Diagnostic validity and added value of the geriatric depression scale for depression in primary care: A meta-analysis of GDS30 and GDS15
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Journal of Affective Disorders
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Background The Geriatric Depression Scale (GDS) has been evaluated in hospital settings but its validity and added value in primary care is uncertain. We therefore conducted a meta-analysis analysing the diagnostic accuracy, clinical utility and added value of the GDS in primary care. Methods A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semi-structured psychiatric interview and of these 17 analyses (in 14 publications) took place in primary care. Seven studies examined the GDS30 and 10 studies examined the GDS15. Heterogeneity was moderate to high, therefore random effects meta-analysis was used. Results Diagnostic accuracy of the GDS30 after meta-analytic weighting was given by a sensitivity of 77.4% (95% CI = 66.3% to 86.8%) and a specificity = 65.4% (95% CI = 44.2% to 83.8%). For the GDS15 the sensitivity was 81.3% (95% CI = 77.2% to 85.2%) and specificity = 78.4% (95% CI = 71.2% to 84.8%). The fraction correctly identified (also known as efficiency) by the GDS15 was significantly higher than the GDS30 (77.6% vs 71.2%, Chi2 = 24.8 P < 0.0001). The clinical utility of both the GDS30 and GDS15 was “poor” for case-finding (UI+ 0.29, UI+ 0.32 respectively). However the GDS15 was rated as “good” for screening (UI− 0.75) whereas the GDS30 was “adequate” (UI− 0.60). Concerning added value, when identification using the GDS was compared with general practitioners' ability to diagnose late-life depressions unassisted by tools, at a prevalence of 15% the GDS30 had no added benefit whereas the GDS15 helped identify an additional 4 cases per 100 primary care attendees and also helped rule-out an additional 4 non-cases per 100 attendees. Thus we estimate the potential gain of the GDS15 in primary care to be 8% over unassisted clinical detection but at a cost of 3–4 minutes of extra time per appointment. Conclusion The GDS yields potential added value in primary care. We recommend the GDS15 but not the GDS30 in the diagnosis of late-life depression in primary care.