Depression Assessment Tools

Screening for Depression

Sharp and Lipsky (2002) reviewed several depression screening measures for their appropriateness of use in primary care settings. The prevalence of depression in adults older than 65 years of age ranges from 7 to 36 percent in medical outpatients and increases to 40 percent in hospitalized elderly patients. Up to 50 percent of patients with Alzheimer's disease or Parkinson's disease develop a depressive disorder, and their caretakers--no matter what their age--are also at an increased risk. Signs of depression that are more common in the elderly than in other populations include diminished self-care, irritability, and psychomotor retardation. Early diagnosis and treatment of depression in the elderly improve quality of life and functional status, and may help prevent premature death.

When using screening instruments with elderly patients, it is important to consider their level of cognitive impairment along with visual deficits. The validity of certain depression screening instruments is significantly decreased in patients with a Mini-Mental State Examination score of 15 or less. A one-item screening question, "Do you often feel sad or depressed?" may screen as effectively as the GDS and save time. Other alternatives for geriatric patients include the BDI and CES-D. In cognitively intact patients older than 65 years, the GDS or one-item screen are currently the preferred instrument because the psychometric data on the BDI and CES-D are mixed in this population. (Sharp and Lipsky, 2002).

Self-Administered Tools

These instruments involve the subject answering a questionnaire that is then scored.

Beck Depression Inventory - 2nd Edition (BDI-II)

  • Authors: Aaron T. Beck, Robert A. Steer, and Gregory K. Brown
  • Administration: The BDI-II produces single score indicating intensity of the depressive symptoms. It takes 5 to 10 minutes to administer, longer for patients with severe depression or obsessional disorders
  • Constructs Measured: The BDI-II is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression. This new revised edition replaces the BDI and the BDI-1A, and includes items intending to index symptoms of severe depression, which would require hospitalization.
  • Reliability and Validity: The BDI has been used for 35 years to identify and assess depressive symptoms, and has been reported to be highly reliable regardless of the population. One of the main objectives of this new version of the BDI was to have it conform more closely to the diagnostic criteria for depression, and items were added, eliminated and reworded to specifically assess the symptoms of depression listed in the DSM-IV and thus increase the content validity of the measure.
  • Assessment in Minorities and Elderly: The BDI-II is also available in Spanish..
  • Costs: $75 includes manual and 25 record forms. Additional forms are $40 for 25 or $145 for 100.
  • Online Notes about the BDI posted at Swinburne University, Australia by Grant J. Devilly.

Center for Epidemiological Studies Depression Scale (CES-D)

  • Authors: LS Radloff (1977)
  • Administration: The CES-D consists of 20 items and takes 5 to 10 minutes to complete.
  • Constructs Measured: The CES-D was developed for use in studies of the epidemiology of depressive symptomatology in the general population. 
  • Reliability and Validity: The CES-D shows excellent internal consistency (coefficient alpha greater than 0.85) and test-retest correlation (r greater than 0.5).
  • Assessment in Minorities and Elderly: The CES-D was evaluated for subsets of the original population including persons older than 64 and Blacks. Coefficient alpha remained high (greater than 0.85) in all subgroups. Test-retest correlations remained greater than 0.40 for the elderly group, but not for Blacks.
  • Costs: None

Geriatric Depression Scale (GDS)

  • Authors: Yesavage, JA, TL Brink, TL Rose, O Lum, V Huang, M Adey, VO Leirer (1983)
  • Administration: The GDS consists of 30 items and takes 10 to 15 minutes to complete. The short version of the GDS consists of 15 items and takes 5 to 10 minutes to complete.
  • Constructs Measured: The items included in the GDS were selected from previously published scales. The Yes/No answer format was chosen for ease of administration, and understanding by sometimes easily confused elderly patients.
  • Reliability and Validity: The GDS is internally consistent and externally valid in comparison with clinically diagnosed depression. Test-retest reliability was excellent (r=0.85).
  • Assessment in Minorities and Elderly: The GDS is specifically written for rating depression in the elderly. It was tested in a population above age 55.
  • Costs: None
  • Online Notes about the GDS scale from the author.

Zung Self-Rating Depression Scale (Zung SDS)

  • Authors: WW Zung (1965)
  • Administration: The Zung SDS consists of 20 items and takes 5 to 10 minutes to complete.
  • Constructs Measured: The 20 items of the scale address each of the four most commonly found characteristics of depression: the pervasive effect, the physiological equivalents, other disturbances, and psychomotor activities. 
  • Reliability and Validity: In an analysis of the discriminatory power of the Zung SDS, scores for clinically depressed patients were significantly higher than normal controls. The mean index score for a group of patients who had gone through a treatment program was significantly lower after the program (0.39) than before (0.74).
  • Assessment in Minorities and Elderly: No assessments in these populations were conducted.
  • Costs: None

Interviewer-Administered Tool

This instrument involves the subject answering questions from an interviewer.

Cornell Scale for Depression in Dementia (CSDD)

  • Authors: GS Alexopoulos, RC Abrams, RC Young, and CA Shanoian (1988)
  • Administration: This is a 19-item clinician-administered instrument that uses information from interviews with both the patient and a nursing staff member, a method suitable for demented patients. It takes 10 minutes to complete with the patient or 20 minutes with the caregiver..
  • Constructs Measured: The CSDD is appropriate for patients who have cognitive deficits.
  • Reliability and Validity: The scale has high interrater reliability (kw = 0.67), internal consistency (coefficient alpha: 0.84), and sensitivity. Total Cornell Scale scores correlate (0.83) with depressive subtypes of various intensity classified according to Research Diagnostic Criteria.
  • Assessment in Minorities and Elderly: This scale is specifically designed for elderly patients with cognitive difficulties.
  • Costs: None

References

Alexopoulos, GS, RC Abrams, RC Young, and CA Shamoian (1988) Cornell Scale for Depression in Dementia. Biol Psychiatry 23, 271 to 284.

Radloff, LS (1977), The CES-D scale: A self-report depression scale for research in the general population. Appl Psychological Measurement 1, 385 to 401.

Sharp, LK, and MS Lipsky (2002) Screening for Depression across the lifespan: A review of measures for use in primary care settings. Am. Fam. Physician 66 (6): 1001 to 1008.

Sheikh, JI and JA Yesavage (1986) Geriatric depression scale (GDS): Recent evidence and development of a shorter version. In; Brink, TL, ed., Clinical gerontology: A guide to assessment and intervention. New York. Haworth, pp 165-173.

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

Zung, WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12, 63 to 70.