Geriatric Depression Scale (GDS) Test

GDS-15 and GDS-4

This health tool uses the GDS-15 and GDS-4 models to evaluate depressive status in elderly patients based on reported symptoms. The models screen for major depression and the shorter version is often used in the monitoring of depressive episodes and changes in the severity of the symptoms.

One of the highlights refers to the fact that the prolonged usage of the shorter version often increases detection rates of depression in older individuals. This has also been validated in several studies.

The geriatric depression scale test is considered an ideal evaluation and monitoring tool that is easy to administer and does not require any specific training for the clinician.

The original version consisted of 30 questions but in time, the most relevant have been compiled in the 15 efficient version (see tab 1 above and also the GDS-15 pdf version) and even a short 4 question version (see tab 2 and the GDS-4 pdf version) with the most discriminating questions with validity percentages closer to the original and with similar high sensitivity and specificity, with around 92% sensitivity and 89% specificity against diagnostic criteria.

The test however, should not be performed as the sole diagnosis tool and should be accompanied by other means of mental status evaluation.

GDS - 15 questions version

1. Are you basically satisfied with your life?

2. Have you dropped many of your activities and interests?

3. Do you feel that your life is empty?

4. Do you often get bored?

5. Are you in good spirits most of the time?

6. Are you afraid that something bad is going to happen to you?

7. Do you feel happy most of the time?

8. Do you often feel helpless?

9. Do you prefer to stay at home, rather than going out and doing new things?

10. Do you feel you have more problems with memory than most?

11. Do you think it is wonderful to be alive now?

12. Do you feel pretty worthless the way you are now?

13. Do you feel full of energy?

14. Do you feel that your situation is hopeless?

15. Do you think that most people are better off than you are?

GDS - short form version with 4 questions

1. Are you basically satisfied with your life?

2. Do you feel that your life is empty?

3. Are you afraid that something bad is going to happen to you?

4. Do you feel happy most of the time?

GDS interpretation

Each of the questions in either version of the test carries a weight of 1 point per positive answer in screening for depressive status except for the items 1, 5, 7, 11 & 13 from GDS-15 where Yes = 0 points and No = 1 point. The patient simply answers with yes or no and then the clinician or the calculator will count the score and provide the interpretation.

The 15 question version score interpretation is as follows:

■ Below 5 - This score is not indicative of a depressive status, however the patient should be monitored further for any more signs displayed and also for their evolution.

■ Between 5 and 10 - This score is indicative of a depressive status in a mild to moderate severity. The patient needs to be referred to further specialist consultation.

■ Above 10 - This score is indicative for the presence of a severe depressive status. The patient needs to be referred to further specialist consultation.

The 4 item version is slightly different, with 0 being considered not indicative of any depressive status, scores of 1 considered to raise suspicion in regard to the patient’s mental health status and scores above 2 indicative of an installed depressive state.

About the study and validation

The Geriatric Depression Scale (GDS) was designed by Yesavage et al. specifically for rating depression in the elderly. The construct of 100 questions was evaluated, with 30 remaining in the original study.

The subjects were then classified as normal, mildly depressed or severely depressed on the basis of Research Diagnostic Criteria (RDC) for depression.

The GDS was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS).

The GDS, HRS-D and SDS were all found to be internally consistent measures. However, the GDS and the HRS-D were significantly better correlated with the RDC symptoms than was the SDS.

A subsequent validation study by Lesher compared the GDS-15 with the original 30-item scale in a sample of depressed, demented, and thought-disordered inpatients.

The two versions of the scale were found to be highly correlated (r = .89) and to have similar high sensitivity rates.

Depression in the elderly

Late life depression is a condition that affects many people aged 65 and above but often the patients do not receive the proper assistance and treatment they require because their symptoms are often put to other illnesses or as adverse reactions to medication they might be under.

It is important to note that depression symptoms in the elderly differ from those in younger people, often with a higher impact on life quality, increasing the risk or worsening cardiac disease conditions and also lasting longer.

There have been studies that arrived at the conclusion that a patient with several other illnesses and who develops depression, has a higher mortality from those illnesses than a patient not suffering from depression. Other studies offered an insight into the increased risk of heart attack.

Some of the risk factors include the female gender, people living alone who lack a supportive social network, traumatic life events or the recent loss of a loved one, comorbidities and even the use of certain medication for other conditions.

Depression symptoms do not differ largely by age group, however, some might be exacerbated by the presence of other illnesses such as Parkinson’s disease, diabetes or cancer.

Some of the symptoms include feelings of worthlessness, sadness, irritability, fatigue, apathy, lack of concentration, insomnia, changes in appetite, self-harm thoughts, physical symptoms induced by the mental status.

In terms of treatment, psychotherapy and counseling are often first resort but also electroconvulsive therapy or even combinations of several therapies. In terms of medication, substance abuse needs to be monitored carefully as well as the choice of drugs used, in order for them not to create any adverse reactions with the medication the patient currently takes for other illnesses.

References

Original references

Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res; 1983 17(1):37-49.

Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontology : A Guide to Assessment and Intervention 165-173, NY: The Haworth Press, 1986.

Validation

Lesher EL, Berryhill JS. Validation of the Geriatric Depression Scale--Short Form among inpatients. J Clin Psychol. 1994; 50(2):256-60.

Almeida OP, Almeida SA Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999; 14(10):858-65.

Other references

van Marwijk HW, Wallace P, de Bock GH, Hermans J, Kaptein AA, Mulder JD. Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract. 1995; 45(393):195-9.