Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale.

Objective To construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients. Methods The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n¼410), the Mini Mental State Examination (n¼410) and a diagnostic interview (SCAN; n¼333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, items that were identified as unsuitable were removed using the data of the Assess project (n¼77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specitivity, area under ROC and positive and negative predictive values), the newly constructed shortened GDS was validated in the AGED data set (n¼333), using DSM-IV diagnosis for depression as measured by the SCAN as ‘gold standard’. Results The eight-item GDS that resulted from stage 1 showed good internal consistency in both the Assess data set (a¼0.86) and the AGED dataset (a¼0.80). In the AGED dataset, high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. Conclusion The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population

Student Showcase Concert

Ida GotkovskyRobert PlanelEdith Piaf & Louis GuglielmiJohnny MandelKen ThomsonBob Becke

Predicting the onset of major depression in subjects with subthreshold depression in primary care: A prospective study.

Objective: That subjects with subthreshold depression have an increased probability of developing major depression has been confirmed by many studies. However, the factors which may predict the onset of major depression have yet to be fully examined. Method: We examined the control group of a randomized trial in primary care patients with subthreshold depression (N ¼ 109), of whom 20 had developed major depression 1 year later. Using the vulnerability-stress theory, we examined which factors predicted the onset of major depression. Results: In both univariate and multivariate analyses, family history and chronic illnesses predicted the onset of major depression. Conclusion: It is possible to predict to a certain degree whether a subject with subthreshold depression will develop major depression within a year

Inpatient treatment and care arrangements to replace or avoid it - Searching for an evidence-based balance

In several countries, it seems to be policy to strive for a mental health system dominated by variants of community care replacing hospital care and culminating in closure of hospitals. Scientific evidence shows that no form of community care for the seriously mentally ill can do without the hospital, but also indicates compellingly that hospital care can be replaced or avoided by community alternatives, although only partially so. The randomized controlled trials that have produced such evidence are reviewed. Emphasis is placed on the convergence of findings across trials, their generalisability and the degree to which community alternatives succeeded in avoiding or replacing inpatient treatment. The results of the review are confronted with the justified demand for an evidence-based mental health system