Journal of Gerontological Social Work, 58:20–45, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 online DOI: 10.1080/01634372.2014.904469

Screening for Geriatric Depression in Residential Care Facilities: A Systematic Narrative Review ANNA AZULAI and CHRISTINE A. WALSH Faculty of Social Work, University of Calgary, Calgary, Canada

Studies in residential care facilities suggest that routine screening can assist in the early detection of geriatric depression. However, the effectiveness of screening instruments in residential care in the US and Canada has not been adequately evaluated. We conducted a systematic narrative review of the English-language literature published between 2000 and 2010 on screening instruments used for depression detection in older adults living in residential care facilities. The review yielded nine scales and their modifications tested in residential care, which we evaluated. We provide specific recommendations for the use of effective scales and discuss implications for practice, policy and research. KEYWORDS long-term care, mental health, quality of life, chronic illness, screening

The population in Western countries is rapidly aging (World Health Organization, 2011). Although the process of aging does not necessarily mean degraded health, health problems are a reality for many older adults (Andrews, Campbell, Denton, & McGilton, 2009). Some chronic conditions that result in disability are likely to lead to admission to residential care facilities (Canadian Health Association, 2009). The number of older adults who require institutional care in residential care facilities is expected to triple or even quadruple by 2040 (Adamek, 2003; Conn et al., 2008). Residential care facilities is a broad term used to refer to congregate living settings for older adults. Although a unified typology of residential Received 15 May 2013; revised 11 March 2014; accepted 11 March 2014. Address correspondence to Anna Azulai, PF3256, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada. E-mail: [email protected] 20

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care facilities for older adults in the United States and Canada is absent, it is generally composed of a variety of care settings including public, proprietary, non-for-profit, and faith-based residencies, which serve different segments of the older population with varied needs and levels of care (Pachana et al., 2010). This review focuses on residential care facilities that provide some level of personal or nursing care for older adults, in addition to accommodation (i.e., providing a room or lodging), including nursing homes or long-term care facilities and assisted living facilities, while excluding apartments or homes for seniors that do not provide any level of care. Conn et al. (2008) reported rates of mental health disorders in older adults living in residential care facilities of between 80% and 90%, depression being the most common (Snowdon, 2010). Prevalence estimates of depression in these care settings range from 14% to 44%, depending on severity of symptoms (Canadian Institute for Health Information, 2010; S. A. Greenberg, 2012; Watson, Zimmerman, Cohen, & Dominik, 2009). Among individuals with dementia, rates of depression range from 14% to 39% (Cohen, Hyland, & Kimhy, 2003). A number of studies have reported low levels of detection of depression in residential care facilities (Allen & Annells, 2009; Cohen at al., 2003; Snowdon, 2010; Snowdon & Fleming, 2008). Undetected depression can result in limited access to mental health services (Bern-Klug, Kramer, & Sharr, 2010; Morrow-Howell et al., 2008), increased physical and cognitive health deterioration (Sutcliffe et al., 2000), increased medical care utilization (Koopmans, Zuidema, Leontjevas, & Gerritsen, 2010; Raj, 2004), poor quality of life (Heisel, Duberstein, Lyness, & Feldman, 2010), and premature death (Harris & Cooper, 2006; Wagenaar et al., 2003). A number of explanations have been suggested for low levels of depression detection in residential care facilities, including ageist attitudes, inadequate staff training on the characteristics of depression in later life and how to screen for depression (Bern-Klug et al., 2010), and the presence of comorbid conditions or false attribution of depressive symptoms to normal aging (Lantz, 2002; Morrow-Howell et al., 2008; Snowden, Sato, & Roy-Byrne, 2003). Also, symptoms of depression, such as poor concentration or loss of interest in usual activities or hobbies, can mimic signs of dementia and, thus, could be misdiagnosed (Moriarty, 2002). According to Soon and Levine (2002), routine screening for depression among older adults in residential care facilities can increase detection and contribute to timely referral to treatment. Pachana et al. (2010) recommended using screening scales as a preliminary assessment, followed by a more comprehensive evaluation if necessary. Although there are growing number of screening measures for geriatric depression (Heiser, 2004), data on their clinical utility, specifically in residential care settings, is mixed. Several systematic reviews have been conducted on the screening scales

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for depression in community-dwelling older adults and primary-care settings (Allen & Annels, 2009; De Bellis & Williams, 2008; Moriarti, 2002; Pignone et al., 2002; Snowden et al., 2003; Watson & Pignone, 2003). None, however, have had a specific focus on older adults in residential care facilities. Systematic reviews have also analyzed best-practice guidelines for depression screening procedures in residential care facilities in the United States, Canada, and elsewhere (Koopmans et al., 2010, Pachana et al., 2010). However, these studies did not provide a comprehensive review of specific screening instruments, nor have they endorsed any particular screening instrument (American Geriatrics Society [AGS] & American Association of Geriatric Psychiatry [AAGP], 2003; Canadian Coalition for Seniors Mental Health [CCSMH], 2006; Conn et al., 2008). Koopmans et al. (2010) suggested that the Geriatric Depression Scale (GDS), the Beck Depression Inventory (BDI), and the Cornell Scale for Depression in Dementia (CSDD) were useful. Pachana et al. (2010) cautioned that endorsing any specific screening instrument would be inappropriate, as no measure has been identified as applicable to all individuals or in all contexts. They further recommended that the proliferation of screening scales requires the creation of a public web domain containing measures validated in residential care facilities, with a description of their features, advantages, and limitations to help clinicians select instruments appropriate for their settings. To date, a web site containing this information has not been created; this may have a negative impact on the effective use of such scales. To our knowledge, there are no systematic studies that summarize evidence on depression screening measures in residential care facilities in general, or in the United States and/or Canada, specifically. To address this deficit and to inform practice for screening depression in these care settings, we conducted a systematic narrative review of the literature on screening instruments for depression in older adults that could be suitable for detection of this condition in residential care facilities in the United States and Canada.

METHOD In the professional literature, there is a distinction between narrative reviews, systematic reviews, and systematic narrative reviews (Cipriani & Geddes, 2003; Popay et al., 2006). According to Cipriani and Geddes (2003), narrative reviews are traditional literature reviews that “usually do not include a section describing the methods used in the review” (p. 146), and systematic reviews are “syntheses of primary research studies that use (and describe) specific, explicit and therefore reproducible methodological strategies to identify, assemble, critical apprise and synthesise all relevant issues on a specific topic” (p. 146). Systematic narrative reviews are based on a

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narrative synthesis (NS) approach to systematic reviews, which according to Popay et al. (2006): refers to an approach to systematic review and synthesis of findings from multiple studies that rely primarily on the use of words and text to summarise and explain the findings of the synthesis. Whilst NS can involve manipulation of statistical data, the defining characteristic is that it adopts a textual approach to the process of synthesis to “tell the story” of the findings from the included studies. (p. 5)

We conducted a systematic narrative review to evaluate the suitability of depression-screening instruments for use in older adults living in residential care facilities in the United States and Canada. The inclusion criteria for the review were articles published in peer-reviewed journals in the English language, from 2000 to 2010, on depression-screening scales that have been tested in residential care facilities for older adults in the United States and Canada, or validated in English-speaking older adults in residential care settings elsewhere. We excluded single-item screens for depression in older adults from this review, as they are generally not recommended for use in residential care facilities (Jongenelis et al., 2005; Koopmans et al., 2010). The two brief versions of the GDS, GDS-4 and GDS-5, were not included in the review due to insufficient data on their performance in residential care facilities (Mitchell, Bird, Rizzo, & Meader, 2010). We have also excluded information published in the gray literature, such as internal and external reports of various organizations and web sites, conference papers, and other unpublished research. Assessing quality of data in gray literature is often difficult (McAuley, Pham, Tugwell, & Moher, 2000). Therefore, the decision to limit the review to peer-reviewed publications was driven by a goal to maximize selection of high-quality studies while minimizing the collection and analysis of potentially unreliable data. Although this decision has increased the threat of publication bias, defined as the tendency of researchers, reviewers and editors to submit or accept manuscripts for publication based on the strength of the study findings (Dickersin, 1990), it is known that any systematic review is subject to publication bias to some extent (Cochrane Collaboration, 2002). We searched the following electronic databases for peer-reviewed articles: PsycINFO, CINAHL, MEDLINE, Health and Psychological Instruments, Mental Measurements Yearbook, and The Cochrane Database of Systematic Reviews. We also hand-checked reference lists in all retrieved articles for additional publications meeting the inclusion criteria. We used the following set of keywords: depression detection, depression recognition, depression screening, depression assessment, screening tools, screening instruments, screening scales, screening measures, geriatric depression, depression in late

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life, older adults, residential aged care facilities, residential homes, homes for the aged, assisted living, long-term care facilities, nursing homes, and geriatric institutions. This study was conducted by two researchers: a doctoral student and a supervising faculty member with extensive research experience. The initial search of relevant articles and the subsequent review of the retrieved articles were completed by the doctoral student, with ongoing consultation from the experienced research team member. The initial search generated a large number of potentially relevant articles (N = 4,678). Applying the inclusion criteria of publication language and date decreased the number of articles to 329. The elimination of duplicates yielded 266 relevant publications, for which full-text papers were retrieved. Full-text papers were then reviewed to exclude studies that described general issues related to depression in residential care settings but did not discuss any specific screening scale, as well as studies on tested scales in non-English-speaking older adults. The remaining 33 articles were reviewed in detail and analyzed by both team members independently, who then discussed the findings together and reached consensus that resulted in including the 33 articles in the review study. These articles yielded nine screening instruments and their various modified versions. Findings have been organized according to the concept-centric approach, using concepts and categories as a framework for data analysis and presentation of the results (Webster & Watson, 2002).

RESULTS The nine screening instruments and their modifications were organized in three categories, including: (a) depression scales designed for older adults; (b) scales used for routine depression screening in residential care facilities in the United States and Canada; and (c) other depression scales tested in older adults living in residential care facilities. These categories are mutually exclusive: scales designed for older adults are not used routinely for depression screening in residential care facilities in United States and Canada; scales used for routine depression screening in residential care facilities, such as Depression Rating Scale (DRS) in the Minimum Data Set (MDS) 2.0, and Mood Questionnaire in the MDS 3.0, are not designed specifically for older adults, but for general use in residential care facilities, and can be applied to assess depression in nongeriatric residents; and, finally, scales in the third category are not designed specifically for older adults and not used for routine screening in residential care settings, but do assess for depression and were tested in older adults, living in residential care settings. The properties of the scales in this review—response format, scoring format, and psychometric evaluation—and their strengths and limitations for use in residential care facilities are summarized in Table 1. Sensitivity—the

25

3

2

DRS (MDS 2.0)

Observational

Observational

CSDD-M-LTCS

CSDD

Self-report or interview Observational

Self-report or interview

GDS-15

GDS-12R

Self-report or interview

GDS-30

1

Scale Format

Name of Scale

#

3-point severity scale (no depression, mild, severe) 3-point frequency scale (never or almost never, sometimes, most of the time) Graded frequency scale (0–3)

Yes/No

Yes/No

Yes/No

Response Format

0–38, higher score indicates depression

19

0–14

0–38, higher score indicates depression

19

7

0–12

0–30: 0–10 = normal; 11–20 = mild depression; 21–30 = severe depression 0–15: 0–4 = normal; 5–8 = mild depression; 9–11 = moderate; 12–15 = severe

Score Range

12

15

30

Number of Items

Yes

Data not available Case finding and severity assessment 3 for mild or moderate depression

No

20–30 min Case finding and severity assessment

12 for major depression

(Continued)

Yes (Canada)

No

Yes (Australia)

Yes Case finding and severity assessment

12 for major depression

No

No

No

No

No

No

Training Required

Used as a Routine Screen in Care Facilities

Data not available 20–30 min

5–7 min

Case finding

5 or higher to indicate depression; 6–7 is recommended for residential care 4–5 Case finding

10–15 min

Completion Time

Case finding

Clinical Cut Point

Goal (Assessment of Change Severity or Case Finding)

10 or 11 to indicate depression

TABLE 1 Screening Scales for Geriatric Depression in Residential Care Facilities

26

HAM-D (HRSD; HDRS) ZUNG (ZSDS)

6

7

PHQ-2

5

Four-point frequency scale: a little of the time, some of the time, good part of the time, most of the time (1–4)

3 or 5 rating scale

Clinical interview

Self-report or interview

Four-point frequency scale (0–3)

Yes/No, plus a graded frequency scale to elaborate (0–3)

Response Format

Self-report or interview

Self-report or Mood interview & Questionnaire [observational (MDS 3.0) & version PHQ-9-OV

4

Scale Format

Name of Scale

#

TABLE 1 (Continued)

17 in the original version 20

2

9

Number of Items

0–80

0–50 for the 17-item version

0–6

0–27

Score Range 0–4 = normal; 5–9 = mild depression; 10–14 = moderate; 15–19 = moderately severe; 20–27 = severe 3 for major depression; 2 for other depressive disorders 15 and above for major depression Generally 40, though most people with depression score 50–69.

Clinical Cut Point

Case finding

Case finding, designed for first-step screening Measures severity

Case finding and severity assessment

Goal (Assessment of Change Severity or Case Finding)

No

Yes

30–45 min

10 min

No

Yes

Training Required

2 min

3 min

Completion Time

No

No

No

Yes (USA)

Used as a Routine Screen in Care Facilities

27

9

8

Self-report or interview

Self-report or interview

CES-D Short Form

Self-report or interview

CES-D

BDI-II

Four-point frequency scale

Four-point frequency scale (0–3)

Four-point scale (0–3) degree of severity

10

20

21

0–10

0–60, each item is scored from 0 to 3

0–63

0–13 for minimal depression; 14–19 mild; 20–28 moderate; 29–63 severe. 16 is a cut point for physically ill Generally used cut score of 16; cut of 21 is suggested in older adults 4 or greater Case finding

Case finding and change assessment

Measures severity

5 min

10 min

5–10 min

No

Some

Some

No

No

No

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percentage of depressed people who are correctly identified as having the condition; specificity—the percentage of healthy people who are correctly identified as not having the condition, positive predictive value (PPV)—the proportion of positive test results that are true positives or correct diagnoses, negative predictive value (NPV)—the proportion of respondents with negative test results who are correctly diagnosed, criterion measures—the gold standard measure against which the instrument is tested (Bewick, Cheek, & Ball, 2004), and sample sizes are reported for each scale when available.

Depression Scales Designed for Older Adults GDS The original version (GDS-30). The GDS-30 is perhaps the most studied and widely used depression-screening measure for older adults (Kohler et al., 2005). The original 30-item version (Yesavage et al., 1983) assesses feelings and behaviors related to depression using a yes/no format (Roman & Callen, 2008). It does not assess vegetative symptoms or somatic components, to minimize false-positive outcomes as a result of co-morbid conditions (Roman & Callen, 2008). The scale can be used as self-report or interview, depending on the respondent’s level of functioning. Scores of 0–10 correspond to a normal condition, scores of 11–20 indicate mild depression, and scores 21–30 indicate severe depression (Kurlowicz, 2000). The GDS-30 is a readily available reliable screening tool that has been translated into, and validated in, many languages (Holroyd & Clayton, 2000). It demonstrated good sensitivity and specificity (Hyer, Carpenter, Bishmann, & Wu, 2005; Snowden et al., 2003). According to Kurlowicz (2000), a clinical cut point of 11 yielded 84% sensitivity and 95% specificity, whereas a cut point of 14 yielded a slightly lower sensitivity and specificity, 80% and 100%, respectively. Some scholars have documented the limitations of the GDS-30 in performing case-finding for minor depression and dysphoria (Allan & Annells, 2010). Also, the clinical utility of the GDS-30 with residents with cognitive impairment is unclear (Sutcliffe et al., 2000). Some researchers have documented good performance of the scale in nursing home patients with no or only mild to moderate cognitive impairment (Mini-Mental State Examination [MMSE] 15 and greater; Roman & Callen, 2008). However, Snowden et al. (2003) found poor performance of the GDS-30 in case detection of moderately to severely impaired residents. Therefore, it has been generally recommended to use the scale only when MMSE scores are 15 or greater (Holroyd & Clayton, 2000). GDS Short Form (GDS-15). The GDS-15, also known as GDS-SF, is a derivative of the original GDS-30, containing the 15 items with highest correlation to depressive symptoms (S. A. Greenberg, 2012). Like the original

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version, the GDS-15 can be used as self-report or interview and has a yes/no response format (Hyer et al., 2005). Scores 0–4 correspond to a normal condition; 5–8 indicate mild depression; 9–11 indicate moderate depression; and 12–15 indicate severe depression. Sensitivity and specificity have been reported as 60% to 79% and 75% to 67% in the GDS-15 using cut points of 4 or 5, respectively (Sutcliffe et al., 2000; Watson et al., 2009). Using cut points of 6 or 7 increased sensitivity and specificity to 92% and 89%, respectively (Watson et al., 2009). Generally, a positive score of 5 or greater on the GDS-15 is indicative of the need for an in-depth psychiatric assessment (S. A. Greenberg, 2012). Other scholars reported sensitivity scores ranging from 79% to 100% and specificity from 67% to 80% in population with different levels of cognitive functioning (Jackson & Boldwin, 1993; Lesher & Berryhill, 1994). Brown and Schinka (2005) conducted a study of GDS-15 patients (N = 147) and reported sensitivity of 67%, specificity of 81%, PPV of 0.31, NPV of 0.95 with cut point equal to or greater than 4. A number of studies reported that the GDS-15 is valid for use in residential care facilities (McCabe et al., 2006; Sutcliffe et al., 2000; Watson et al., 2009). As a measure of criterion validity, Blank, Gruman, and Robinson (2004) compared the Center for Epidemiological Studies Depression Rating Scale (CES-D) short form and the GDS-15 against the Diagnostic Interview Schedule (Rogers, 2001) in a sample of cognitively intact or mildly cognitively impaired (MMSE over 24) community-dwelling older adults (N = 360) and older clients in different healthcare settings including nursing homes (N = 85). The GDS-15 performed better than the other measures with sensitivity of 86% and specificity of 83% at the cut point 7. Although the GDS-15 did not show a significant advantage, compared with the GDS-30, in cognitively impaired residents, its brevity makes it more feasible to administer with physically ill residents or those with mild dementia (Sutcliffe et al., 2000). However, some items in the GDS-15 appear irrelevant in the context of institutional living (Sutcliffe et al., 2000). GDS Residential (GDS-12R). The GDS-12R, a 12-item version of the GDS-15, was developed with specific focus on residential care facilities and validated in nursing home residents (N = 308), in England, against GDS-15 as a criterion measure (Sutcliffe et al., 2000). No other depression screening scale was designed specifically for this setting. GDS-12R can be used as self-report or interview, depending on the physical or cognitive limitations of the respondents. The scale showed greater internal consistency than the GDS-15 and is considered a brief, easyto-administer depression screening scale suitable for residential care facility individuals, including those with moderate to severe cognitive impairment (Sutcliffe et al., 2000). Cut points of 4 or 5 produced sensitivity of 73%, and specificity of 77%, respectively. Cut points of 3 or 4 produced greater sensitivity (79%) and lower specificity (69%).

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According to Sutcliffe et al. (2000), the GDS-12R showed good psychometric properties in a sample of English-speaking older adults in residential care facilities in England, supporting its applicability for use in the United States and Canada. CSDD The original version. The CSDD is a 19-item instrument designed to detect a broad range of depressive symptoms in the affective, cognitive, behavioral, and somatic realms in persons with cognitive impairment (Alexopoulos, Abrams, Young, & Shamoian, 1988). Items ask about symptoms in the past week, on a 3-point severity scale (0 = absent; 1 = mild or intermittent; 2 = severe); higher scores reflect more severe depression. It uses a multisource approach to gathering information by utilizing residents’ responses, interviewer observation, and collateral sources’ reports. It requires 20 to 30 min to administer by a trained clinician and is reported most effective when completed and scored through careful observation, rather than an interview (De Bellis & Williams, 2008). The CSDD was validated in older adults who ranged from cognitively impaired to intact (Hyer et al., 2005; Snowden et al., 2003). However, there was mixed evidence on the clinical utility of the CSDD in residential care facilities. For example, Vida, Des Rosiers, Carrier, and Cauthier (1994) reported good results on the performance of CSDD in their cross-sectional study of nursing home residents with cognitive impairment (N = 26): high sensitivity of 90% and specificity of 75% at the cut point of 7 for major depression, compared with a psychiatric diagnostic interview as the gold standard. Loren Greenberg et al. (2004) conducted a cross-sectional study of 75 older residents in palliative care in a US nursing home and concluded that the CSDD agreement with the gold standard psychiatric diagnosis was not optimal and less than the GDS-15. The CSDD outperformed the GDS-15 in detecting depression in residents with severe dementia (MMSE = 0). They reported the CSDD sensitivity of 75% and a very low specificity of 29%, which may have been caused by the small sample size. In addition, the CSDD required a high level of resources and training, which may not be feasible in some residential care facilities (McCabe et al., 2006; Snowden et al., 2003). Despite mixed results, the CSDD has been judged as the best existing tool for identifying depression and monitoring the effects of treatment in residential care facilities residents with cognitive impairment (De Bellis & Williams, 2008). In Australia, for instance, CSDD is now a mandatory assessment measure for depression and is used routinely in residential care facilities (De Bellis & Williams, 2008). The modified version for use by long-term care staff (CSDD-M-LTCS). Watson et al. (2009), in a study of older adults (N = 112) and staff members

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(N = 27) in nursing homes and assisted living settings, modified the CSDD to make it easier to administer for paraprofessional staff, such as personal care aides. Paraprofessional staff members provide the majority of care for residents in such facilities and are, thus, well-positioned to screen residents for depression. The technical language of the scale was modified and the response format was changed from severity (i.e., none, mild, severe) to frequency (i.e., never or almost never, sometimes, most of the time). It, however, performed poorly against the gold standard DSM-IV diagnosis of major or minor depression (American Psychological Association, 2000). Watson et al. reported sensitivity of 33% and specificity of 86% for CSDD-M-LTCS at a cut point equal to or greater than 13.

Scales Used for Routine Depression Screening in Residential Care Facilities in the United States and Canada The MDS, an internationally validated standardized assessment system for residents in residential care facilities (Burrows, Morris, Simon, Hirdes, & Phillips, 2000), is currently mandated for utilization in nursing homes in the United States and Canada that are regulated on federal or provincial levels (Canadian Institute for Health Information, 2010; Kohler et al., 2005). Other nonmandated residential care settings, such as assisted living facilities, do not normally use MDS. The MDS consists of a number of measures for different health domains including depression. DRS The DRS, designed by Burrows et al. (2000), is embedded in the second version of the MDS (MDS 2.0). It is a 7-item observational scale, in which caregivers report frequency of depressed behaviors in the resident over the last 30 days. Scoring is based on frequency: 0 = the behavior was not exhibited in the last 30 days, 1 = exhibited in the last 5–30 days, and 2 = exhibited daily or almost daily. A cut point of 3 or greater indicates the need for further evaluation (Anderson, Buckwalter, Buchanan, Maas, & Imnof, 2003). Data on the performance of DRS in nursing home residents is mixed. McCuren (2002) and Kohler et al. (2005) reported a low correlation between the DRS and the GDS-15 in nursing home settings in the United States. Kohler et al. suggested that the DRS and the GDS-15 are not interchangeable, as they measure different aspects of the depression syndrome. Differences between these scales may be due to differences in the scales’ symptom content and the fact that GDS is self-reported and DRS observer-reported. Kohler et al. (2005) also noted a low correlation between the DRS and the CSDD, attributing it to different data collection strategies. Interestingly, Ruckdeschel, Thompson, Datto, Streim, and Katz (2004) converted the DRS into a self-report assessment and found high correlation

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with the GDS-30. In a cross-sectional study of nursing home patients (N = 204) with MMSE above 12, the converted version of the DRS performed well, producing sensitivity of 93%, specificity of 71%, PPV of 53, and NPV of 96 at the cut point of 3, against the DSM-IV diagnostic criteria as a gold standard. The study did not include residents with severe cognitive impairment. Sullivan Kerber et al. (2005) conducted a secondary data analysis of a sample of randomly selected older residents (N = 279) in nursing homes in rural Iowa, US, and concluded that there was only a chance of successful identification of depression using DRS, as well as a chance agreement between the DRS and the GDS-15; sensitivity and specificity were not reported. In a cross-sectional study of residents (N = 348) in a large nursing home in New York City, Heiser (2004) compared the GDS, DRS, and a number of other scales, against the Schedule for Affective Disorders (SADS; Rogers, 2001) as a gold standard. The DRS produced sensitivity of 75 percent and specificity of 83 percent, with the GDS-15 outperforming the DRS (Heiser, 2004). Due to the unsatisfactory performance of the DRS in this setting, some scholars recommended that it might need to be revised or replaced for use in this population (Heiser, 2004; Snowdon, 2004). It continues to be used, however, in Canadian nursing homes as a part of the MDS 2.0 (Huang & Carpenter, 2011). THE MOOD QUESTIONNAIRE (PHQ-9, MODIFIED) The original PHQ-9, developed by Kroenke, Spitzer, and Williams (2001), is a 9-item self-report scale (responses rated on a frequency scale from 0 to 3 (0 = not at all, 1 = several days, 3 = more than half the days, and 4 = nearly every day) based on the DSM-IV criteria for major depressive disorder; as expected, its correlation with the DSM-IV was high (Roman & Callen, 2008). It has been validated in older adults in primary care, home care, and outpatient clinical settings (Arroll et al., 2010; Phelan et al., 2010; Saliba & Buchanan, 2008). Phelan et al. (2010) conducted a diagnostic accuracy study of PHQ-9 in older adults in primary care in the United States (N = 71), comparing it to GDS-15, PHQ-2, and Structured Clinical Interview for Depression (SCID; Rogers, 2001) as a criterion measure for major and minor depression diagnosis. Sensitivity was 63% and specificity 82% at the cut point 10, producing comparable results to GDS-15 and PHQ-2. However, the PHQ9 was found less successful in identifying dysthymia (Roman & Callen, 2008). Owing to good sensitivity and specificity in older adults, coupled with its dual utility of measuring severity and case finding of major depression, the original PHQ-9 has been endorsed by the Geriatric Mental Health Foundation for use as a screening tool in geriatric primary care and hospitals (Phelan et al., 2010).

Screening for Geriatric Depression in Residential Care Facilities

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Although the original PHQ-9 had not been tested in residential care facilities, it was validated in those care settings when remodified to fit the needs of residential care (Saliba & Buchanan, 2008). Since 2010, when MDS 3.0 replaced the MDS 2.0 in all US nursing homes (Saliba, Jones, et al., 2012), depression has been screened using this modified version of the PHQ-9, called the Mood Questionnaire. In the Mood Questionnaire, each yes/no item inquires about the presence of specific depression symptoms with subsequent optional elaboration of the response to the frequency scale. This modified version was renamed to the Mood Questionnaire and is embedded in the new MDS 3.0 (Saliba & Buchanan, 2008). The Mood Questionnaire is a four-point scale of severity of symptoms that takes approximately 3 min to complete. Scores range from 0 to 27: from 0 to 4 indicate no depression; 5 to 9 mild depression; 10 to 14 moderate depression; 15 to 19 moderately severe depression; and 20 to 27 severe depression. The scale can be administered in self-report or interview format. The PHQ-9 Observer Version (PHQ-9 OV) targets residents who cannot self-report and is completed by the staff member who best knows the resident (Saliba & Buchanan, 2008). The OV contains same 9 items of the PHQ-9 plus an additional item assessing irritability. The interview format was determined to be feasible and appropriate for use in residents with varied levels of cognitive functioning (Saliba & Buchanan, 2008). The Mood Questionnaire was tested in a large US national MDS 3.0 evaluation study among nursing home residents scheduled for MDS 2.0 assessments (Saliba, DiFilippo, et al., 2012). Residents from 71 community nursing homes in eight US states were randomly included in a feasibility sample (N = 3,258) and a validation sample (N = 418). SADS and the CSDD were used as criterion measures. In the validation sample, the agreement between the Mood Questionnaire and SADS was good (weighted κ = 0.69, 95% CI = 0.61–0.76), whereas agreement between DRS of the MDS 2.0 and m-SADS was poor (weighted κ = 0.15, 95% CI = 0.06–0.25). Likewise, in residents with severe cognitive impairment, the Mood Questionnaire correlation with the criterion standard CSDD was superior to the DRS for both the Mood Questionnaire (0.63 vs. 0.34) and the PHQ-9 OV (0.84 vs. 0.28). Sensitivity, specificity, PPV, and NPV were not reported.

Other Depression Scales Tested in Older Adults PATIENT HEALTH QUESTIONNAIRE,

A

BRIEF SCREEN (PHQ-2)

The PHQ-2, a 2-item self-report scale derived from the original PHQ-9, can be completed in about 2 min (Sowden, Mastromauro, Januzzi, Fricchione, & Huffman, 2010). It has been found to be a sensitive tool in primary care (Arroll et al., 2010), as well as in a general population of older adults (Kroenke, Spitzer, & Williams, 2003). Watson et al. (2009) compared

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several measures for depression in older adults—CSDD-M-LTCS, GDS-15, DRS, PHQ-2 and a one item screen—against a gold standard diagnostic interview by a geriatric psychiatrist, in residents (N = 112) and staff members (N = 27) in assisted living settings. The authors reported that PHQ-2 yielded sensitivity of 100 and specificity of 77 and concluded that, of the known self-reported measures, the PHQ-2 seemed to have the best mix of brevity, sensitivity, and ease of administration. It was thus recommended for use in residential care facilities (Watson et al., 2009). HAMILTON RATING SCALE

FOR

DEPRESSION (HRSD; HDRS; HAM-D)

Max Hamilton (1960, as cited in Roman & Callen, 2008) originally developed the HRSD, also known as Hamilton Depression Rating Scale (HDRS) or HAM-D. It is a multiple-choice questionnaire administered in a semistructured interview format by trained clinicians. It has been revised many times with versions consisting of 17 (in the original) to 29 items. Typically, cut points of 17 to 20 are used to indicate depression. The HDRS demonstrated a strong agreement with the DSM-IV criteria for major depression, as well as good reliability with hospitalized older adults (Hyer et al., 2005). However, Hammond (1998) argued that a 17-item HDRS is not a reliable among geriatric, physically ill patients. Aben, Verhey, Lousberg, Lodder, and Honig (2002) claimed the opposite. In a sample of stroke patients (N = 202), they compared the BDI and the HDRS against the standard diagnostic interview as a criterion measure. Sensitivity was 78% and specificity was 75% for the HDRS. It also performed better in men than in women. Despite this gender difference, Aben at al. concluded that the scale was an acceptable screening instrument for poststroke depression. Similarly, in a cross-sectional study of geriatric patients with Alzheimer’s disease (N = 26) in outpatient or hospital clinics, Vida, Des Rosiers, Carrier, and Gauthier (1994) found a high correlation with the CSDD, as well as sensitivity of 90% and specificity of 63% at the cut point of 7. The HDRS was also validated in geriatric nursing home residents, outperforming the DRS (Anderson et al., 2003). However, the clinical utility of the HDRS in residential care facilities has been questioned due to the presence of somatic items in the scale, a complex response format, and a lengthy time (30 to 45 min) to administer (Burrows et al. 2000; Holroyd & Clayton, 2000). Zung Self-Rated Depression Rating Scale (ZSDS). The ZSDS (Zung, 1965) is a self-report scale for assessment of depression in the general population, consisting of 20 items rated on a 4-point frequency scale. Raw scores range between 20 and 80. A cut point of 50 indicates mild depression; scores 60 and over indicate moderate to severe depression. Using the converted score, scores below 0.50 indicate no depression; 0.50 to 0.60 mild depression; 0.61 to 0.70 moderate depression; and above 0.70 indicate severe depression (Adalberto, 2006; Hyer et al., 2005; Zung, 1965; Zung & Zung, 1986).

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In the general population, psychometric properties of the scale were sensitivity of 87%, specificity of 74%, PPV of 41%, and NPV of 97% at the clinical cut point of 40 (Adalberto; 2006). However, in older adults, the suggested cut point of 40 yielded high sensitivity (88%) with false-positive rate (44%; Hyer et al., 2005). Adjusted cut point of 60 in older adults produced sensitivity of only 58% and specificity was 87% (Zung & Zung, 1986). Dunn and Sacco (1989) in the study of community-dwelling older adults (N = 439) found ZSDS inferior to the GDS-15 in terms of the completion rate, pointing to the multiple-choice response format of the ZSDS as a challenge for older respondents. On the other hand, Agrell and Dehlin (1989) endorsed using ZSDS in geriatric stroke patients (N = 40) both in outpatient clinics and in nursing homes, owing to its sensitivity of 76%, specificity of 96%, PPV of 93%, and NPV of 84% at the cut point of 45. However, due to the limited and mixed data regarding the instrument’s performance in older adults, there is a general recommendation to avoid using ZSDS in either research or clinical assessments of geriatric depression (Holroyd & Clayton, 2000). BECK DEPRESSION INVENTORY (BDI

AND

BDI-II)

BDI and its second edition BDI-II are self-report scales (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) considered useful in older adults for screening for depression (Hyer et al., 2005). Gallagher (1986) argued that BDI could be used in older adults without serious medical problems. Laprise and Vezina (1998) found that BDI had acceptable reliability and validity for cognitively intact older adults living in nursing homes. At the usual cut point of 10 and 11, sensitivity was 96% for BDI, and the specificity rate was 46%. McCabe at al. (2006), however, argued that BDI has limited usefulness in residential care settings: Items are written at an 8th-grade reading level and have responses on a 4-point scale. This may pose difficulties for residents with low levels of literacy, poor English language skills, or mild cognitive impairment. Also, a number of items refer to somatic symptoms; residents are likely to have these symptoms due to other reasons. Given these limitations, the BDI and the BDI-II are not recommended for use in residential care facilities (Snowden et al., 2003). CES-D The original version. This scale, originally developed for populationbased studies, can be administered in either self-report or interview format (Radloff, 1977). It consists of 20 items addressing depressive symptoms over the previous week (Fisher & Shumaker, 2004) and responses, graded on a 4-point scale, for a maximum total score of 60 (Roman & Callen 2008). Clinical cut points vary; generally, a cut point of 16 indicates depressive symptoms, and a cut point of 21 is used in older adults (Fisher & Shumaker,

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2004; Radloff, 1977). Radloff and Teri (1986), in their review, stated that a cut point of 20 on the CES-D yielded the optimal balance between false positives and false negatives for older adults; it had a PPV of 82%. Smarr and Kerrer (2011) conducted a study of CES-D performance in communitydwelling older adults, using SCID (Rogers, 2001) as a criterion measure. A cut point of 22 yielded sensitivity of 84%, specificity of 60%, and PPV of 77%. Lyness et al. (1997) reported sensitivity ranging between 73% and 93%, depending on the cut point, and specificity range of 87% to 92%. Blank et al. (2004) compared CES-D and GDS-15 against SCID as a criterion measure in the sample of older adults who were cognitively intact or had mild cognitive impairment (MMSE over 24) in a combined sample (N = 360) of the community-dwelling older adults and those in different healthcare settings, including older residents in nursing homes (n = 85). The CES-D showed sensitivity of 86%; specificity of 78% at the cut point of 14. Although the CES-D has been used with older adults in various settings (Blank et al., 2004; Pignone et al., 2002; Snowden et al., 2003), its suitability specifically in residential care facilities has been questioned due to complicated response format and focus on somatic symptoms (Watson & Pignone, 2003). Further, a number of scholars reported only fair agreement between the CES-D and the GDS-15. The CES-D produced mixed results in sensitivity and specificity for older adults with medical illness, as well as those with cognitive impairment (Blank et al., 2004; Hyer et al, 2005; Roman & Callen, 2008). CES-D Short Form. The CES-D Short Form is a 10-item scale derived from the original CES-D. It has been validated for use in older adult populations (Irwin, Artin, & Oxman, 1999; Roman & Callen, 2008). In the same study described previously, Blank et al. (2004) compared the short form and the GDS-15 against SCID as a criterion measure. According to Blank et al., despite demonstrated excellent sensitivity and specificity for major depression in clinical and hospital settings, the CES-D 10 item scale was found inferior to the GDS-15 in this sample: it showed sensitivity of 71%, and specificity of 83% at the cut point of 4.

DISCUSSION This study reviewed, for the first time, scales for screening of depression suitable for use in residential care facilities in the United States and Canada. This knowledge is critical in assisting social workers, nurse professionals, physicians, and other clinicians in selecting the most appropriate instruments for their particular settings and clientele. We generally concur with conclusions of previous individual studies, in that it is difficult to identify one optimal screening scale for detection of

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depression in residential care facilities (Koopmans et al., 2010; Pachana et al., 2010). Selection of screening scales for each facility ultimately should be guided by clinical goals, residents’ characteristics and important contextual factors, such as financial resources and the availability of trained clinicians, among others (Pachana et al., 2010). However, a preference should be given to scales with good psychometric performance demonstrated in residential care, high agreement with the gold standard, simpler response formats, good match with residents’ characteristics, and fewer resources required for administration in terms of time completion and clinical training (Koopmans et al., 2010). For residents who have difficulties completing self-report instruments due to physical, communicative, and/or cognitive abilities, a combination of self, observer, or collateral sources data should be used. Despite the challenge in recommending a single scale, this systematic narrative review identifies some scales as more suitable and feasible for use in residential care facilities. The Mood Questionnaire based on the PHQ-9 that is embedded in the MDS 3.0 resident assessment protocol used currently in the US nursing homes is one such scale. It, along with the DRS embedded in the earlier version MDS 2.0 that is used now in Canadian nursing homes, are the only two instruments out of the nine reviewed that are used for mandatory screening for depression in residential care facilities in the United States and Canada. The Mood Questionnaire is currently the most robust and effective scale, owing to its excellent performance in detecting depression in older adults regardless of cognitive status, its simple response format, brevity, strong agreement with the DSM-IV-TR diagnostic criteria, and its availability in a self-report and observational versions (Rahman & Appelbaum, 2009; Saliba & Buchanan, 2008; Saliba, Jones, et al., 2012). The DRS, on the other hand, has been shown as relatively ineffective. When used for assessment of depression in older adults in residential care facilities, as it is currently in Canada, it is advisable to supplement the DRS with a scale that has been validated in these care settings. This suggestion concurs with the two-step screening recommendation outlined in the Canadian and the US clinical best-practice guidelines for detection of depression in long-term care facilities (AGS & AAGP, 2003; CCSMH, 2006). Using the DRS without supplementation could increase the risk of a false-positive or a false-negative diagnoses, resulting in undertreatment of depressed residents or unnecessary labelling and treatment of persons who are not depressed. The GDS, the PHQ-2 and the CSDD are recommended as appropriate scales to supplement the DRS, although each scale has advantages and disadvantages. Although the GDS is one of the screening scales recommended for use in residential care facilities in the Canadian and the US clinical best-practice guidelines (AGS & AAGP, 2003; CCSMH, 2006), findings suggest that not all versions of the GDS are effective in these care settings. Consequently, the GDS should not necessarily be the default instrument in

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residential care facilities. For instance, the original GDS-30 is lengthy and could be tiring for physically ill residents to complete; as well, it may not be the most feasible scale for use in residents with moderate to severe cognitive impairment, a common condition among those living in residential care facilities. The GDS-15 is also not recommended for residents with cognitive and communicative difficulties, a fact that limits its utility in residential care settings. It also has a number of items that could cause confusion or irritation of respondents. The GDS-12R, the only scale that has been designed specifically for residential care, showed excellent performance in English-speaking older adults living in residential care facilities. This scale is promising, but requires further testing in the United States and Canada. The very brief PHQ-2 scale has been found sensitive to identify depression in nursing home residents in the United States and Canada and may be useful as an initial screen, owing to the very modest resources it requires for excellent properties it shows. However, given the limited number of validation studies, further testing of this instrument in residential care is needed. The CSDD, acknowledged as the best screening scale for detection of depression in older adults with various stages of dementia, is used for mandatory screening in residential care facilities in Australia (De Bellis & Williams, 2008). However, it shows low levels of agreement with the gold standard and requires considerable resources in time and trained personnel for administration, making it less suitable in its present form. Modification of this scale to simplify format and administration has not been successful (Watson et al., 2009). It is important to note that a number of highly reputable scales used in the general population and in community-dwelling older adults (e.g. CES-D, HAM-D, HDRS, HRDS, BDI, BDI-II, and ZSDS) are not recommended in the context of residential care facilities for several reasons, including their complex response formats, length, and a focus on somatic components that may generate false positive in residents with compromised health. In conclusion, we recommend using the Mood Questionnaire in the MDS 3.0 to screen for depression in residential care facilities across North America. The DRS, on the other hand, is federally mandated for assessment of depression in older adults in nursing homes in Canada and cannot be ignored, even though its reliability has been questioned. The DRS should be supplemented with another validated scale, such as PHQ-2 or the GDS-15, and potentially the GDS-12R. However, these self-report tools may not be suitable for residents with severe cognitive impairment or physically compromised residents who are unable to self-report. In those cases, using the CSDD is advisable.

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Suitable and feasible screening scales will improve the accuracy of detection of depression and in promoting residents’ mental health care and quality of life. It is important to remember, however, that screening is not a substitute to formal psycho-geriatric assessment, which should always follow any positive screening outcome. Also, screening by itself, without available and accessible mental health services, is of limited benefit. This study has several limitations, including retrieval and review of only English-language articles; studies that report findings on residential care facilities in Canada, but were published in French or in other languages have been excluded. Only peer-reviewed articles were selected, a fact that means that potentially valuable information may have been missed. As well, it subjects the review to publication bias. In addition, the details of psychometric data of the scales’ performances was not equally available for all measures; when data was not found, we had to rely on the analysis and conclusions of the studies’ authors. Finally, this review did not take into consideration the diversity in study samples from the perspectives of gender, race, ethnicity, age, and so on. Although information on the diversity of the samples on which the instruments have been tested is important, most studies provided few details about this and consequently these factors could not be assessed in the review. Despite the study limitations, findings from this review could be used as a basis for developing a public web domain for screening measures for geriatric depression in residential care facilities in the United States and Canada, as has been recommended (Pachana et al., 2010). A public web domain hosting this information would be useful for clinicians, researchers, and policy makers. In addition, this review identifies problems in current practices, including the use of inefficient screens such as the DRS in Canada and the lack of uniform guidelines on screening for depression in nonmandated facilities, such as assisted living settings. Further research is necessary in several areas. First, further validation of the GDS-12R in US and Canadian residential care facilities is needed. Second, there is a need to investigate the use of any depression screening scales in nonmandated residential care facilities in both the United States and Canada, to inform policy and to ensure adequate assessment and treatment of depressed residents in different types of residential care facilities. Third, it would be beneficial to review studies on the performance of the scales in diverse subgroups of older adults in residential care facilities, relating to race, ethnicity, gender, age and health status. Forth, it is important to learn how the recommendations of the national clinical best-practice guidelines on depression screening are implemented in residential care facilities. Finally, the utility of routine screening depends on the availability of resources in the residential or health care systems to react to the findings, such as access to mental health services for older adults.

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REFERENCES Aben, I., Verhey, F., Lousberg, R., Lodder, J., & Honig, A. (2002). Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients. Psychometrics, 43, 386–393, doi:10.1176/appi.psy.43.5.386 Adalberto, C. A. (2006). Validation of Zung’s self-rating depression scale among the Colombian general population. Social Behavior and Personality: An International Journal, 34, 87–89. Adamek, M. E. (2003). Chapter 2: Late life depression in nursing home residents: Social work opportunities to prevent, educate, and alleviate. In B. Berkman & L. K. Harootyan (Eds.), Social work and health care in an aging society: Education, policy, practice and research, (pp. 15–48). New York, NY: Springer Publishing. Agrell, E., & Dehlin, O. (1989). Comparison of six depression rating scales in geriatric stroke patients. Stroke: Journal of the American Heart Association, 20, 1190– 1194, doi:10.1161/01.STR.20.9.1190 Alexopoulos, G. A., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284. Allen, J., & Annells, M. (2009). A literature review of the application of the Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder: Checklist to community nursing cohorts. Journal of Clinical Nursing, 18, 949–959. doi:10.1111/j.1365-2702.2008.02731.x American Geriatrics Society & American Association for Geriatric Psychiatry. (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: Management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287–1298. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder (4th ed., text rev.). Washington, DC: Author. Anderson, R. L., Buckwalter, K. C., Buchanan, R. J., Maas, M. L., & Imnof, S. L. (2003). Validity and reliability of the Minimum Data Set Depression Rating Scale (MDSDRS) for older adults in nursing homes. Age and Ageing, 32, 435–438. Andrews, G. J., Campbell, L., Denton, M., & McGilton, K.S. (2009). Gerontology in Canada: History, challenges, research. Aging International, 34, 136–153, doi: 10.1007/s12126-009-9042-7. Arroll, B., Goodyear-Smith, F., Grengle, S., Gunn, J., Kerse, N., Fishman, T., . . . Hatcher, S. (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine, 8, 348–353, doi:10.1370/afm.1139. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. Bern-Klug, M., Kramer, C. W. O., & Sharr, P. (2010). Depression screening in nursing homes: Involvement of social services departments. American Journal of Geriatric Psychiatry, 18, 266–275. Bewick, V., Cheek, L., & Ball, J. (2004). Statistics review 13: Receiver operating characteristic curves. Critical Care, 8, 508–512. doi:10.1186/cc3000

Screening for Geriatric Depression in Residential Care Facilities

41

Blank, K., Gruman, C., & Robison, J. T. (2004). Case-finding for depression in elderly people: Balancing ease of administration with validity in varied treatment settings. Journal of Gerontology, 59(A), 378–383. Brown, L. M., & Schinka, J. A. (2005). Development and initial validation of a 15-item informant version of the Geriatric Depression Scale. International Journal of Geriatric Psychiatry, 20, 911–918, doi:10.1002/gps.1375 Burrows, A. B., Morris, J. N., Simon, S. E., Hirdes, J. P., & Phillips, S. (2000). Development of a Minimum Data Set-based depression rating scale for use in nursing homes. Age and Aging, 29, 165–172. Canadian Coalition for Seniors Mental Health. (2006). National guidelines for seniors’ mental health: The assessment and treatment of mental health issues in long-term care homes. Retrieved from http://www.ccsmh.ca/en/natlGuidelines/ initiative.cfm Canadian Healthcare Association. (2009). New directions for facility-based long term care. Ottawa, Canada: Author. Canadian Institute for Health Information. (2010, May). Depression among seniors in residential care. Analysis in Brief. Retrieved from https://secure.cihi.ca/estore/ productFamily.htm?locale=en&pf=PFC1432&lang=en&media=0 Cipriani, A., & Geddes, J. (2003). Comparison of systematic and narrative reviews: The example of the atypical antipsychotics. Epidemiologia e Psiciatria Sociale, 12, 146–153. Cochrane Collaboration (2002). The Cochrane Collaboration open learning material: Publication bias. Retrieved from http://www.cochrane-net.org/openlearning/ html/mod15-2.htm Cohen, C. I., Hyland, K. & Kimhy, D. (2003). The utility of mandatory depression screening of dementia patients in nursing homes. American Journal of Psychiatry, 160, 2012–2017. Conn, D., Gibson, M., Feldman, S., Hirst, S., Leung, S., MacCourt, P., . . . Mokry, J. (2008). Guidelines for the assessment and treatment of mental health issues in LTC: Focus on mood and behaviour symptoms. Canadian Nursing Home, 19, 24–35. De Bellis, A., & Williams, J. (2008). The Cornel Scale for Depression in Dementia in the context of Australian Aged Care Funding Instrument: A literature review. Contemporary Nurse, 30, 20–31. doi:10.5172/conu.673.30.1.20 Dickersin, K. (1990). The existence of publication bias and risk factors for its occurrence. Journal of American Medical Association, 263, 1385–1389, doi: 10.1001/jama.1990.03440100097014 Dunn, V. K., & Sacco, V. P. (1989). Psychometric evaluation of the Geriatric Depression Scale and the Zung Self-Rating Depression Scale using an elderly community sample. Psychology and Aging, 4, 125–126. Fisher, K., & Shumaker, L. (2004). Assessment of depression and cognitive impairment among elders in rural housing facilities. Journal of the American Psychiatric Nurses Association, 10, 67–72. doi:10.1177/1078390304263021 Gallagher, D. (1986). The Beck Depression Inventory and older adults. Clinical Gerontologist, 5, 149–163. doi:10.1300/J018v05n0_08 Greenberg, L., Lantz, M. S., Likourezos, A., Burack, O. R., Chichin, E., & Carter, J. (2004). Screening for depression in nursing home palliative care

42

A. Azulai and C. A. Walsh

patients. Journal of Geriatric Psychiatry and Neurology, 17, 212–218. doi: 10.1177/0891988704269817 Greenberg, S. A. (2012). The Geriatric Depression Scale. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf Hammond, M. (1998). Rating depression severity in the elderly physically ill patient: Reliability and factor structure of the Hamilton and Montgomery-Asberg Depression Rating Scales. International Journal of Geriatric Psychiatry, 13, 257–261. doi:10.1002/(SICI)1099-1166(199804) Harris, Y., & Cooper, J. K. (2006). Depressive symptoms in older people predict nursing home admission. Journal of American Geriatric Society, 54, 593–597. Heisel, M. J., Duberstein, P. R., Lyness, J. M., & Feldman, M. D. (2010). Screening for suicide ideation among older primary care patients. Journal of the American Board of Family Medicine, 23, 260–269. doi:10.3122/jabfm.2010.02.080163 Heiser, D. (2004). Depression identification in the long-term care setting: The GDS vs. the MDS. Clinical Gerontologist, 27(4), 3–18. doi:10.1300/J018v27n04_02 Holroyd, S., & Clayton, A. H. (2000). Measuring depression in the elderly: Which scale is best? Medscape General Medicine, 2(4). Retrieved from http://www. medscape.com/viewarticle/430554 Huang, Y., & Carpenter, I. (2011). Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardized care assessment in nursing homes. Aging and Mental Health, 15, 1045–1051. doi: 10.1080/13607863.2011.583626 Hyer, L., Carpenter, B., Bishmann, D., & Wu, H. (2005). Depression in longterm care. Clinical Psychology: Science and Practice, 12, 280–299. doi: 10.1093/clipsy/bpi031 Irwin, M., Artin, K. H., & Oxman, M. N. (1999). Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Archives of Internal Medicine, 159, 1701–1704. Jackson, R., & Baldwin, B. (1993). Detecting depression in elderly medically ill patients: The use of the Geriatric Depression Scale compared with medical and nursing observations. Age and Aging, 22, 349–353. Jongenelis, K., Pot, A. M., Eisses, A. M. H., Gerritsen, D. L., Derksen, M., Beekman, A. T. F., . . . Ribbe, M. W. (2005). Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. International Journal of Geriatric Psychiatry, 20, 1067–1074. doi: 10.1002/gps.1398 Kohler, M., Rabinovitz, T., Hirdes, J., Stones, M., Carpenter, G. I., Fries, B. E., . . . Jones, R. N. (2005). Measuring depression in nursing home residents with the MDS and GDS: An observational psychometric study. BioMed Central Geriatrics, 5, 1–8. doi:10.1186/1471-2318-5-1 Koopmans, R. T. C. M., Zuidema, S. U., Leontjevas, R., & Gerritsen, D. L. (2010). Review: Comprehensive assessment of depression and behavioral problems in long-term care. International Psychogeriatrics, 22, 1054–1062. doi: 10.1017/S1041610210000736 Kroenke, K., Spitzer R. L., & Williams, J. B. (2001). The PHQ-9 validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

Screening for Geriatric Depression in Residential Care Facilities

43

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire2: Validity of a two-item depression screener. Medical Care, 41, 1284–1294. Kurlowicz, L. (2000). The Geriatric Depression Scale (GDS). Insight, 25, 18–19. doi: 10.1067/min.2000.105803 Lantz, M. S (2002, February). Depression in nursing homes. Presented at American Association for Geriatric Psychiatry 15th Annual Meeting, Medscape Conference, Orlando, Florida. Laprise, R., & Vezina, J. (1998). Diagnostic performance of Geriatric Depression Scale and the Beck Depression Inventory with nursing home residents. Canadian Journal on Aging, 17, 401–413. doi:10.1017/S0714980800012678 Lesher, E. L., & Berryhill, J. S. (1994). Validation of the Geriatric Depression Scale– Short form among inpatients. Journal of Clinical Psychology, 50, 256–260. McAuley, L., Pham, Tugwell, P., & Moher, D. (2000). Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet, 356, 1228–1231. McCabe, M. P., Davison, T., Mellor, D., George, K., Moore, K., & Ski, C. (2006). Depression among older people with cognitive impairment: Prevalence and detection. International Journal of Geriatric Psychiatry, 21, 633–644. doi: 10.1002/gps.1538 McCurren, C. (2002). Assessment for depression among nursing home elders: Evaluation of the MDS Mood Assessment. Geriatric Nursing, 23, 103–108. doi: 10.1067/mgn.2002.123796 Mitchell, A. J., Bird, V., Rizzo, M., & Meader, N. (2010). Which version of Geriatric Depression Scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. American Journal of Geriatric Psychiatry, 18, 1066–1077. doi:10.1097/JGP.0b013e3181f60f81 Moriarty, J. (2002). Assessing the mental health needs for older people: Systematic review on the use of standardized measures to improve assessment practice. Research report paper prepared by Social Care Workforce Research Unit, University of London, UK: King’s College London. Morrow-Howell, N., Proctor, E., Choi, S., Lawrence, L., Brooks, A., Hasche, L., . . . Blinne, W. (2008). Depression in public community long-term care: Implications for intervention development. Journal of Behavioral Health Services & Research, 35, 37–51. Pachana, N. A., Helmes, E., Byrne, G. J. A., Edelstein, B. A, Konnert, C. A., & Pot, A. M. (2010). Screening for mental disorders in residential aged care facilities. International Psychogeriatrics, 22, 1107–1120. doi:10.1017/S1041610210000128 Phelan, E., Williams, B., Meeker, K., Bonn, K., Frederick, J., LoGerfo, J., & Snowden, M. (2010). A study of the diagnostic accuracy of the PHQ-9 in primary care elderly. BMC Family Practice, 11(63), 11–29. doi:10.1186/1471-2296-11-63 Pignone, M., Gaynes, B. N., Rushton, J. L., Murlow, C. D., Orleans, C. T., Whitener, B. L., . . . Lohr, K. N. (2002). Screening for depression: Systematic evidence review. Research Triangle Park, NC: Research Triangle Institute, Evidence-based Practice Center. Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., . . . Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. Retrieved from http://www.lancaster.ac.uk/shm/research/nssr/index.htm

44

A. Azulai and C. A. Walsh

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. Radloff, L. S., & Teri, L. (1986). Use of the Center of Epidemiological Studies Depression Scale with older adults. Clinical Gerontologist, 5, 119–136. Rahman, A. N., & Appelbaum, R. A. (2009). The nursing home Minimum Data Set Assessment Instrument: Manifest functions and unintended consequences— Past, present, and future. Gerontologist, 49, 727–735. Raj, A. (2004). Depression in the elderly: Tailoring medical therapy to their special needs. Postgraduate Medicine, 115(6), 26–42. Rogers, R. (2001). Handbook of diagnostic and structured interviewing. New York, NY: Guilford. Roman, M., & Callen, B. (2008). Screening instruments for older adult depressive disorders: Updating the evidence-based tool box. Issues in Mental Health Nursing, 29, 924–941. doi:10.1080/01612840802274578. Ruckdeschel, K., Thompson, R., Datto, C. J., Streim, J. E., & Katz, I. R. (2004). Using the Minimum Data Set 2.0 Mood Disturbance items as a self-report screening instrument for depression in nursing home residents. American Journal of Geriatric Psychiatry, 12, 43–49. Saliba, D., & Buchanan, J. (2008). Development and validation of a revised nursing home assessment tool: MDS 3.0. Baltimore, MD: Centers for Medicare and Medicaid Services. Saliba, D., DiFilippo, S., Edelen, M. O., Kroenke, K., Buchanan, J., & Streim, J. (2012). Testing the PHQ-9 interview and Observational versions (PHQ-9-OV) for MDS 3.0. JAMDA, 13, 618–625. doi:10.1016/j.jamda.2012.06.003. Saliba, D., Jones, M, Streim, J., Quaslander, J., Berlowitz, D., & Buchanan, J. (2012). Overview of significant changes in the Minimum Data Set for nursing homes version 3.0. Journal of the American Medical Directors Association, 13, 595–601. Smarr, K. L., & Keefer, A. L. (2011). Measures of depression and depressive symptoms. Arthritis Care and Research, 63, 454–466. Snowden, M., Sato, K., & Roy-Byrne, P. (2003). Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: A review of the literature. Journal of the American Geriatric Society, 51, 1305–1317. Snowdon, J. (2004). The minimum data set depression rating scale (MDSDRS) lacks reliability for identifying depression among older adults living in nursing homes. Evidence Based Mental Health, 7(1), 7. Snowdon, J. (2010). Review: Depression in nursing homes. International Psychogeriatrics, 22, 1143–114. doi:10.1017/S1041610210001602. Snowdon, J., & Fleming, R. (2008). Recognising depression in residential facilities: An Australian challenge. International Journal of Geriatric Psychiatry, 23, 295–300, doi:10.1002/gps.1877 Soon, J. A., & Levine, M. (2002). Screening for depression in patients in long-term care facilities: A randomized controlled trial of physician response. Journal of American Geriatric Society, 50, 1092–1099. Sowden, G., Mastromauro, C. A., Januzzi, J. L., Fricchione, G. L., & Huffman, J. C. (2010). Detection of depression in cardiac inpatients: Feasibility and

Screening for Geriatric Depression in Residential Care Facilities

45

results of systematic screening. American Heart Journal, 159, 780–787. doi: 10.1016/j.ahj.2010.02.029 Sullivan Kerber, C., Dyck, M. J., Culp, K. R, & Buckwalter, K. (2005). Comparing the Geriatric Depression Scale, Minimum Data Set, and primary care provider diagnosis for depression in rural nursing home residents. Journal of the American Psychiatric Nurses Association, 11, 269–275. doi:10.1177/1078390305281345 Sutcliffe, C., Cordingley, L., Burns, A., Godlove Mosley, C., Bagley, H., Huxley, P., & Challis, D. (2000). A new version of the Geriatric Depression Scale for nursing and residential home populations: The Geriatric Depression Scale (Residential) (GDS-12R). International Psychogeriatrics, 12, 173–181. Vida, S., Des Rosiers, P., Carrier, L., & Gauthier, S. (1994). Depression in Alzheimer’s disease: Receiver operating characteristic analysis of the Cornell Scale for Depression in Dementia and the Hamilton Depression Scale. Journal of Geriatric Psychiatry and Neurology, 7, 159–162. doi: 10.1177/089198779400700306. Wagenaar, D., Colenda, C. C., Kreft, M., Sawade, J., Gardiner, J., & Poverejan, E. (2003). Treating depression in nursing homes: Practice guidelines in the real world. Journal of the American Osteopathic Association: Clinical Practice, 103, 465–469. Watson, L. C., & Pignone, M. P. (2003). Screening accuracy for late-life depression in primary care: A systematic review. Journal of Family Practice, 52, 956–964. Watson, L. C., Zimmerman, S., Cohen, L. W., & Dominik, R. (2009). Practical depression screening in residential care/assisted living: Five methods compared with gold standard diagnosis. American Journal of Geriatric Psychiatry 17, 556–564. Webster, J., & Watson, R. T. (2002). Analyzing the past to prepare for the future: Writing a literature review. MIS Quarterly, 26(2), xiii–xxiii. World Health Organization. (2011). Health topics: Aging. Retrieved from http://www. who.int/topics/ageing/en/ Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. doi: 10.1016/0022-3956(82)90033-4 Zung, W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70. Zung, W. K., & Zung, E. M. (1986). Use of the Zung Self-rating Depression Scale in the elderly. Clinical Gerontologist, 5, 137–148.

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