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Smith ML, Steinman LE, Montoya CN, Thompson M, Zhong L, Merianos AL. Effectiveness of the Program to Encourage Active, Rewarding Lives (PEARLS) to reduce depression: a multi-state evaluation. Front Public Health 2023; 11:1169257. [PMID: 37361168 PMCID: PMC10289834 DOI: 10.3389/fpubh.2023.1169257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction An estimated 15% of community-dwelling older adults have depressive symptoms in the U.S. The Program to Encourage Active, Rewarding Lives (PEARLS) is an evidence-based program for managing late-life depression. PEARLS is a home/community-based collaborative care model delivered by community-based organizations to improve access to quality depression care. Trained staff actively screen for depression to improve recognition, teach problem-solving and activity planning skills for self-management, and connect participants to other supports and services as needed. Methods This study examined 2015-2021 data from 1,155 PEARLS participants across four states to assess PEARLS effectiveness to reduce depressive symptoms. The clinical outcomes were measured by the self-reported PHQ-9 instrument to assess changes in depressive symptoms scored as depression-related severity, clinical remission, and clinical response. A generalized estimating equation (GEE) model was fitted to examine changes in composite PHQ-9 scores from baseline to the final session. The model adjusted for participants' age, gender, race/ethnicity, education level, income level, marital status, number of chronic conditions, and number of PEARLS sessions attended. Cox proportional hazards regression models were conducted to estimate the hazard ratio for improvement of depressive symptoms (i.e., remission or response), while adjusting for the covariates. Results PHQ-9 scale scores significantly improved from baseline to their final sessions (mean difference = -5.67, SEM = 0.16, p < 0.001). About 35% of participants achieved remission with PHQ-9 score < 5. Compared to participants with mild depression, patients with moderate depression (HR = 0.43, 95%CI = 0.35-0.55), moderately severe depression (HR = 0.28, 95%CI = 0.21-0.38), and severe depression (HR = 0.22 95%CI = 0.14-0.34) were less likely to experience clinical remission with PHQ-9 score < 5, while adjusting for the covariates. About 73% achieved remission based on no longer having one or both cardinal symptoms. Compared to participants with mild depression, patients with moderate depression (HR = 0.66, 95%CI = 0.56-0.78), moderately severe depression (HR = 0.46, 95%CI = 0.38-0.56), and severe depression (HR = 0.38, 95%CI = 0.29-0.51) were less likely to experience clinical remission, while adjusting for the covariates. Nearly 49% of participants had a clinical response or a ≥ 50% decrease in PHQ-9 scores over time. There were no differences between the severity of depression groups based on the time to clinical response. Discussion Findings confirm that PEARLS is an effective program to improve depressive symptoms among older adults in diverse real-world community settings and can be a more accessible option for depressive older adults who are traditionally underserved by clinical care.
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Affiliation(s)
- Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, United States
| | - Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Lixian Zhong
- School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
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Wang L, Liu Q, Sun D, Xie J, Lao D, Zhang L. Effects of Combination Treatment in Hypertensive Patients with Depression: A Systematic Review and Meta-Analysis of 27 Randomized Controlled Trials. Ther Clin Risk Manag 2022; 18:197-211. [PMID: 35281776 PMCID: PMC8906860 DOI: 10.2147/tcrm.s347622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension commonly co-exists with depression and is associated with adverse health outcomes. This meta-analysis aimed to examine whether combination treatment can improve the outcomes of patients with comorbid hypertension and depression. Methods We searched for relevant randomized controlled trials (RCTs) published through July 2021 using PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. RCTs on patients with an antihypertensive outcome and data on mean blood pressure differences were extracted for both intervention and control groups. Continuous and dichotomous measures of outcomes were pooled using weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CI) by random or fixed effects. Subgroup and meta-regression analyses were performed to identify any existing heterogeneous sources. Results A total of 27 RCTs with 2606 participants were included. Combination treatment significantly improved systolic blood pressure (SBP) by 11.27 mmHg (WMD = −11.27, 95% CI: −14.12 to −8.43), I2 = 95.4%), diastolic blood pressure (DBP) by 8.21 mmHg (WMD = −8.21, 95% CI: −10.73 to −5.69), I2 = 96.9%), and antihypertensive efficiency by 42% (RR = 1.42, 95% CI: 1.32 to 1.52, I2 = 0.0%) compared with in the control group. Combination treatment improved SBP and DBP levels in patients aged <65 years compared with those in patients aged ≥65 years (p = 0.020 and 0.007, respectively). Conclusion Pooled evidence suggests that combination treatment significantly improves both blood pressure levels and antihypertensive efficiency in hypertensive patients with depression. Elderly patients with comorbid hypertension and depression may require a more collaborative approach to improve their outcome. Registration PROSPERO registration number CRD42020213430. Registered on November 08, 2020.
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Affiliation(s)
- Lin Wang
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Qingqing Liu
- Department of Respiratory and Critical Care Medicine, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Dongsheng Sun
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Jianhong Xie
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Dibo Lao
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Li Zhang
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
- Correspondence: Li Zhang, Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People’s Republic of China, Tel/Fax +86 571-85893957, Email
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How can light be used to optimize sleep and health in older adults? PROGRESS IN BRAIN RESEARCH 2022; 273:331-355. [DOI: 10.1016/bs.pbr.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gramaglia C, Gattoni E, Marangon D, Concina D, Grossini E, Rinaldi C, Panella M, Zeppegno P. Non-pharmacological Approaches to Depressed Elderly With No or Mild Cognitive Impairment in Long-Term Care Facilities. A Systematic Review of the Literature. Front Public Health 2021; 9:685860. [PMID: 34336772 PMCID: PMC8322575 DOI: 10.3389/fpubh.2021.685860] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Compared to old people who live at home, depressive symptoms are more prevalent in those who live in long-term care facilities (LTCFs). Different kinds of non-pharmacological treatment approaches in LTCFs have been studied, including behavioral and cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and life review/reminiscence. The aim of the current review was to systematically review non-pharmacological treatments used to treat depressed older adults with no or mild cognitive impairment (as described by a Mini Mental State Examination score > 20) living in LTCFs. Methods: A research was performed on PubMed and Scopus databases. Following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flowchart, studies selection was made. The quality of each Randomized Controlled Trial was scored using the Jadad scale, Quasi-Experimental Design studies and Non-Experimental studies were scored based on the Newcastle-Ottawa Scale (NOS) Results: The review included 56 full text articles; according to the type of intervention, studies were grouped in the following areas: horticulture/gardening (n = 3), pet therapy (n = 4), physical exercise (n = 9), psychoeducation/rehabilitation (n = 15), psychotherapy (n = 3), reminiscence and story sharing (n = 14), miscellaneous (n = 8). Discussion and Conclusion: Despite mixed or negative findings in some cases, most studies included in this systematic review reported that the non-pharmacological interventions assessed were effective in the management of depressed elderly in the LTCFs context. Regrettably, the limitations and heterogeneity of the studies described above hinder the possibility to generalize and replicate results.
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Affiliation(s)
- Carla Gramaglia
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Eleonora Gattoni
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Debora Marangon
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Diego Concina
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Elena Grossini
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
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Knight J. Understanding and managing depression in older people. Nurs Older People 2019; 31:41-48. [PMID: 31576729 DOI: 10.7748/nop.2019.e1138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 05/24/2023]
Abstract
Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.
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Wei J, Hou R, Zhang X, Xu H, Xie L, Chandrasekar EK, Ying M, Goodman M. The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis. Br J Psychiatry 2019; 215:449-455. [PMID: 30968781 DOI: 10.1192/bjp.2019.74] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults. METHOD We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings. RESULTS A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression. CONCLUSION Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology,Gillings School of Global Public Health,University of North Carolina at Chapel Hill,USA
| | - Ruixue Hou
- Department of Nutrition,Gillings School of Global Public Health,University of North Carolina at Chapel Hill,USA
| | | | - Huiwen Xu
- Department of Public Health Sciences,School of Medicine and Dentistry,University of Rochester,USA
| | - Liyang Xie
- Department of Health Services Administration,School of Public Health,University of Maryland,USA
| | | | - Meiling Ying
- PhD Student,Department of Public Health Sciences,School of Medicine and Dentistry,University of Rochester,USA
| | - Michael Goodman
- Professor of Epidemiology,Department of Epidemiology,Rollins School of Public Health,Emory University,USA
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Melrose S. Late life depression: nursing actions that can help. Perspect Psychiatr Care 2019; 55:453-458. [PMID: 30499598 DOI: 10.1111/ppc.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This article explains the symptoms of late life depression (LLD) and discusses evidence-informed actions that nurses can implement to provide older adults with the help they need. CONCLUSIONS Recognizing and addressing depression in older adults can enhance quality of life. PRACTICE IMPLICATIONS People with LLD may not appear sad or express feelings of depression. Instead, they demonstrate loss of interest, frailty, cognitive impairment, suicidal ideation, unexplained somatic complaints, and loneliness. Documenting symptoms, screening, and assessing suicidal ideation are essential. Positive outcomes are associated with antidepressant medications, cognitive behavioral therapy, electroconvulsive therapy, neuromodulation therapies, and exercise.
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Affiliation(s)
- Sherri Melrose
- Faculty of Health Disciplines, Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta
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Dong L, Xu L, Li Y, Lv Y, Liu H, Li Y, Xu F, Wu J, Zheng Q, Li L. Model-based comparing efficacy of fluoxetine between elderly and non-elderly participants with major depressive disorder. J Affect Disord 2018; 229:224-230. [PMID: 29324370 DOI: 10.1016/j.jad.2017.12.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/23/2017] [Accepted: 12/31/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The high heterogeneity was existed among the studies of the elderly participants with major depressive disorder (MDD), which may lead to incorrect conclusions in the previous meta-analysis. This study used model based meta-analysis to compare the efficacy of fluoxetine between the elderly and non-elderly participants with MDD and to explain the heterogeneity among the studies. METHODS A comprehensive literature search was conducted in the public databases, involving utilization of fluoxetine for treating MDD in the acute-phase. The time-efficacy model was established based on the changes of the Hamilton Depression Rating Scale (HDRS) score compared to baseline level. The efficacy features and related factors of fluoxetine in the elderly participants were investigated by comparing with the non-elderly population. RESULTS Sixty-one studies encompassing 4058 participants were included in the analysis. We found the trial design of placebo controlled vs. comparator controlled was a significant impact factor for the efficacy of fluoxetine. The typical decrease rate of HDRS score in the elderly participants was strikingly lower than that of the non-elderly participants at week 8, with 39.9% vs. 49.1% in the placebo controlled trial and 46.5% vs. 57.2% in the comparator controlled trial. LIMITATION The efficacy of other antidepressants except fluoxetine in the elderly participants need to be explored in the future study. CONCLUSIONS The efficacy of fluoxetine in the elderly participants was lower than that of the non-elderly participants. The heterogeneity of the trial design should be distinguished when comparing the efficacy of antidepressants between the elderly and non-elderly MDD participants.
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Affiliation(s)
- Lidan Dong
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ling Xu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yanfei Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yinghua Lv
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Hongxia Liu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yunfei Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Fengyan Xu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Junyi Wu
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Abbott R, Chang DD, Eyre HA, Bousman CA, Merrill DA, Lavretsky H. Pharmacogenetic Decision Support Tools: A New Paradigm for Late-Life Depression? Am J Geriatr Psychiatry 2018; 26:125-133. [PMID: 29429869 PMCID: PMC5812821 DOI: 10.1016/j.jagp.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/13/2017] [Accepted: 05/18/2017] [Indexed: 12/20/2022]
Abstract
Clinicians still employ a "trial-and-error" approach to optimizing treatment regimens for late-life depression (LLD). With LLD affecting a significant and growing segment of the population, and with only about half of older adults responsive to antidepressant therapy, there is an urgent need for a better treatment paradigm. Pharmacogenetic decision support tools (DSTs), which are emerging technologies that aim to provide clinically actionable information based on a patient's genetic profile, offer a promising solution. Dozens of DSTs have entered the market in the past 15 years, but with varying level of empirical evidence to support their value. In this clinical review, we provide a critical analysis of the peer-reviewed literature on DSTs for major depression management. We then discuss clinical considerations for the use of these tools in treating LLD, including issues related to test interpretation, timing, and patient perspectives. In adult populations, newer generation DSTs show promise for the treatment of major depression. However, there are no primary clinical trials in LLD cohorts. Independent and comparative clinical trials are needed.
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Affiliation(s)
- Ryan Abbott
- School of Law, University of Surrey, Guildford, UK; Department of Medicine for Abbott, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Donald D Chang
- School of Medicine, Ochsner Clinical School, University of Queensland, Brisbane, Queensland, Australia
| | - Harris A Eyre
- Texas Medical Center Innovation Institute, Houston, TX, USA; Department of Psychiatry, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Chad A Bousman
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, Victoria, Australia
| | - David A Merrill
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Penny K, Barron A, Higgins AM, Gee S, Croucher M, Cheung G. Convergent Validity, Concurrent Validity, and Diagnostic Accuracy of the interRAI Depression Rating Scale. J Geriatr Psychiatry Neurol 2016; 29:361-368. [PMID: 27647789 DOI: 10.1177/0891988716666376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Depression Rating Scale (DRS) is one of the clinical outcome measures of the International Resident Assessment Instrument (interRAI) assessment. The primary aim of this study is to investigate the diagnostic accuracy and concurrent validity of the 3-day assessment window version of the DRS. METHODS The performance of DRS was compared with a gold standard clinical diagnosis of depression in 92 patients (age ≥65) who had interRAI version 9.1 Home Care assessment completed within 30 days of discharge from psychogeriatric inpatient care or memory clinic assessment. RESULTS The DRS had poor diagnostic accuracy for depression diagnosis with an area under the curve of 0.68 (95% confidence interval [CI] = 0.57-0.77). The DRS score had a poor to moderate correlation with the Health of the Nation Outcome Scale 65+ depression item score ( rs = 0.30, 95% CI = 0.09-0.48, P = .006). CONCLUSION This study and the existing literature raise concerns that the DRS is not an adequate measure of depression.
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Affiliation(s)
| | | | | | - Susan Gee
- 4 Canterbury District Health Board, Christchurch, New Zealand
| | | | - Gary Cheung
- 1 University of Auckland, Auckland, New Zealand
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