Brief report
Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly?

https://doi.org/10.1016/S0165-0327(03)00163-0Get rights and content

Abstract

Background: Little is known about the performance of the Geriatric Depression Scale (GDS) in the screening of post-stroke depression (PSD) among Chinese elderly. Methods: Three months after the index stroke, a research assistant administered the 15-item GDS to 127 Chinese elderly patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the GDS scores, administered the Structured Clinical Interview for DSM-IV to all patients and made DSM-IV diagnosis of depression, which served as the benchmark for judging the performance of GDS in screening PSD. Results: The optimal cut-off point of GDS was 6/7. The sensitivity, specificity, positive and negative predictive values of GDS and the area under the receiver operating characteristic curve, were 89, 73, 37, 98 and 90%, respectively. Limitations: The sample size was small and there was no separate analysis of the performance of GDS for subtypes of PSD. Conclusions: Due to its low positive predictive value, a more specific instrument should supplement GDS in screening PSD in Chinese elderly.

Introduction

Post-stroke depression (PSD) is common in Chinese stroke patients with a prevalence ranging from 17 to 62.2% (Zhang, 1992, Fuh et al., 1997, Chan et al., 1995, Tang et al., 2002). To date, however, screening for PSD in Chinese patients has received little attention in the literature.

The Geriatric Depression Scale (GDS) has been used to detect PSD in Caucasian patients in acute inpatient and rehabilitation settings (Schubert et al., 1992, Diamond et al., 1995). GDS performed well as a screening instrument in Caucasian patients with stroke (Argell and Dehlin, 1989, Johnson et al., 1995).

The Chinese version of GDS is a reliable and valid instrument (Chiu et al., 1994a, Lai, 2000), which has been employed in detecting depression among Chinese stroke survivors in the community (Fuh et al., 1997). To our knowledge, there has been no study examining the performance of GDS as a screening instrument for PSD in a Chinese geriatric stroke population.

The aim of this study was to determine the optimal cut-off point, sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve of the 15-item Chinese version of GDS (Lim et al., 2000), as a screening instrument for PSD in Chinese geriatric stroke patients.

Section snippets

Methods

Participants in the study were patients in the Acute Stroke Unit of Prince of Wales Hospital (PWH) who were consecutively admitted with first-ever or recurrent stroke over a period of 6 months. PWH is a general hospital serving a population of 800,000 in Hong Kong. Inclusion criteria were: (1) Chinese ethnicity; (2) age ≥65 years; (3) well-documented (clinical presentation and CT and/or MRI scan of the brain) first or recurrent acute stroke occurring within 7 days prior to admission; (5)

Results

Recruitment of subjects took place from January to July 2002. Two hundred and ninety-three patients (>65 years) with acute stroke were admitted to PWH during this period. Altogether, 166 (56.7%) patients were excluded from the study; their demographic and clinical characteristics are shown in Table 1. When compared to the study sample, excluded patients were older, more likely to be female and had a higher pre-stroke Modified Rankin Score (van Swieten et al., 1988) and National Institute of

Discussion

This investigation was carried out in a cohort of Chinese elderly with stroke. There is no conclusive evidence concerning the role of ethnicity in ascertaining PSD (Tang et al., 2002). Since the Chinese versions of GDS, MMSE and SCID-DSM-IV used in the study are properly validated instruments, our results are likely to be applicable to stroke patients of other ethnic background.

The main limitation of the study shared by most investigations in this field is the high attrition rate resulting in a

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