Prevalence of depression and depression recognition in nursing homes

The aim of this study was to estimate the prevalence of depression among nursing home residents, and the extent of depression recognition among nursing home staff. Random samples totaling 319 nursing home residents, drawn from a simple random sample of six downstate New York nursing homes were evaluated psychiatrically for depression. Samples of nurse aides, nurses and social workers also assessed the same residents for the presence of depressive symptomatology.

Psychiatrists assessed residents using the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Depression measures used were the Cornell Scale for Depression in Dementia, the Feeling Tone Questionnaire, the Hamilton Depression Rating and the Structured Clinical Interview for DSM-III-R Personality Disorders Scale. Nursing and social services staff assessed residents using Depression Recognition Measures.

Based on psychiatric evaluation, the prevalence estimate for probable and/or definite major depressive disorder among testable subjects was 14.4% (95% CI of 10.6%-19.3%); 15.4% were not able to be assessed due to their refusal, impairment of consciousness, or severe physical illness. The estimate for minor depression was 16.8% (95% CI of 12.6%-21.9%). The prevalence of significant depressive symptomatology (including the category of possible depression) was 44.2% (95% CI of 38.2%-50.3%). The corresponding estimates of any depression were 19.7% for social workers, 29% for nurses and 32.1% for nurse aides.

The prevalence of depressive disorders among nursing home residents is high; depression recognition is relatively low, with only 37%-45% of cases diagnosed by psychiatrists recognized as depressed by staff. A structured Depression Recognition Scale increased the rates of recognition (sensitivity of staff ratings) to 47%-55%, demonstrating the utility of the scale in increasing awareness of symptomatology.