Geriatric Depression Scale (GDS)

Evidence Reviewed as of before: 12-01-2012
Author(s): Katie Marvin, MSc. PT (Candidate)
Editor(s): Annabel McDermott, OT; Nicol Korner-Bitensky, PhD OT

Purpose

The Geriatric Depression Scale (GDS) is a self-rating screening tool developed to detect depression in elderly individuals (Yesavage et al., 1983).

In-Depth Review

Purpose of the measure

The Geriatric Depression Scale (GDS) is a self-rating screening tool developed to detect depression in elderly individuals (Yesavage et al., 1983). The GDS is comprised of 30 items that were selected by researchers and clinicians for their validity in distinguishing groups of elderly people with depression from the general population (McDowell & Newell, 1996). Questions were developed to be non-threatening and age-appropriate and require respondents to answer using yes or no (Stiles & McGarrahan, 1998).

Available versions

  • Geriatric Depression Scale (GDS)
  • Geriatric Depression Scale – Short Form (GDS-SF)

Short forms of the GDS with 1, 3, 4, 10 and 15 questions have been developed (compared to the 30 questions as seen in the original form of the scale). The short forms were developed in response to criticism that the original form of the GDS was too lengthy and time intensive to administer thus making it impractical in primary care settings (van Marwijk et al., 1995).

While many of the shortened versions of the GDS have been found to be highly correlated with the original, the short forms tend to have higher negative predictive values suggesting that the short forms might be best suited to screening out patients with possible depression van Marwijk et al., 1995; Almeida & Almeida, 1999).

Note: There are many different short-forms comprised of different sets of questions making comparisons difficult between studies and groups (Teasell, Foley & Salter, 2011). The 15-item short form is the most commonly used short form and will be the focus of short forms reviewed in this module.

15-item GDS:
It requires approximately 5 to 7 minutes to administer.

The client must choose the best answer (yes or no) for how they have felt over the past week:

  1. Are you basically satisfied with your life?
  2. Have you dropped many of your activities and interests?
  3. Do you feel that your life is empty?
  4. Do you often get bored?
  5. Are you in good spirits most of the time?
  6. Are you afraid that something bad is going to happen to you?
  7. Do you feel happy most of the time?
  8. Do you often feel helpless?
  9. Do you prefer to stay at home, rather than going out and doing new things?
  10. Do you feel you have more problems with memory than most?
  11. Do you think it’s wonderful to be alive now?
  12. Do you feel pretty worthless the way you are now?
  13. Do you feel full of energy?
  14. Do you feel that your situation is hopeless?
  15. Do you think that most people are better off than you are?

A score of > 3 points is suggestive of post-stroke depression.
A score of > 5 points is suggestive of depression.
A score of > 10 points is almost always indicative of depression (Sheik & Yesavage,1986).

Features of the measure

Items:
The original GDS is comprised of 30-items in which the participant is asked to respond by answering “yes” or “no” in reference to how they felt on the day of administration.

What to consider before beginning:
The GDS can be self-reported or administered orally. However it should be awknowledged that oral administration may result in the endorsement of fewer items when compared to the self-administered method (Cannon et al., 2002). The need to provide an answer aloud may discourage some respondents from providing an answer they may consider embarrassing (Williams, Rittman, Boylstein, Faircloth & Haijing. 2005).

Gender has been found to have an effect on the ability of the GDS to correctly classify individuals. The GDS has been reported to be more accurate in classifying women as depressed than men. In the case of male respondents, there tend to be more false negatives (Stiles & McGarrahan, 1998).

Scoring and score interpretation:
The respondent is to provide responses (“yes” or “no”) to each question with reference to the past week. One point is given for each “yes” response and the number of points is summed to provide a single score.

  • Scores from 0 to 10 are considered normal
  • Scores > 11 indicate depression
  • Scores between 11 and 20 indicate mild depression
  • Scores between 21 and 30 indicate moderate depression (Brink et al.,1982; McDowell & Newell, 1996).

Time:
The test requires approximately 8-10 minutes to complete in self-administered format (McDowell & Newell, 1996). Due to the number of questions and length of time to administer, it has been suggested that the use of the GDS as a screening tool is impractical in primary care settings (van Marwijk et al., 1995). Many shortened forms of the GDS have been developed to address this potential challenge.

Training requirements:
No additional training is required to administer the GDS (Teasell, Foley & Salter, 2011).

Subscales:
There are no subscales reported for this measure.

Equipment:
A copy of the measure and a pen or a pencil.

Alternative form of the assessment

Geriatric Depression Scale – Short Forms (GDS-SF)

Client suitability

Can be used with:

  • Geriatric patients with stroke
  • Geriatric patients in in-patient, out-patient and nursing home settings (Rinaldi et al., 2003)
  • Patients who require a proxy to complete
  • Clients with aphasia: Suggestion by Dr. Rita Hargrave is to use a point-board, or a board with the scale and yes/no next to the items and have patient point out correct answer.

Should not be used with:

  • Clients with poor reading comprehension and visual ability in the self-administered format. However, in the case of illiteracy or poor vision, the items and possible responses may be read to the respondent.
  • Clients who have more than a moderate cognitive impairment (McDowell & Newell, 1996; McGivney et al., 1994; Stiles & McGarrahan, 1998).

Languages of the measure

The GDS has been adapted and translated, but not necessarily validated, into following languages:
Arabic, Brazilian, Chinese, Creole, Danish, Dutch, Farsi, French, German, Greek, Hebrew, Hindi, Hungarian, Icelandic, Irish, Italian, Japanese, Korean, Lithuania, Malay, Maltse, Norwegian, Portuguese, Romanian, Russian, Serbian, Spanish, Swedish. Thai, Turkish, Vietnamese, Welsh and Yiddish.

Summary

What does the tool measure? Depression in geriatric patients.
What types of clients can the tool be used for? Adults over the age of 65 years. Can be used with, but is not limited to, clients with stroke.
Is this a screening or assessment tool? Screening tool.
Time to administer 8-10 minutes to administer
Versions Geriatric Depression Scale – Short Form (GDS-SF)
Other Languages Arabic, Brazilian, Chinese, Creole, Danish, Dutch, Farsi, French, German, Greek, Hebrew, Hindi, Hungarian, Icelandic, Irish, Italian, Japanese, Korean, Lithuania, Malay, Maltse, Norwegian, Portuguese, Romanian, Russian, Serbian, Spanish, Swedish. Thai, Turkish, Vietnamese, Welsh and Yiddish.
Measurement Properties
Reliability

Internal Consistency:
– Two studies examined the internal consistency of the GDS and reported excellent internal consistency.

Test-retest:
– One study examined the test-retest reliability of the GDS and reported excellent test-retest reliability

Validity

Convergent:
– One study examined the convergent validity between the GDS and the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS). Excellent correlation between the GDS and both measures were found.

Floor/Ceiling Effects No studies have examined the floor or ceiling effects of the GDS.
Does the tool detect change in patients? Not applicable.
Acceptability The items were developed specifically for an elderly population. The yes/no response format is easy to understand and familiar.
Feasibility The GDS is easy to administer and requires no additional training. The GDS-SF may be more practical for use in primary care settings. When used as a screening tool, the GDS performs as well as some longer interview-based assessments but requires much less time and training to administer.
How to obtain the tool?

A copy of the English GDS and the 15-item GDS can be obtained from the following website: http://www.stanford.edu/~yesavage/GDS.html
Note: Links to some of the other language versions can also be found on this page.

Psychometric Properties

Overview

There is an abundance of research on the psychometric properties of the various GDS short-forms. However, little research has been conducted specifically in patients with stroke. For the purposes of this review, we conducted a literature search to identify all relevant publications on the psychometric properties of the GDS and the 15-item GDS relevant for patients with stroke. We then selected the original validation and reliability studies as content to be summarized and presented here.

Floor/Ceiling Effects

No studies have reported on the floor or ceiling effects of the GDS.

Reliability

Internal constancy:
Yesavage and Brink (1983) examined the internal consistency of the GDS in the original validation study involving elderly patients with depression and healthy controls. The internal consistency was excellent (alpha = 0.94).

Agrell and O’Dehlin (1989) examined the internal consistency of the GDS used as a screening test for post-stroke depression. The internal consistency was excellent (alpha = 0.90).

Test-retest:
Yesavage and Brink (1983) examined the test-retest reliability of the GDS in the original validation study. Twenty subjects completed the questionnaire twice, with one week in between each completion. Test-retest reliability was found to be excellent (ICC = 0.84, p<0.001).

Intra-rater:
No studies have reported on the intra-rater reliability of the GDS with patients with stroke.

Inter-rater:
No studies have reported on the inter-rater reliability of the GDS with patients with stroke

Validity

Content:
No studies have reported on the content validity of the GDS with patients with stroke.

Criterion:
Concurrent:
No studies have reported on the concurrent validity of the GDS with patients with stroke.

Predictive:
No studies have reported on the predictive validity of the GDS with patients with stroke.

Sensitivity/Specificity:
Agrell and Dehlin (1989) examined the sensitivity and specificity for identifying depression of the GDS in 40 geriatric patients with stroke (mean age 80 years). A diagnosis of depression was confirmed using a clinical examination and psychiatric interview. A GDS score of >10 was found to have good sensitivity and moderate specificity for detecting any depression (88% and 64% respectively). Based on these results, the GDS can be used as a brief screening measure for assessing depression in geriatric patients with stroke.

Almeida and Almeida (1999) examined the sensitivity and specificity of the 15-item GDS (and other short form versions) for identifying a major depressive episode in 64 patients, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Using a cutoff score of 4/5 for the 15-item GDS produced a sensitivity and specificity of 97% and 54.8% respectively (with a positive predictive value of 69.6% and negative predictive value of 94.4%).

Rinaldi et al. (2003) examined the sensitivity and specificity of the 5-item and 15-item GDS in 181 geriatric patients (>65 years). A diagnosis of depression was made using a neuropsychological evaluation administered by a geriatrician using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression. A score of > 5 on the 15-item GDS had a sensitivity of 0.92 and specificity of 0.83 for detecting depression.

Tang et al. (2003) evaluated an alternative language version of the GDS in 127 Chinese geriatric patients with acute stroke. Diagnoses of depression were made by a psychiatrist who conducted the Structured Clinical Interview Diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV). Using an optimal cut-off score of 6/7 the sensitivity, specificity, positive and negative predictive values were 89, 73, 37, 98 and 90% respectively.

Construct:
Convergent/Discriminant:
Yesavage and Brink (1983) examined the convergent validity between the GDS and the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS). Excellent correlations between the GDS and both the HRS-D (0.83, p<0.001) and SDS (0.84, p<0.001) were found.

Known Groups:
No studies have reporte on the known groups validity of the GDS with patients with stroke

Responsiveness

Not applicable as the GDS is a screening tool.

References

  • Agrell, B. & Dehlin, O. (1989). Comparison of six depression rating scales in geriatric stroke patients. Stroke, 20, 1190-1194.
  • Almeida, O.P. & Almeida, S.A. (1999). Short versions of the geriatric depression scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. International Journal of Geriatric Psychiatry, 14, 858-865.
  • Brink, T.L., Yesavage, J.A., Lum, O., Heersema, P.H., Adey, M. & Rose, T.L. (1982). Screening tests for geriatric depression. Clinical Gerontologist, 1, 37-43.
  • Cannon, B.J., Thaler. T. & Roos, s. (2002). Oral versus written administration of the Geriatric Depression Scale. Aging and Mental Health, 6(4), 418-422.
  • McDowell, I. & Newell, C. (1996). Measuring health. A guide to rating scales and questionnaires., 2nd ed. New York: Oxford University Press.
  • McGivney, S.A.,Mulvihill, M. & Taylor, B. (1994). Validating the GDS depression screen in the nursing home. Journal of the American Geriatrics Society, 42(5), 490-492.
  • Rinaldi, P., Mecocci, P., Benedetti, C et al. (2003). Validation of the five-item geriatric depression scale in elderly subject in three different settings. Journal of the American Geriatrics Society, 51, 694-698.
  • Sheik, J. & Yesavage, J. (1986). Geriatric Depression Scale (GDS): recent findings and development of a shorter version. In: Brink TL (ed.), Clinical Gerontology: A guide to assessment and intervention. New York, NY: Howarth Press.
  • Stiles, P.G. & McGarrahan, J.E. (1998). The Geriatric Depression Scale: A comprehensive review. Journal of Clinical Geropsychology, 4, 89-109.
  • Tang, W.K., Chan, S.S.M., Chiu, H.F.K., Kwok, T.C.Y, Mok, V. & Ungvari, G.S. (2004). Can the Geriatric Depression Scale detect post-stroke depression in the Chinese elderly. Journal of Affective Disorders, 81(2), 153-156.
  • Teasell, R., Foley, N. C., & Salter K. (2011). EBRSR: Evidence-Based Review of Stroke Rehabilitation. 13th ed. London (ON): EBRSR.
  • van Marwijk, H., Wallace, P., De Bock, G.H., Hermans, J., Kaptein, A. & Mulder, J.D. (1995). Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the Geriatric Depression Scale. British Journal of General Practice, 45, 195-199.
  • Williams, C.L., Rittman, M.R., Boylstein, C., Faircloth, C. & Haijing, Q. (2005). Qualitative and quantitative measurement of depression in veterans recovering from stroke. Journal of Rehabilitation Res Dev, 42, 277-290.
  • Yesavage, J.A., Brink, T.L. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37-49.

See The Measure

How to obtain the GDS?

A copy of the English GDS and the 15-item GDS can be obtained from the following website: http://www.stanford.edu/~yesavage/GDS.html
Note: Links to some of the other language versions can also be found on this page.

Click HERE for the Stroke Specific Geriatric Depression Scale

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