201. Screening for depression in African-Caribbean elders
- Author
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Greta Rait, Robert Baldwin, Melanie Abas, Alistair Burns, A. Selwyn St Leger, Michael Morley, and Carolyn Chew-Graham
- Subjects
Male ,medicine.medical_specialty ,Black People ,Pilot Projects ,Sensitivity and Specificity ,Severity of Illness Index ,Sampling Studies ,Age Distribution ,Risk Factors ,Severity of illness ,Confidence Intervals ,medicine ,Humans ,Mass Screening ,Sex Distribution ,Medical diagnosis ,Psychiatry ,Depression (differential diagnoses) ,Aged ,Depressive Disorder ,business.industry ,Incidence ,Incidence (epidemiology) ,Middle Aged ,Health Surveys ,Mental health ,United Kingdom ,Confidence interval ,Middle age ,Caribbean Region ,ROC Curve ,Family medicine ,Female ,Geriatric Depression Scale ,Family Practice ,business - Abstract
There are increasing numbers of older African-Caribbeans in the UK. Primary care staff often feel less confident about diagnosing depression in this group. Screening instruments may assist in making diagnoses in cross-cultural consultations.We aimed to determine the sensitivity and specificity of screening instruments for depression in older African-Caribbean people in Manchester, UK.We carried out a two-stage study to compare three screening instruments for depression (Geriatric Depression Scale, Brief Assessment Schedule Depression Cards, Caribbean Culture Specific Screen), with a computerized diagnostic interview for mental health disorders in older adults (Geriatric Mental State). The study was set in inner-city Manchester. The subjects were community-resident African-Caribbeans aged 60 years and over; 227 subjects were approached. Of the 160 people screened, 130 agreed to diagnostic interview. The main outcome measures were Spearman correlation coefficients; these were calculated between each screening instrument and the diagnostic interview. Receiver-operating characteristic (ROC) curve analysis was used to determine appropriate sensitivity and specificity for each instrument.The results for the largest subgroup, the Jamaicans (n = 96/130), demonstrated highly significant correlations between screening instruments and diagnostic interview (P0.001). Each instrument had a high sensitivity: Brief Assessment Schedule depression cards (cut-offor =6; sensitivity 90.9% (95% CI 58.8-99.8), specificity 82.1% (95% CI 74.0-90.3)), Caribbean Culture Specific Screen (cut-offor =6; sensitivity 90.9% (95% CI 58.8-99.8), specificity 74.1% (95% CI 64.8-83.4)), and Geriatric Depression Scale (cut-offor =4; sensitivity 100% (95% CI 97.1-100), specificity 69.1% (95% CI 59.6-79.2)).These screening instruments demonstrate high sensitivity levels, if an appropriate cut-off point is used. The culture-specific instrument did not perform better than the traditional instruments. Health professionals should approach the consultation in a culturally sensitive manner and use the validated instrument they are most familiar with.