Anxiety and depression among medical and surgical patients nearing hospital discharge

J American Geriatrics Society

Meador

Cohen

et al. 1988

216

126

Until now, no self-rated depression scale had been validated as a screening measure for major depression in the older patient hospitalized with medical illness. The present report establishes the validity of two brief, easily administered depression screening tests, the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS), in this population. Structured psychiatric interviews were performed and self-rated depression measures administered to 128 men, aged 70 and over, consecutively admitted to medical and neurological services of a VA hospital. The GDS and BCDRS were both shown to have high sensitivity and specificity for detecting major depression in this setting. Optimal cut-off scores determined by the receiver operating curve characteristics of these tests were 11 for the GDS and 6 for the BCDRS. At a cutoff score of 11, the GDS had a sensitivity of 92%, a specificity of 89%, and a negative predictive value of 99%; lowering the break point to 8 did not increase sensitivity. At a cutoff score of 6, the BCDRS achieved a 100% sensitivity, 93% specificity, and 100% negative predictive value. Whether clinicians decide to implement either of these depression screens in their practice will depend to a large degree on the importance ascribed to the detection of these disorders and on attitudes toward the benefits of treatment.

Section: Discussionmentioning

confidence: 99%

Self‐Rated Depression Scales and Screening for Major Depression in the Older Hospitalized Patient with Medical Illness

J American Geriatrics Society

Meador

Cohen

et al. 1988

216

126

“…Only a few studies have examined age and racial differences in reports of self-rated depressive symptoms in medical inpatients, and results have been conflictive. Investigators variably report higher rates in younger patients [6], in older patients [lo], in blacks [6,10]; a number have found little relationship with either age or race [4,11,261. One study reported an interaction between age, sex, and race, with the highest rates reported for young black males [6].…”

Section: Physical Health Variablesmentioning

confidence: 99%

“…In previous studies, only severity of the medical illness has been consistently linked to self-rated depressive symptoms [2,4,[9][10][11]261. Other more variably reported correlates have included medical diagnosis (neurological) [8], low socioeconomic status or social class [2, 9, lo], low social support [ll], low educational level [ll], male sex [2], female sex [8], and religious denomination (Jewish) [4].…”

Section: Physical Health Variablesmentioning

confidence: 99%

Self-Rated Depressive Symptoms in Medical Inpatients: Age and Racial Differences

Meador

Goli

et al. 1992

Int J Psychiatry Med

One thousand and eleven men under age forty (n = 161) or over age sixty-four (n = 850) admitted to medical and neurological services of an acute care hospital were screened for depressive symptoms as part of the Durham VA Mental Health Survey. Thirty-three percent of younger and 22 percent of older men scored 11 or higher on the Geriatric Depression Scale. Self-rated symptoms were most prevalent among younger whites (40%) and least common in older blacks (19%). Other exogenous factors such as being retired or unemployment and prior psychiatric history were also related to depressive symptoms, as were poor functional status, impaired cognitive status, and respiratory illness. Coping resources associated with fewer symptoms were social support and moderate alcohol use. In a subgroup of 443 patients, self-rated symptoms were compared with observer-rated symptoms. Agreement was highest among young Whites and lowest in older Blacks. Other correlates also varied depending on whether self-rated or observer-rated symptoms were considered. We conclude that self-rated symptoms are common among medical inpatients, are linked with and confounded by certain health and sociodemographic factors, and may be relatively insensitive as a measure of depression in elderly blacks.

“…The outcome after hospital discharge of medical patients with major depressive disorder, regardless of age, has not yet been studied. Walker et al (1987) report that 48% (12/25) of patients scoring above the usual cutoff on the Symptom Distress Checklist during their hospital stay had scores within the normal range on followup three to four weeks after hospital discharge. Scoring above the normal range on a symptom checklist, however, is not the same as major depressive disorder.…”

mentioning

confidence: 99%

Major depression in hospitalized medically ill older men: Documentation, management, and outcome

Int J Geriat Psychiatry

Goli

Shelp

et al. 1992

SUMMARYFifty-three hospitalized elderly men with medical illness were diagnosed with major depressive disorder and followed up for a mean of 2.3 months. Documentation and management of the depression by medical housestaff during the followup period were examined. There was no note of depression in the medical records of 44% of depressed patients, and depression was on the active problem list of only 32%. Followup and management plans for the depression after discharge were documented in 29%. No form of treatment was prescribed for 44% of depressed patients. Outcomes were determined by psychiatric evaluation at the end of the followup period. Of the 33 patients still alive and evaluated at followup, 64% had persistent depression, 18% improved, and 18% were in complete remission. No baseline patient sociodemographic or health characteristic, including severity of depression, was significantly related to improvement. Likewise, neither extent of documentation nor treatment implemented by housestaff was a significant predictor of outcome. We conclude that serious clinical depression in medically ill older patients may persist for a considerable period after hospital discharge and neither detection nor current management strategies appear to have a major impact on outcome.KEY woms-Major depression, elderly, medically ill, hospital, treatment, outcome, documentation.Major depressive disorder is common among older medically ill hospitalized patients. Recent studies have demonstrated that the prevalence rate of this disorder in elderly hospitalized men may be 15 to 30 times as high as in community settings. The NIMH Epidemiologic Catchment Area studies a t five sites in the United States found rates of major depression in community-dwelling men age 65 or over averaged 0.4% (Weissman et al., 1988). Studies of hospitalized elderly male inpatients have found rates for major depressive disorder varying from 5% to 13%) (O'Riordan et al., 1989;Rapp et al., 1988a; Koenig etal., 1988a Koenig etal., , 1991. Despite this fact, very little is known about the epidemiology of serious depressive disorders in the medical setting, the detection and management of these disorders by medical physicians, or outcomes after hospital discharge. Part of the problem is that small samples have limited the number of major depressive disorders available for study, with cases ranging from 5 to 15 in most reports.Detection rates of depression have been reported as low as 9% by primary care physicians in older medical inpatients (Rapp et al., 1988b). Rates of antidepressant use in medical inpatients are in the range of 0.5-1.6% (Raft et al., 1975;Callies and