An examination of the 'gold standard' diagnosis of major depression in aged-care settings

Davison, Tanya E., McCabe, Marita P. and Mellor, David 2009, An examination of the 'gold standard' diagnosis of major depression in aged-care settings, American journal of geriatric psychiatry, vol. 17, no. 5, pp. 359-367.

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Title An examination of the 'gold standard' diagnosis of major depression in aged-care settings
Author(s) Davison, Tanya E.
McCabe, Marita P.
Mellor, David
Journal name American journal of geriatric psychiatry
Volume number 17
Issue number 5
Start page 359
End page 367
Total pages 9
Publisher American Association for Geriatric Psychiatry
Place of publication Washington, DC
Publication date 2009-05
ISSN 1064-7481
1545-7214
Keyword(s) depression
aged care
diagnosis
assessment
Summary Objectives: Individual clinical interviews are typically viewed as the “gold standard” when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample.

Design: The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument.

Setting: Low-level aged-care residential facilities in Melbourne (equivalent to “residential homes,” “homes for the elderly,” or “assisted living facilities” in other countries).

Participants: One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning.

Measurements: Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15).

Results: The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure.

Conclusion: Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.
Language eng
Field of Research 170106 Health, Clinical and Counselling Psychology
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
HERDC collection year 2009
Copyright notice ©2009, American Association for Geriatric Psychiatry
Persistent URL http://hdl.handle.net/10536/DRO/DU:30019490

Document type: Journal Article
Collection: School of Psychology
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