 10 indicated the presence of depression with affirmative answer, the remaining five indicated depression with negative answer.


Initially, the GDS was validated on a sample of 35 older adults 18 from the community, 17 from a variety of treatment settings for complaints of depression. Among 72 older adults, both the long and short forms of the GDS were administered to three diagnostic groups were identified: Factor-analytic studies of the GDS most frequently identified a two-factor solution was most frequently identified. However, a stable factor solution was not consistently found across studies and samples, as the nature of factors extracted in various studies changed.

Friedman et al examined the factor structure of the GDS in a nonclinical sample of adults aged 65 and older. The most desirable features of the GDS are its ease of administration and economy of time, important characteristics for a depression scale for the older adults. The BDI-II is one of the best-known and most widely used self-report questionnaire for measuring the severity of depression in diagnosed patients and for detecting possible depression in normal populations of adults and adolescents aged 13 years and older.

It is currently available in more than 10 languages. The BDI-II is composed of 21 items, each representing a symptom characteristic of depression, such as guilt, low mood, loss of interest, suicidal thoughts, and worthlessness.

For each symptom, patients rate how they have felt in the last two weeks in line with the diagnostic criteria for MDD of the DSM-IVon a Guttman scaling designed to assess the depression levels.

The items are scored from 0 to 3, with the sum of the scores representing the BDI-II total score, which can range from 0 to Scores from 0 to 13 indicate minimal depression, scores from 14 to 19 mild depression, scores from 20 to 28 moderate depression, and scores from 29 to 63 severe depression.

For example, using a cutoff of 16, the BDI-II seems to be an adequate screening tool for depressive disorders in advanced cancer patients with an average age of 60 years. It can usually be completed in 5—10 minutes. The test—retest reliability coefficient estimated by the test developers on 26 outpatients from a normative sample including older adults, was equal to 0.

The construct validity of the BDI-II was mainly supported by its significant relationships with its predecessor and with other measures of depression.

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Segal et al found a solid evidence for convergent and discriminant validity of the BDI-II in a sample of community-dwelling older and younger adults. According to the BDI-II manual, 83 two two-factor models emerged consistently by iterated principal exploratory factor analyses. The first model, that emerged in the psychiatric outpatient sample, was termed somatic-affective and cognitive SA—Cand the second model, that emerged in the student sample, was labeled as cognitive-affective and somatic dimensions CA—S.

Some items were consistent indicators of the cognitive dimension and other items consistently define the somatic dimension. The remaining items variably load on one factor or the atnon to produce either a CA factor or an SA factor. A study by Steer et al confirmed the noncognitive somatic-affective and cognitive dimensions of the BDI-II as identified heersemx Beck et al in depressed geriatric inpatients. Among the positive features of the BDI-II are the fact that it likely captures as many depressive symptoms aton possible and has been frequently considered the most widely used screening instrument in large-scale anron studies among cognitively normal older adults persons, and hersema assess depressive symptomatology in older nonclinical samples.

However, the somatic content of some items may complicate interpretation of scores, as the complaints can result from depression, physical disorders, or heeersema. The Center for Epidemiological Studies Depression Scale CES-D is a item self-report measure designed from large-scale epidemiological studies in the general population to measure current levels of depression.

The sum of the ratings of the 20 items provides a total score, ranging from 0 to 60 with the higher scores indicating higher frequency of depressive symptomatology experienced during the past week. Originally, items of the CES-D were chosen from other existing valid measures of depression to cover the areas of depressed mood, feelings of helplessness, loss of energy, and disturbances of sleep and appetite.