Symptom Scale Proves Superior In Finding Depression, Anxiety


SAN DIEGO – A multisymptom scale identified elderly primary care patients with depression and anxiety symptoms who were missed by the standard 15-item Geriatric Depression Scale, results from a large pilot study have found.

The finding suggests that elderly patients may respond better to less-overt questions about depressive symptoms, Angela Hoth, Pharm.D., said in an interview during a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

“We're finding that a lot of people will deny that they have depressive symptoms as defined by the GDS, or they don't associate those particular symptoms with what they're feeling,” said Dr. Hoth, a clinical pharmacy specialist with the Iowa City VA Medical Center.

“If we asked them questions about symptoms, like 'How are you feeling physically over time?' and 'How is that affecting your overall quality of life?' we were able to pick up some patients that the standard GDS didn't pick up. We might be able to avoid missing some people in primary care by asking them more about their symptoms and relating that back to depression, rather than asking them the regular DSM-type of symptom questions,” she explained.

The instrument used by the investigators is the Elderly Symptom Assessment Scale (ESAS), a measure developed to identify adverse drug events in VA patients. It contains six depression-related items (sadness, concentration, memory, fatigue, sleep, appetite) and three anxiety-related items (anxiety, irritability, and restlessness). Results are reported as a symptom count, with a range of 0-9. The ESAS contains 47 overall symptoms.

For the study, Dr. Hoth and her associates simultaneously administered the GDS and the ESAS to 351 cognitively intact VA outpatients. They categorized patients as depressed or nondepressed based on scores from both scales.

Of the 351 patients, 94 (27%) screened positive for depression by the GDS and 121 (34%) by the ESAS. The ESAS identified 64 depressed patients classified as nondepressed by the GDS. Dr. Hoth considered this the “greatest surprise” of the study.

“The other major finding was that patients who were very somatic had a lot more anxiety as part of their depression,” she added. “This is not dissimilar from the medical literature, but in a veteran population that is significant, at least for how we're going to approach treating them, because a lot of them don't want to admit they're depressed. There's still a lot of stigma.”

She and her associates plan to implement the scale in a depression clinic they are launching in the primary care division of the Iowa City VA Medical Center.

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