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

Magnil, Maria, Gunnarsson, Ronny, and Bjorkelund, Cecilia (2011) Using patient-centred consultation when screening for depression in elderly patients: a comparative pilot study. Scandinavian Journal of Primary Health Care, 29 (1). pp. 51-56.

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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.

Item ID: 26773
Item Type: Article (Research - C1)
ISSN: 1502-7724
Keywords: depressive symptoms, elderly, family practice, primary care, screening instruments
Additional Information:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.

Date Deposited: 24 Apr 2013 11:04
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 60%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111702 Aged Health Care @ 40%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920410 Mental Health @ 10%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920502 Health Related to Ageing @ 90%
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