Measuring Symptoms of Depression: Comparing the Cornell Scale for Depression in Dementia and the Patient Health Questionnaire-9-Observation Version

Phillips, Lorraine J.

doi:10.3928/19404921-20111206-03

Cited by 9 publications

(8 citation statements)

References 50 publications

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“…The other two were designed for use in the general population, but their ability to utilise observational methods, either alongside MADRS or in place of the PHQ-9 OV self-report or clinical interview, means that they have been widely used in older adult care homes. 107,115,120,125,211 The focus of both the anxiety and the depression tools is primarily the symptoms of these conditions. Unlike pain, for which self-report tools reflect the subjectivity of the experience by asking the person to rate their pain on a given scale (e.g.…”

Section: Anxiety and Depression Tools Rapid Reviewmentioning

confidence: 99%

“…[110][111][112] Even though the impacts of living with depression and anxiety in later life are, as outlined above, well documented, and the conditions themselves are often treatable, 113,114 there is a large body of evidence suggesting that depression, in particular, is both under-recognised and undertreated or poorly managed, particularly in residents who live with dementia. 107,[115][116][117][118][119][120][121][122] Less evidence exists around the under-recognition and undertreatment of anxiety in care home residents, but, given the lack of attention that anxiety has received in this setting, 86 it is likely that both of these are very common.…”

Section: Introductionmentioning

confidence: 99%

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Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

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Background Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design This was a mixed-methods study. Setting The setting was care homes for older adults in England. Participants Care home residents participated. Results Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations No care homes rated as inadequate were recruited to the study. Conclusions The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

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Section: Anxiety and Depression Tools Rapid Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…4 The authors of a study comparing the CSDD and the PHQ-9OV in a sample of 54 US long-term care residents, most of whom were female (87%), further concluded that all participants with mild to severe symptoms on the CSDD were considered to have minimal (total scores 5 to 9) or greater symptoms on the observer version of the PHQ-9, although agreement was higher with a cutoff point at 10 or more. 13 Overall, validation studies have been conducted in relatively small samples of NH residents with cognitive impairment and limited measurement properties have been examined.…”

Section: Introductionmentioning

confidence: 99%

“…the four items most suitable to assess depression in the validation of an abridged CSDD in NHs 32. Given evidence of slightly poorer measurement validity for the PHQ-10OV and conflicting findings of previous studies,4,13,33,34 we recommend larger validation studies comparing the PHQ-10OV with the CSDD against clinical assessment by qualified health care providers.Research using the Geriatric Depression Scale in Australia revealedthat among 168 assisted living residents without cognitive impairment, there was an increase in the detection of major depressive disorder from 16% to 22% when considering the responses of care staff 35. It is therefore not surprising to obtain a higher prevalence of major depression when using provider assessments.…”

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confidence: 96%

Measurement validity of the Patient‐Health Questionnaire‐9 in US nursing home residents

Bélanger

Thomas

Jones

et al. 2019

Int J Geriat Psychiatry

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Objectives The objective of this study was to assess the measurement properties of the self‐reported Patient Health Questionnaire‐9 (PHQ‐9) and its 10‐item observer version (PHQ‐10OV) among nursing home residents. Methods We conducted a retrospective study of Minimum Data Set 3.0 assessments for national cohorts of Medicare Fee‐for‐Service beneficiaries who were newly admitted or incident long‐stay residents in 2014‐2015 at US nursing homes (NHs) certified by the Center for Medicare and Medicaid Services. Statistical analyses included examining internal reliability with McDonald's omega, structural validity with confirmatory factor analysis, and hypothesis testing for expected gender differences and criterion validity with descriptive statistics. The Chronic Condition Warehouse depression diagnoses were used as an administrative reference standard. Results Both the PHQ‐9 and PHQ‐10OV had good internal reliability with omega values above 0.85. The self‐reported scale yielded good model fit for a one‐factor solution, while the PHQ‐10OV had slightly poorer fit and a lower standardized factor loading on the additional irritability item. Both scales appear sufficiently one‐dimensional given that somatic items had higher factor loading on a general depression factor than on a somatic subfactor. We were unable to obtain expected gender differences on the PHQ‐10OV scale. The PHQ‐9 and PHQ‐10OV were both highly specific but had poor sensitivity compared with an administrative reference standard. Conclusions The PHQ‐9 appears to be a valid and promising measurement instrument for research about depression among NH residents, while the validity of the PHQ‐10OV should be examined further with a structured psychiatric interview as a stronger criterion standard.

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“…In practice, this measure may be completed by nursing staff designated to complete MDS measures with residents who are less familiar with residents' care. This may result in underestimations of depressive symptoms (Phillips, 2012). Subsequent research has brought into question the convergent validity ofthe PHQ-9 with long-term care residents with dementia as this measure was not shown to correlate with depression diagnoses as indicated in medical charts (Phillips, 2012).…”

Section: Limitationsmentioning

confidence: 99%

Anxiety in older adults with dementia residing in long-term care facilities.

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Measuring Symptoms of Depression: Comparing the Cornell Scale for Depression in Dementia and the Patient Health Questionnaire-9-Observation Version

Cited by 9 publications

References 50 publications

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Measurement validity of the Patient‐Health Questionnaire‐9 in US nursing home residents

Anxiety in older adults with dementia residing in long-term care facilities.

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