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Title: Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions.
Authors: Esiwe, Collin
Baillon, Sarah
Rajkonwar, Aniruddha
Lindesay, James
Lo, Nelson
Dennis, Michael
First Published: 3-Mar-2015
Publisher: Oxford University Press (OUP) for British Geriatrics Society
Citation: Age Ageing, 2015, 44 (5), pp. 771-775
Abstract: BACKGROUND: depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). METHODS: one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). RESULTS: a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. CONCLUSION: the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases.
DOI Link: 10.1093/ageing/afv018
ISSN: 0002-0729
eISSN: 1468-2834
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. This article is distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License ( ), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Appears in Collections:Published Articles, Dept. of Health Sciences

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