The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy. (February 2022)

• Record Type: Journal Article
• Authors: Lozupone, Madia; D'Urso, Francesca; Copetti, Massimiliano; Sardone, Rodolfo; Arcuti, Simona; Castellana, Fabio; Galizia, Ilaria; Lofano, Lucia; Veneziani, Federica; Piccininni, Carla; Barulli, Maria Rosaria; Grasso, Alessandra; Battista, Petronilla; Tortelli, Rosanna; Capozzo, Rosa; Griseta, Chiara; Doricchi, Fabrizio; Quaranta, Nicola; Resta, Emanuela; Daniele, Antonio; Seripa, Davide; Solfrizzi, Vincenzo; Bellomo, Antonello; Logroscino, Giancarlo; Panza, Francesco
• Is Part Of: Psychiatry research. Volume 308(2022)
• Publication Date: 2022-02
• Subjects: Dementia -- Depression -- Apathy -- Mild cognitive impairment -- Biomarkers; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2021.114346
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: We estimated the accuracy of the 30 item-Geriatric Depression Scale (GDS-30) against the gold standard diagnosis of late-life depression performed with the Semi-Structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorder. In 843 older subjects from a large population-based study, at the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity. Using the standard cut-off score (≥ 10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, with lower levels of screening accuracy. The interaction between GDS-30 and educational level showed a significant effect, but not with age, gender, cognitive variables, apathy, somatic and psychiatric multimorbidity. At the optimal cut-off score (≥ 7), the GDS-30 had better discrimination performances for the subjects with subjective memory complaints, with the educational level modulating diagnostic performance. Abstract: The prevalence of late-life depression (LLD) depends on the study sample, measurements, and diagnostic approaches. We estimated the 30 item-Geriatric Depression Scale (GDS-30) accuracy against the gold standard LLD diagnosis made with the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, focusing on the prevalence of a late-life major depressive disorder (MDD), in a population-based sample of 843 subjects aged>65 years, subdivided into three groups: normal cognition, subjective memory complaints, and mild cognitive impairment. At the optimal cut-off score (≥4), the GDS-30 showed 65.1% sensitivity and 68.4% specificity for LLD (63% and 66% for late-life MDD, respectively). Using the standard cut-off score (≥10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, indicating a lower screening accuracy [area under the curve(AUC):0.728, 95% confidence interval(CI):0.67–0–78]. The GDS-30 performance was associated with educational level, but not with age, gender, cognition, apathy, and somatic/psychiatric multimorbidity. For subjective memory complaints subjects, at the optimal cut-off score (≥7), the GDS-30 showed better discrimination performances (AUC=0.792, 95%CI:0.60–0.98), but again the educational level affected the diagnostic performance. In subjective memory complaints subjects, symptom-based scales like the GDS-30 may feature a better performance for diagnosing depression in older age, but the GDS-30 seems to require adjustment to the patient's educational level.