IntroductionThe assessment of depression in elderly homecare patients is essential for determining the magnitude and nature of depression (1); however in clinical practice where time is at a premium, diagnostic instruments like the Structured Clinical Interview for DSM-IV (SCID) (2) are not routinely used in the homecare setting. While screening for depression is part of the comprehensive assessment of homecare patients, there is no information on the validity of standardized screens relative to diagnostic assessment in such populations. This study examines the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) (3) compared to the SCID, a gold standard assessment.More than 20 years ago the 30-item GDS was developed as a self-report instrument to screen for clinical depression among the elderly (4). The instrument excludes certain somatic symptoms which might be due to medical illness, and makes use of a simple response format (yes/no, rated 1or 0) which facilitates easier use by individuals with impaired cognitive functions. The endorsed items are then totaled, generating a score from which patients are classified as depressed or non-depressed. The development, validation and factor structure of the shorter GDS-15 has been described previously, elsewhere (3), and has been evaluated in a variety of inpatient, outpatient, primary care, and nursing home populations (5). While the short form is more practical for use amongst the elderly, its administration to homecare patients burdened with poor medical and functional status has not been reported on. Furthermore, its validity, reliability, sensitivity and specificity, compared to a gold standard have not yet been examined in homebound patients.Although the use of the GDS score assumes unidimensionality (a single underlying construct of depressive symptoms) and no item-level bias, the effect of independent factors (i.e., age, educational attainment, gender, and race/ethnicity) on the measurement properties of the GDS in homebound patients is unknown. While there have been reports that the instrument performs poorly in the "old-old" (6), and amongst persons with low or no formal level of education (7,8), Tang et al. (9) found no differential item functioning (DIF) across age or education in an elderly population. To our knowledge, there have been no reports on item bias due to the effect NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of gender or race/ethnicity on the measurement properties of the GDS. To further examine the effects of these variables on the properties of the GDS-15 in a homebound population we will employ DIF analysis to examine the degree to which items that comprise the scale are systematically related to these independent factors (10,11). As an example, item difficulty bias can be determined across gender if we investigate whether women, compared to men, more frequently respond higher on certain items, after matching the subgroups on level of depression (usually the total scale score) (12). ...

It is widely recognized that adherence to antiretroviral therapy is critical to long-term treatment success, yet rates of adherence to antiretroviral medications are frequently subtherapeutic. Beliefs about antiretroviral therapy and psychosocial characteristics of HIV-positive persons naive to therapy may influence early experience with antiretroviral medication adherence and therefore could be important when designing programs to improve adherence to antiretroviral therapy. As part of a multicenter AIDS Clinical Trial Group (ACTG 384) study, 980 antiretroviral-naive subjects (82% male, 47% White, median age 36 years, and median CD4 cell count 278 cells/mm3) completed a self-administered questionnaire prior to random treatment assignment of initial antiretroviral medications. Measures of symptom distress, general health and well-being, and personal and situational factors including demographic characteristics, social support, self-efficacy, depression, stress, and current adherence to (nonantiretroviral) medications were recorded. Associations among variables were explored using correlation and regression analyses. Beliefs about the importance of antiretroviral adherence and ability to take antiretroviral medications as directed (adherence self-efficacy) were generally positive. Fifty-six percent of the participants were "extremely sure" of their ability to take all medications as directed and 48% were "extremely sure" that antiretroviral nonadherence would cause resistance, but only 37% were as sure that antiretroviral therapy would benefit their health. Less-positive beliefs about antiretroviral therapy adherence were associated with greater stress, depression, and symptom distress. More-positive beliefs about antiretroviral therapy adherence were associated with better scores on health perception, functional health, social-emotional-cognitive function, social support, role function, younger age, and higher education (r values = 0.09-0.24, all p < .001). Among the subset of 325 participants reporting current use of medications (nonantiretrovirals) during the prior month, depression was the strongest correlate of nonadherence ( r = 0.33, p < .001). The most common reasons for nonadherence to the medications were "simply forgot" (33%), "away from home" (27%), and "busy" (26%). In conclusion, in a large, multicenter survey, personal and situational factors, such as depression, stress, and lower education, were associated with less certainty about the potential for antiretroviral therapy effectiveness and one's perceived ability to adhere to therapy. Findings from these analyses suggest a role for baseline screening for adherence predictors and focused interventions to address modifiable factors placing persons at high risk for poor adherence prior to antiretroviral treatment initiation.

We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD. This new survey tool may help physicians screen for and identify factors contributing to impaired sexual functioning in their male patients.

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