Snowdon John, Fleming Richard
Discipline of Psychological Medicine, University of Sydney, Sydney, Australia.
Int J Geriatr Psychiatry. 2008 Mar;23(3):295-300. doi: 10.1002/gps.1877.
Depression in aged care facilities (ACFs) is reportedly under-recognised and under-treated. Observer-rated and self-rated depression rating scales can help identify cases of depression, and could be used to estimate the prevalence of depression in ACFs.
Direct care staff in 168 ACFs used a survey form and administered the Cornell Scale for Depression in Dementia (CSDD) and (in those able to be tested) the 15-item Geriatric Depression Scale (GDS-15) to every fourth resident. In seven facilities the same subjects were clinically assessed and (where appropriate) diagnosed by a psychiatrist.
Survey forms and CSDD ratings were completed by staff concerning 91.6% of the one-in-four selected subjects. Their mean age was 82.1 years. CSDD scores of 8 or more, indicating depression, were recorded for 34.7% of the ACF residents, comprising 40.5% of the 1,084 high care (nursing home level) residents, and 25.4% of the 674 low care residents. Of 1,250 residents tested with the GDS-15, 41.1% scored 6 or more, indicating depression. The correlation between GDS-15 and CSDD scores was 0.6. Use of the survey tool allowed staff to identify which factors were most strongly associated with depression, the strongest being grief over loss of abilities and opportunities to participate in valued activities.
The CSDD (and the GDS-15 in those without severe cognitive impairment) proved useful in identifying residents who were depressed. Survey questions helped draw attention to factors of importance in development or persistence of these depressions, and hence to strategies for intervention.
据报道，老年护理机构（ACF）中的抑郁症未得到充分认识和治疗。观察者评分和自评抑郁量表有助于识别抑郁症病例，并可用于估计ACF中抑郁症的患病率。
168家ACF的直接护理人员使用调查问卷，对每四名居民使用康奈尔痴呆抑郁量表（CSDD）以及（对能够进行测试的居民）15项老年抑郁量表（GDS-15）进行测评。在七家机构中，由精神科医生对相同的受试者进行临床评估并（在适当情况下）诊断。
工作人员完成了调查问卷以及对四分之一选定受试者中91.6%的CSDD评分。他们的平均年龄为82.1岁。ACF居民中34.7%的人CSDD得分达到8分或更高，表明患有抑郁症，其中包括1084名高护理（养老院级别）居民中的40.5%，以及674名低护理居民中的25.4%。在1250名接受GDS-15测试的居民中，41.1%的人得分6分或更高，表明患有抑郁症。GDS-15与CSDD得分之间的相关性为0.6。使用调查工具使工作人员能够确定哪些因素与抑郁症关联最为密切，其中最主要的是因丧失能力以及失去参与有价值活动的机会而产生的悲伤情绪。
CSDD（以及对无严重认知障碍者使用的GDS-15）被证明有助于识别患有抑郁症的居民。调查问题有助于引起对这些抑郁症发生或持续存在的重要因素的关注，从而有助于制定干预策略。
