CHAPTER 67: GERIATRIC DEPRESSION SCALE—SHORT FORM (SFGDS)
Description
The Geriatric Depression Scale—Short Form (sfGDS) by Yesavage et al. (1986) is a 15-item rating scale developed to screen for depression in older populations but may also be appropriate for people who have mild cognitive impairment because it is known that significant depressive symptoms are often observed in 30% to 50% of that population (Debruyne et al., 2009). The sfGDS is a self-report/interview questionnaire based on validation studies of the original 30-item assessment where 15 items were selected that had the highest correlation with depressive symptoms for the revised short form (Lesher & Berryhill, 1994). Sample test items include the following:
- Are you afraid that something bad is going to happen to you?
- Do you feel happy most of the time?
- Do you often feel helpless?
- Do you prefer to stay at home rather than going out and doing new things?
- Do you feel you have more problems with memory than most?
Items are rated as either yes or no, and depending on the question, either response may indicate depressive symptoms. The sfGDS can be completed in less than 10 minutes with higher scores indicative of more depressive symptoms.
Psychometrics
The original GDS and the GDS-15 were found to be highly correlated at r = 0.84 (Sheikh & Yesavage, 1986). Results of a study by Lesher & Berryhill (1994) concurred with those results where they too established correlates between the 2 outcome measures at r = 0.89. A study of functionally impaired yet cognitively intact community-dwelling persons aged 65 years and older (n = 960) found that the internal consistency reliability for the total scale was α = 0.75 (Friedman, Heisel, & Delavan, 2005). A study by Incalzi, Pedone, and Carbonin (2003) found that 3 factors were able to explain 47.7% of variance of the sfGDS comprising the following dimensions: positive attitude toward life, distressing thoughts/negative judgment about one’s own condition, and inactivity/reduced self-esteem. Research by Lyness et al. (1997) showed that the GDS-15 had 92% sensitivity and 81% specificity when using a cutoff score of 5. Lesher and Berryhill (1994) argued to the contrary and suggested that one area of weakness of the sfGDS was its low specificity rates, where they found that at a score ≥ 5 the sensitivity was 0.91 and specificity was 0.54; however, at a score of ≥ 6 sensitivity was 0.83 and specificity was 0.69, at ≥ 7 sensitivity was 0.83 and specificity was 0.73, and at ≥ 10 sensitivity was 0.72 with a specificity of 0.92. Finally, a study of 198 elderly subjects who completed the sfGDS (34%) scored above a cutoff score of 4/5 for probable depression (D’ath, Katona, Mullan, Evans, & Katona, 1994).
Advantages
The sfGDS is a relatively quick measure to determine if further services are needed. It is easy to administer and can be used by both client and caregiver to determine levels of depression. No training or certifications are needed and there is a significant amount of research pertaining to both the original and short versions. The assessment is located in the public domain, thus no special permissions are required for its use in research or publication. Finally, D’ath et al. (1994) found the questionnaire to be acceptable to older adults as only 3.6% found it difficult or stressful to complete (n = 198).
Disadvantages
One study has noted inconsistencies associated with the scale’s sensitivity and specificity and another found that the question, “Do you feel that your life is empty?” was able to identify 84% of cases. Continuing with that information, further research found that ad hoc generated 10-, 4-, and 1-item versions displayed significant agreement with the sfGDS at 0.95, 0.91, and 0.79, respectively suggesting possible problems with uni-dimensionality (D’ath et al. 1994).
Administration
The sfGDS is completed as either self-report or interview and consists of 15 items scored yes or no, where specific answers are indicative of depressive symptoms as follows: for no answers they are items 1, 5, 7, 11, and 13 and for yes answers they are items 2 to 4, 6, 8 to 10, 12, 14, and 15. A score > 5 points is suggestive of depression and should warrant a more thorough investigation. A score ≥ 10 points is indicative of depression.
TABLE 67-1
ITEMS ON THE GERIATRIC DEPRESSION SCALE—SHORT FORM
• Are you basically satisfied with your life? |
• Have you dropped many of your activities and interests? |
• Do you feel that your life is empty? |
• Do you often get bored? |
• Are you in good spirits most of the time? |
• Are you afraid that something bad is going to happen to you? |
• Do you feel happy most of the time? |
• Do you often feel helpless? |
• Do you prefer to stay at home rather than going out and doing new things? |
• Do you feel you have more problems with memory than most? |
• Do you think it is wonderful to be alive now? |
• Do you feel pretty worthless the way you are now? |
• Do you feel full of energy? |
• Do you feel that your situation is hopeless? |
• Do you think that most people are better off than you are? |
Adapted from Crawford, G. B., & Robinson, J. A. (2008). The Geriatric Depression Scale in palliative care. Palliative & Supportive Care, 6(3), 216.
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