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Identifying depressed older adults in primary care: a secondary analysis of a multisite randomized controlled trial
Corrine I Voils1, Maren K Olsen, John W Williams
1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and the Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA. voils001@mc.duke.edu
Objective:
To determine whether a subset of depressive symptoms could be identified to facilitate diagnosis of depression in older adults in primary care.
Method:
Secondary analysis was conducted on 898 participants aged 60 years or older with major depressive disorder and/or dysthymic disorder (according to DSM-IV criteria) who participated in the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study, a multisite, randomized trial of collaborative care for depression (recruitment from July 1999 to August 2001). Linear regression was used to identify a core subset of depressive symptoms associated with decreased social, physical, and mental functioning. The sensitivity and specificity, adjusting for selection bias, were evaluated for these symptoms. The sensitivity and specificity of a second subset of 4 depressive symptoms previously validated in a midlife sample was also evaluated.
Results:
Psychomotor changes, fatigue, and suicidal ideation were associated with decreased functioning and served as the core set of symptoms. Adjusting for selection bias, the sensitivity of these 3 symptoms was 0.012 and specificity 0.994. The sensitivity of the 4 symptoms previously validated in a midlife sample was 0.019 and specificity was 0.997.
Conclusion:
We identified 3 depression symptoms that were highly specific for major depressive disorder in older adults. However, these symptoms and a previously identified subset were too insensitive for accurate diagnosis. Therefore, we recommend a full assessment of DSM-IV depression criteria for accurate diagnosis.