Psychometric evaluation of a brief geriatric depression screen

Comparing life review writing with active control groups: Results of a feasibility study

INTRODUCTION

Life review writing can be used to improve depressive symptoms in well older adults, but it is unclear whether the reminiscing, writing, or socialising is associated with the improvements. This study assessed the feasibility of a controlled trial comparing life review writing with two active control groups designed to isolate the acts of (a) engaging in a meaningful leisure activity and (b) socialising.

METHODS

Twenty-four participants from a 100-bed assisted living facility were enrolled in the study. Participants ranged in age from 70 to 98 years (M = 83.9, SD = 7.6). Eight 1-hour weekly sessions were held, with participants assigned to one of three groups: (a) life review writing, (b) painting, or (c) coffee from around the world. At baseline, participants completed a demographic and health questionnaire, the Mini-Cog, and the Geriatric Depression Scale Short Form (GDS-15). The GDS-15 was administered again at weeks 4 and 8, along with the health questionnaire at post-test.

RESULTS

Nearly 25% (N = 24) of the facility's residents attended at least one session, with an average attendance rate of 66.4%, or 5.3 sessions. However, to achieve this participation rate, our original plan to employ random assignment had to be abandoned. The groups were a partial success insofar as we successfully isolated engaging in a meaningful activity in the painting group, but the writing group engaged in less reminiscing than hoped. At post-test, seven participants reported health, mood, and social life benefits. GDS-15 scores fluctuated over time, with no significant improvement from pre- to post-test.

CONCLUSION

The residents' low willingness to be randomised creates a serious selection bias, but randomising volunteers into different activities runs counter to client-centred therapy. To scrutinise the mechanisms of change of life review writing, we recommend comparing two writing groups: one that reminisces and one that does not.

Comparing Patient-Reported Outcomes Measure Information System Depression Scale with Legacy Depression Measures in a Community Sample of Older Adults with Varying Levels of Cognitive Functioning

OBJECTIVE

This study evaluated the utility of Patient-Reported Outcomes Measure Information System Depression Scale (PROMIS-8a) compared with selected "Legacy" depression scales, including the Montgomery-Asberg Depression Rating Scale (MADRS), Geriatric Depression Scale (GDS), and GDS-Short Form (GDS-SF). Additionally, the measures' properties were assessed across levels of cognitive functioning.

METHODS

This cross-sectional analysis was extracted from a prospective cohort study. PROMIS-8a and Legacy depression measures were administered to individuals aged at least 70 years grouped by cognitive status based on the Saint Louis University Mental Status Examination. McNemar tests were run to determine if measures categorized the absence or presence of depression differently and item analysis evaluated classification discrepancies.

RESULTS

Sample mean age was 78, and most participants were women (71%), white (79%), with at least a high school education (89%). The percentage of individuals with at least mild depression was similar across measures (20.7% PROMIS-8a, 19.0% MADRS, 17.9% GDS, 13.9% GDS-SF). PROMIS-8a total score correlated moderately with MADRS (r = 0.56, df = 295, p <0.01), GDS (r = 0.68, df = 291, p <0.01), and GDS-SF (r = 0.60, df = 291, p <0.01), and predictive validity of the measures was similar. There were no significant mean differences on depression measures by cognitive status.

CONCLUSION

Although all measures identified a similar percent of depressed individuals, the classification differed by measure. Item analysis showed that PROMIS-8a was more likely to identify feelings of dysphoria while the MADRS and GDS were more likely to identify physiologic aspects of depression. Given the brevity and ease of administration of the PROMIS-8a, it appears to be a useful depression screen for community-dwelling older adults.

Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults

OBJECTIVE. We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults.

METHOD. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi’s qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data.

RESULTS. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p &lt; .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits.

CONCLUSION. Living Legends enhanced participants’ sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, compared with life review writing alone.

Effect of life review writing on depressive symptoms in older adults: a randomized controlled trial

OBJECTIVE

We examined the effects of engaging in the occupation-based intervention of life review through writing on expressed depressive symptoms as measured with the Geriatric Depression Scale in older adults residing in senior residences.

METHOD

The study design was a randomized controlled trial that took place in four senior residences in New York City. Forty-five participants (23 treatment, 22 wait-list control) ≥ 65 yr old participated in the 8-wk, once-weekly autobiographical writing workshop, Share Your Life Story (Sierpina, 2002).

RESULTS

Depressive symptoms were significantly less prevalent for the treatment group than for the control group after the 8-wk life review program (repeated-measures analysis of variance p = .03).

CONCLUSION

The results suggest that the Share Your Life Story writing workshop is an effective occupation-based intervention for occupational therapists to use with older adults who reside in senior residences.

Health and safety at work in the transport industry (TRANS-18): factorial structure, reliability and validity

In this article, we study the psychometric properties of a short scale (TRANS-18) which was designed to detect safe behaviors (personal and vehicle-related) and psychophysiological disorders. 244 drivers participated in the study, including drivers of freight transport vehicles (regular, dangerous and special), cranes, and passenger transport (regular transport and chartered coaches), ambulances and taxis. After carrying out an exploratory factor analysis of the scale, the findings show a structure comprised of three factors related to psychophysiological disorders, and to both personal and vehicle-related safety behaviors. Furthermore, these three factors had adequate reliability and all three also showed validity with regard to burnout, fatigue and job tension. In short, this scale may be ideally suited for adequately identifying the safety behaviors and safety problems of transport drivers. Future research could use the TRANS-18 as a screening tool in combination with other instruments.

An efficient screening tool for preoperative depression: the Geriatric Depression Scale-Short Form

BACKGROUND

Depression is highly prevalent in patients before surgery, and it has been widely shown to have a serious impact on their postoperative outcomes. It would therefore be desirable for physicians to obtain a quick, simple screen to evaluate depression to consider treatment of symptomatology and potentially optimize postoperative outcomes.

METHODS

In this study, we investigated the prevalence of depression in a presurgical inpatient sample undergoing major, noncardiac surgery. In addition, we sought to establish the Geriatric Depression Scale-Short Form (GDS-SF) as a valid screening tool for depression by examining its relationship to the Beck Depression inventory (BDI) by age and gender.

RESULTS

In our sample of 1043 presurgical candidates, prevalence of depression as established by the BDI was significantly higher than rates consistently found in healthy community samples. Depression was more common in women than in men (P = 0.02), and depression rates were lower in elders relative to middle-aged and younger groups (P = 0.003 and 0.003, respectively). In addition, we found that there was a high correlation between the BDI and the GDS-SF within each of the age groups.

CONCLUSIONS

These data further support the need for depression screens in presurgical populations and establish the validity of the GDS-SF as a valid quick assessment alternative available to physicians.

Screening for depression in a geriatric rehabilitation sample

OBJECTIVE

To examine the utility of a short depression inventory (SDI) for use with elderly medical inpatients.

METHOD

Subjects were 132 consecutive admissions to the inpatient geriatric rehabilitation unit at MetroHealth Medical Center, a general medical teaching hospital in Cleveland, Ohio. Sixty of the original sample qualified for inclusion in the final sample. Within the first five days of admission, all subjects were administered the Mini-Mental Status Examination (MMSE). Ss who scored 20 or above were asked to complete the SDI and the GDI. A clinical interview used DSM-III-R criteria to establish the diagnosis of major depression. The order of presentation of questionnaire or interview was varied to control for the effects of presentation order.

RESULTS

When an optimal cut-off score of 4 or above on the SDI was used, the sensitivity and specificity were 100% and 85% respectively. Using the GDS, sensitivity and specificity were 100% and 90%.

CONCLUSIONS

Using the SDI, impressive sensitivity and specificity were achieved. The SDI was also essentially equivalent to the GDI psychometrically. The SDI appears to have good promise as a depression screen in medical populations.