Lu Niu1, Cunxian Jia2, Zhenyu Ma3, Guojun Wang4, Zhenjun Yu5, Liang Zhou6. 1. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou 510370, China. 2. School of Public Health, Shandong University, Jinan, China. Electronic address: Jiacunxian@sdu.edu.cn. 3. School of Public Health, Guangxi Medical University, Nanning, China. Electronic address: Zhenyu.m@qq.com. 4. Xiangya School of Public Health, Central South University, Changsha, China. Electronic address: 609142326@qq.com. 5. Xiangya School of Public Health, Central South University, Changsha, China. Electronic address: 174796678@qq.com. 6. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou 510370, China. Electronic address: Liangzhou_csu@vip.163.com.
Abstract
BACKGROUND: The Geriatric Depression Scale (GDS) has been widely used for late-life depression, but it lacks validation in psychological autopsy research. This study aimed to assess the validity and establish the optimal cut-off values of the GDS-30 and the GDS-15 with proxy-based data in rural China. METHODS: We applied psychological autopsy to collect data from 242 consecutive suicide cases and 242 paired living community controls. RESULTS: Subject-proxy concordance for the GDS-30 (ICC = 0.590) and the GDS-15 (ICC = 0.539) were fair in the living controls. Based on proxy-data, we found that the suicide cases had higher scores of depression than the living controls did; the values of Cronbach's alpha demonstrated good internal consistency of the GDS-30 and the GDS-15; the Spearman correlation analysis indicated that the GDS scores were correlated with hopelessness, loneliness, and quality of life. For suicide cases, the GDS-30 showed the highest Youden's index as 34.86% with a cut-off value at 22, when its sensitivity and specificity was 0.78 and 0.56, respectively; the score of 12 on the GDS-15 showed the highest Youden's index of 31.39%, and its sensitivity and specificity was 0.74 and 0.58, respectively. LIMITATIONS: This study is limited to its generalizability to Chinese urban elderly with psychological autopsy method. CONCLUSIONS: The GDS-30 and the GDS-15 were both valid tools for measuring the severity of depressive symptoms rather than screening for major depression in psychological autopsy research in rural China. The GDS-15 can be considered as a good substitute for the GDS-30.
BACKGROUND: The Geriatric Depression Scale (GDS) has been widely used for late-life depression, but it lacks validation in psychological autopsy research. This study aimed to assess the validity and establish the optimal cut-off values of the GDS-30 and the GDS-15 with proxy-based data in rural China. METHODS: We applied psychological autopsy to collect data from 242 consecutive suicide cases and 242 paired living community controls. RESULTS: Subject-proxy concordance for the GDS-30 (ICC = 0.590) and the GDS-15 (ICC = 0.539) were fair in the living controls. Based on proxy-data, we found that the suicide cases had higher scores of depression than the living controls did; the values of Cronbach's alpha demonstrated good internal consistency of the GDS-30 and the GDS-15; the Spearman correlation analysis indicated that the GDS scores were correlated with hopelessness, loneliness, and quality of life. For suicide cases, the GDS-30 showed the highest Youden's index as 34.86% with a cut-off value at 22, when its sensitivity and specificity was 0.78 and 0.56, respectively; the score of 12 on the GDS-15 showed the highest Youden's index of 31.39%, and its sensitivity and specificity was 0.74 and 0.58, respectively. LIMITATIONS: This study is limited to its generalizability to Chinese urban elderly with psychological autopsy method. CONCLUSIONS: The GDS-30 and the GDS-15 were both valid tools for measuring the severity of depressive symptoms rather than screening for major depression in psychological autopsy research in rural China. The GDS-15 can be considered as a good substitute for the GDS-30.