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A community-based study of depression in older people in Hefei, China - the GMS-AGECAT prevalence, case validation and socio-economic correlates
- Authors:
- CHEN Ruoling, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.407-413.
- Publisher:
- Wiley
Previously published studies of prevalence of depression in older people in China showed much variation in the results, while the pooled prevalence is low. In this study we used a standardised method, the Geriatric Mental State (GMS) to investigate the prevalence of depression in older people in China, validate the GMS-AGECAT depression cases and examine the relationship between depression and socio-economic deprivation. 1736 subjects aged 65 were recruited from Hefei city, China. They were interviewed at home by a survey team from Anhui Medical Universtiy using the GMS and other interviews. Their mental disorders were diagnosed by the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Chinese psychiatrists re-examined depression cases and their controls. 39 depressed cases were diagnosed by the GMS-AGECAT. Age-standardised prevalence was 2.2% (95% CI 1.5-2.9), which was about five-times lower than that of older people in Liverpool, UK. Agreement on depression diagnoses between the GMS-AGECAT and local Chinese psychiatrists was 83.6%, with a Kappa of 0.67 (p<0.001). Depression was significantly related to socio-economic deprivation. This community-based study suggested a low prevalence of depression in older people in urban China. Approved training in the use of the GMS-AGECAT in mainland China should make it possible to carry out a large scale epidemiological study on depression in the Chinese elderly population to investigate its geographic variation and risk factors. The dose-response relation between socio-economic deprivation and depression indicates that strategies for tackling inequality in depression in elderly are urgently needed in China.
Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese
- Authors:
- LAM Chee Kum, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.422-428.
- Publisher:
- Wiley
The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale.
Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm
- Authors:
- PRINCE Martin, et al
- Journal article citation:
- British Journal of Psychiatry, 185(11), November 2004, pp.429-436.
- Publisher:
- Cambridge University Press
The Geriatric Mental State (GMS) is the most widely used psychiatric research assessment for older persons. Evidence for validity comes from the developed world. The aims was to assess the validity of GMS/AGECAT organicity and depression diagnoses in 26 centres in India, China, Latin America and Africa. The authors studied 2941 persons aged 60 years and over: 742 people with dementia and three groups free of dementia (697 with depression, 719 with high and 783 with low levels of education). Local clinicians diagnosed dementia (DSM–IV) and depression (Montgomery–Åsberg Depression Rating Scale score 18). For dementia diagnosis GMS/AGECAT performed well in many centres but educational bias was evident. Specificity was poor in India and sensitivity sub-optimal in Latin America. A predictive algorithm excluding certain orientation items but including interviewer judgements improved upon the AGECAT algorithm. For depression, sensitivity was high. The EURO–D depression scale, derived from GMS items using European data, has a similar factor structure in Latin America, India and, to a lesser extent, China. Valid, comprehensive mental status assessment across cultures seems achievable in principle.