Using patient-centred consultation when screening for depression in elderly patients: A comparative pilot study

Abstract

Objective. Using validated screening instruments to detect depressive symptoms in the elderly has been recommended. The aim of this study was to compare a patient-centred consultation model with the PRIME-MD screening questionnaire, using the MADRS-S as reference for detecting depressive symptoms in an elderly primary care population. Design. Comparative study. Setting. Primary care, Sweden. Subjects. During an 11-month period 302 consecutive patients aged 60 and over attending a primary care centre were screened with the PRIME-MD and the Montgomery-Asberg Depression Rating Scale-Self-rated version (MADRS-S) instrument. The results were unknown to the GPs who used a structured, patient-centred consultation model comprising seven open-ended “key questions”. Main outcome measures. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for the PRIME-MD screening questionnaire and the patient-centred consultation model using MADRS-S as reference for possible depression at two cut-off levels with 15% prevalence. Results. Sensitivity was lower for the consultation model than the PRIME-MD screening questionnaire: 78% and 98%, respectively. The GPs failed to identify every fifth patient using the lower cut-off (MADRS-S≥13) but the number of required diagnostic interviews decreased by almost 50%: 85 versus 162, respectively. PPV was 43% and 28%, respectively. Both instruments showed high sensitivity (93%) using the higher cut-off (MADRS-S≥20) and had high NPV: 95% and 99%, respectively. Conclusions. The findings suggest that the consultation screening procedure might be as useful in everyday practice as the PRIME-MD screening questionnaire. Both screening procedures may also be useful for ruling out depressive symptoms.

Key Words::

• Depressive symptoms
• elderly
• family practice
• primary care
• screening instruments

Acknowledgements

This study was supported by grants from the Västra Götaland Region and from Gothenburg Primary Care. The authors would like to thank the patients and the staff at the Lundby-Brämaregården Primary Care Centre for their cooperation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.