Depression screening scale validation in an elderly, community-dwelling population.

Abstract

This study contrasted the relative effectiveness of an interviewer-rated instrument, the Hamilton Depression Rating Scale, and 2 self-report scales, the short form of the Beck Depression Inventory and the depression scale from the Brief Symptom Inventory, in identifying cases of depression. Cases of major depression, dysthymia, and depressive disorder not otherwise specified (NOS) were identified by means of the Structured Clinical Interview for DSM-III-R (SCID) in a sample of 177 elderly community-dwellers. Receiver operating curves were used to evaluate the relative abilities of the 3 screening instruments to identify cases of depression. All 3 instruments identified major depression and depressive disorder NOS. None was consistently sensitive to cases ofdysthymia. The incremental utility of the interview-based instrument for screening was nonsignificant, suggesting that the increased expense in a community setting may not be justified. Depression screening instruments have been designed to identify potential cases of depression quickly, inexpensively, and with a minimum of psychometric time or training. Paperand-pencil inventories meet these criteria extremely well (Yeasavage et al., 1983). Interviewer-rated depression rating scales, although more expensive and time-consuming, allow for normatively based symptom-severity comparisons on the part of a trained clinician (Hamilton, 1967). In the present study, we evaluated the incremental utility of an interview-based screening scale in addition to pencil-and-paper scales for an elderly, community-dwelling population. Depression scales, whether self-report or interviewer-rated, provide continuous measures of symptomatology. In practice, however, whether in the clinic or in the research lab, they are used to identify potential cases of depression. The transformation of a continuous measure to a discrete measure is generally quite simple: a cutoff score is created. The ability of the cutoff score to predict the presence or absence of a case must then be determined. A number of techniques have been used in the evaluation of psychological screening instruments' validity, with clinical diagnosis as a criterion. Measures of sensitivity (or ability to detect cases of depression) and specificity (or ability to correctly

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