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RehabMeasures Instrument

Geriatric Depression Scale

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Purpose

Assesses depression and suicide ideation in elderly individuals.

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instrument details

Acronym GDS

Area of Assessment

Depression

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury
  • Parkinson's Disease + Neurologic Rehabilitation
  • Stroke Recovery

Key Descriptions

  • Self-rating scale comprised of 30 items selected from a pool of 100 items selected by researchers and clinicians.
  • Questions require simple YES/NO answers and are non-threatening and age-appropriate.
  • The patient is asked to provide responses to each question in reference to the past week.
  • One point is given for each “yes” response, and the number of points is summed to provide a single score.
  • Scores are categorized as (McDowell, 2006):
    1) Normal
    2) Mild
    3) Moderate-Severe
  • Scores above 11 indicate depression.
  • The GDS does not measure somatic symptoms.
  • Translations to other languages available at author's website: http://www.stanford.edu/~yesavage/GDS.html

Number of Items

30
Short forms: 15, 10, and 4

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references of PD and stroke populations by Ya-Ju Wang, SPT and Jassica Webster, SPT in 2011; Updated with references of Dementia, Cognitive Impairment, PD, and Stroke populations by Joe Ascher, SPT and Tony Gravin, SPT in 11/2012.

ICF Domain

Body Function

Measurement Domain

Emotion

Considerations

  • The authors of the GDS did not recommend a clear cut-off value for the 15- and the 30-item versions of the GDS (Wancata et al, 2006)
  • When comparing the 30 and 15 item versions of the GDS to a general practitioners' ability to diagnose late-life depressions, the GDS-30 had no added benefit, however, the GDS-15 helped identify an additional 4 cases per 100 primary care attendees and also helped rule-out an additional 4 non-cases per 100 (Mitchell et al, 2009)

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Alzheimer's Disease and Progressive Dementia

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Cut-Off Scores

Cognitive Impairment:

(Debruyne et al, 2009; = 156, Cognitive Impairment)

  • For the GD, cut off scores was 8; sensitivity = 0.95, specificity = 0.67 

 

Dementia:

(Schreiner et al, 2003; = 74; mean age = 59.9 years, Dementia)

  • For the GDS, cut off score was 6; sensitivity = 0.973, specificity = 0.959, FRP = 0.894, FNR = 0 

 

(Korner et al, 2006, = 47, age > 65 years old) 

  • GDS-30 cut-off was 10 with a sensitivity = 0.83, specificity = 1.00
  • GDS-15 cut-off was 4 with a sensitivity = 0.81, specificity = 0.72
  • GDS-10 cut-off was 3 with a sensitivity = 0.72, specificity = 0.63
  • GDS-4 cut-off was 1 with a sensitivity = 0.72, specificity = 1.00

Criterion Validity (Predictive/Concurrent)

Dementia:

(Korner et al, 2006, = 47, age > 65 years old, Dementia) 

  • GDS-30 had a spearman’s correlation with the GDS-15 of 0.96
  • GDS-30 had a spearman’s correlation with the GDS-10 of 0.93
  • GDS-30 had a spearman’s correlation with the GDS-4 of 0.88
  • GDS-30 had a spearman’s correlation with the CSDD of 0.82
  • GDS-30 had a spearman’s correlation with the CGI of 0.79

Parkinson's Disease

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Cut-Off Scores

Parkinson's Disease:

(McDowell, 2006; n = 57; mean age = 58.6 (8.4) years; Unified Parkinson’s Disease Rating Scale score of 75 (18.4), Parkinson’s Disease)

  • Acceptable sensitivity and specificity with a cutoff of 9/10

 

(Tumas et al, 2008; n = 50; mean age without depression = 62.4 (12.6) years, mean age with depression = 64.5 (12.7) years; disease duration without depression = 54.5 (14.5) years, disease duration with depression = 56 (12.9) years, Parkinson’s Disease)

  • For the GDS-15, cut-off score 10/11; specificity = 0.97, PPV = 0.88

 

(Chagas et al, 2010; n = 78; mean age = 61.03 (10.52) years; disease duration 8.22 (4.98) years, Parkinson’s Disease)

  • For the GDS-15, cut-off score of 8; sensitivity = 0.778, specificity = 0.883, PPV = 0.667, NPV = 0.93

 

(Weintraub et al, 2006; = 32; mean age = 72 years old, Parkinson’s Disease)

  • Cut-off score was 4/5; sensitivity of 0.88 and specificity of 0.85 

 

(Mondolo et al, 2006; n=46, mean age= 67.7 years old, Parkinson’s Disease)

  • GDS optimal cut-off score is 10/11; sensitivity= 1.00; specificity= 0.76; PPV= 0.33; NPV=1.00

Normative Data

Parkinson’s Disease:

(Mondolo et al, 2006; = 46, mean age = 67.7 years old, Parkinson’s Disease)

  • The mean for the population was 9.7 on the GDS, with a standard deviation of 5.4, and a range of 1-24

Internal Consistency

Parkinson’s Disease:

(Ertan et al, 2005; n = 109; mean age = 66.5 (11) years, Parkinson’s Disease)

· High Internal Consistency (Cronbach’s alpha = 0.92)

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

(Mondolo et al, 2006; = 46, mean age = 67.7 years old, Parkinson’s Disease)

  • GDS has a correlation with the HADS test of 0.72 
  • GDS has a correlation with the HAN-D test of 0.59 
  • GDS has a correlation with the FACE scale of 0.39 
  • GDS has a correlation with the VAS Depression scale of -0.47 
  • All the values were significant at the 0.01 alpha level

Construct Validity

Parkinson’s Disease:

(Ertan et al, 2005; n = 109; mean age = 66.5 (11) years, Parkinson’s Disease) 

  • The depressed group had a significantly higher mean GDS total score compared with those without depression 
  • 9.7 (7) vs. 7.6 (5), t = 9.5, p = 0.000, 95% CI (9.6 - 14.6)

Stroke

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Cut-Off Scores

Stroke:

(Sivrioglu et al, 2009; n = 85; mean age = 60.1 (14) years; mean time since stroke = 237 (231) days, Chronic and Acute Stroke)

  • Non-depressed cut-scores of 10 to 11; sensitivity = 0.69, specificity = 0.75 
  • Minor depression cut-scores of 11 to 12; sensitivity = 0.66, specificity = 0.79

 

(Tang et al, 2004; = 127, Post-Stroke)

  • The optimal cut-off score is 6/7; sensitivity = 0.89; specificity = 0.73; PPV = 0.37; NPV = 0.98

Test/Retest Reliability

Stroke:

(Sivrioglu et al, 2009, Chronic and Acute Stroke)

  • Excellent test-retest reliability (7 days between administrations; r = 0.75)

 

Interrater/Intrarater Reliability

Post-stoke: 

(Cinamon et al, 2010; n = 91; mean age = 72 (10.5) years; time post-stroke = 6 months)

  • Person-item Hierarchy:  Stoke specific GDS-17 is 0.79 and GDS-30 is 0.98

Internal Consistency

Stroke:

(Sivrioglu et al, 2009, Chronic and Acute Stroke)

  • Excellent Internal Consistency (Cronbach’s alpha = 0.89)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Agrell et al, 1989, = 40, mean age = 80, Chronic and Acute Stroke)

  • Excellent concurrent validity between GDS and Zung Scale (= 0.82) and between GDS and the HRS (Hamilton Rating Scale) (= 0.82)

Construct Validity

Stroke:

(Sivrioglu et al, 2009, Chronic and Acute Stroke) 

  • Higher mean scores were obtained for depressed elderly stroke survivors 
  • 17.2 (4) vs. 12.8 (2), t(83) = 5.67, p = 0.000, 95% CI (2.8 - 5)

Older Adults and Geriatric Care

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Normative Data

Elderly with and without a history of depression:

(Yesavage et al, 1982; n = 47; age > 55 years, Elderly with and without a history of depression)

  • Normal (no depression), scores of 0 to 10 
  • Possible depression, scores of 11 or more

Internal Consistency

Institutionalized elderly population:

(Lesher, 1986, n = 51 nursing home residents, Institutionalized Elderly Population)

  • Excellent Internal Consistency (Cronbach’s alpha = 0.99)

Criterion Validity (Predictive/Concurrent)

Institutionalized Elderly Population:

(Kiernan et al, 1986, Institutionalized Elderly Population)

  • Excellent convergent validity with the Beck Depression Inventory (r = 0.78)

Non-Specific Patient Population

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Criterion Validity (Predictive/Concurrent)

Meta analytic evidence of Criterion Related Validity: (Wancata et al, 2006)

  • GDS validity was similar to the Center for Epidemiological Studies Depression scale (CES-D), but significantly better than the "Yale-1-question" scale
  • Excellent correlations between classification criteria “no depression,” “mild depression,” and “severe depression” and the GDS (r = 0.82), SDS (r = 0.69), and HAMD (r = 0.83)

Content Validity

(Brink et al, 1982; Yesavage et al, 1983)

  • 100 items were selected by researchers and clinicians familiar with depression in geriatric populations. 
  • 30 items were then empirically selected based on their correlation with the initial 100 item measures total scores.

Responsiveness

Meta-analytic Results:

(Wancata et al, 2006; n = 42 studies; mixed sample)

  • GDS-30: sensitivity 0.753, specificity 0.770 
  • GDS-15: sensitivity 0.805, specificity 0.750

 

Meta-analytic Results: 

(Mitchell et al, 2009; n = 17 studies reported)

  • GDS-30 (after meta-analytic weighting) sensitivity = 77.4% (95% CI = 66.3% to 86.8%) and a specificity = 65.4% (95% CI = 44.2% to 83.8%).
  • GDS-15 (after meta-analytic weighting) sensitivity = 81.3% (95% CI = 77.2% to 85.2%) and specificity=78.4% (95% CI = 71.2% to 84.8%)

Bibliography

Agrell, B. and Dehlin, O. (1989). "Comparison of six depression rating scales in geriatric stroke patients." Stroke 20(9): 1190-1194. Find it on PubMed

Brink, T., Yesavage, J., et al. (1982). "Screening tests for geriatric depression." Clinical Gerontologist 1(1): 37-43. 

Chagas, M. H., Tumas, V., et al. (2010). "Validity of a Brazilian version of the Zung self-rating depression scale for screening of depression in patients with Parkinson's disease." Parkinsonism Relat Disord 16(1): 42-45. Find it on PubMed

Cheng, S. T., Yu, E. C., et al. (2010). "The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention." Am J Geriatr Psychiatry 18(3): 256-265. Find it on PubMed

Cinamon, J. S., Finch, L., et al. (2011). "Preliminary evidence for the development of a stroke specific geriatric depression scale." Int J Geriatr Psychiatry 26(2): 188-198. Find it on PubMed

Debruyne, H., Van Buggenhout, M., et al. (2009). "Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment?" Int J Geriatr Psychiatry 24(6): 556-562. Find it on PubMed

Ertan, F. S., Ertan, T., et al. (2005). "Reliability and validity of the Geriatric Depression Scale in depression in Parkinson's disease." J Neurol Neurosurg Psychiatry 76(10): 1445-1447. Find it on PubMed

Kiernan, B., Wilson, D., et al. (1986). "Comparison of the Geriatric Depression Scale and Beck Depression Inventory in a nursing home setting." Clinical Gerontologist 6(1): 54-56. 

Korner, A., Lauritzen, L., et al. (2006). "The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study." Nord J Psychiatry 60(5): 360-364. Find it on PubMed

Lesher, E. (1986). "Validation of the Geriatric Depression Scale among nursing home residents." Clinical Gerontologist 4(4): 21-28. 

McDowell, I. (2006). Measuring health: a guide to rating scales and questionnaires, Oxford University Press, USA. Mitchell, A. J., Bird, V., et al. (2009). "Diagnostic validity and added value of the geriatric depression scale for depression in primary care: A meta-analysis of GDS(30) and GDS(15)." J Affect Disord. Find it on PubMed

Mondolo, F., Jahanshahi, M., et al. (2006). "The validity of the hospital anxiety and depression scale and the geriatric depression scale in Parkinson's disease." Behav Neurol 17(2): 109-115. Find it on PubMed

Schreiner, A. S., Hayakawa, H., et al. (2003). "Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects." Int J Geriatr Psychiatry 18(6): 498-505. Find it on PubMed

Sivrioglu, E. Y., Sivrioglu, K., et al. (2009). "Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression." J Clin Exp Neuropsychol 31(8): 999-1006. Find it on PubMed

Tang, W. K., Chan, S. S., et al. (2004). "Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly?" J Affect Disord 81(2): 153-156. Find it on PubMed

Tumas, V., Rodrigues, G. G., et al. (2008). "The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory." Arq Neuropsiquiatr 66(2A): 152-156. Find it on PubMed

Wancata, J., Alexandrowicz, R., et al. (2006). "The criterion validity of the Geriatric Depression Scale: a systematic review." Acta Psychiatr Scand 114(6): 398-410. Find it on PubMed

Weintraub, D., Oehlberg, K. A., et al. (2006). "Test characteristics of the 15-item geriatric depression scale and Hamilton depression rating scale in Parkinson disease." Am J Geriatr Psychiatry 14(2): 169-175. Find it on PubMed

Yesavage, J., Brink, T., et al. (1983). "Development and validation of a geriatric depression screening scale: a preliminary report." Journal of psychiatric research 17(1): 37-49. 

Yesavage, J. A., Brink, T. L., et al. (1982). "Development and validation of a geriatric depression screening scale: a preliminary report." J Psychiatr Res 17(1): 37-49. Find it on PubMed

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