Nurses' and nursing assistants' recognition of depression in elderly who depend on long-term care

Recognition and treatment of depression is a quality indicator for nursing homes. Nurses and nursing assistants are in a particularly good position to recognize depression in long-term care. How well do nurses and nursing assistants recognize depression, compared with a DSM-IV diagnosis of depression? To answer this question a critical review of relevant literature in PubMed searches was performed.

It was found that nurses and nursing assistants recognize true depression in about 55% (sensitivity 42% to 78%) and "over-recognized" depression in about 40% of nondepressed patients (specificity 56% to 67%).

The prominent role of nurses and nursing assistants in daily mental health care is not reflected in the number of methodologically sound studies. Sensitivity of the Geriatric Depression Scale (GDS) is about 50% higher than nurses' recognition of depression. A specific recommendation for specially trained nursing assistants in depression management and standard use of screening scales in an update of the American Medical Directors Association's Clinical Practice Guideline on Depression might improve depression recognition, as well as nursing assistants' work satisfaction and staff turnover.

Recognition of depression by nurses and nursing assistants is low. Standard use of a screening scale like the GDS would improve recognition of depression in the elderly. More research is needed aimed at how nursing assistants can empower their role as mental health care provider in long-term care.