Parallel Session 2 2.3 Neglected Conditions : Depression and Violence THE SHORT FORM HEALTH SURVEY AS AN INSTRUMENT FOR THE SCREENING OF DEPRESSIVE SYMPTOMS.

Parallel Session 2

2.3 Neglected Conditions : Depression and Violence

THE SHORT FORM HEALTH SURVEY AS AN INSTRUMENT FOR

THE SCREENING OF DEPRESSIVE SYMPTOMS IN THE ELDERLY

POPULATION.

Jair Licio Ferreira SANTOS ([email protected])

Ana Teresa de Abreu RAMOS-CERQUEIRA

Antonia Regina Ferreira FUREGATO

Maria Lucia LEBRÃO

Yeda Aparecida de Oliveira DUARTE

Parallel Session 2

2.3 Neglected Conditions : Depression and Violence

THE SHORT FORM HEALTH SURVEY AS AN INSTRUMENT FOR

THE SCREENING OF DEPRESSIVE SYMPTOMS IN THE ELDERLY

POPULATION.

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THE SHORT FORM HEALTH SURVEY AS AN INSTRUMENT FORTHE SCREENING OF DEPRESSIVE SYMPTOMS IN

THE ELDERLY POPULATION.

Jair Licio Ferreira SANTOS

Ana Teresa de Abreu RAMOS-CERQUEIRA

Antonia Regina Ferreira FUREGATO

Maria Lucia LEBRÃO

Yeda Aparecida de Oliveira DUARTE

SAÚDE, BEM ESTAR E ENVELHECIMENTO:Estudo longitudinal sobre as condições de vida e saúde dos idosos do município de São Paulo

Health, well-being and aging:A longitudinal study of health and living conditions of elderly in the city of São Paulo.

BACKGROUND

Mental Illness - in particular Depression - has a broad impact on a patient's life, setting his perception of life, of himself, his health and his quality of life. (FLECK et al, 2002)

The proximity of the worldview of the depressed patient, of his dismay,

and self rated health

to the possibility that, in trying to measure one of the entities,

one is also measuring the other.

LEADS

the subjectivity implicit in the measurements of quality of life

TO

BACKGROUND

When measuring quality of life emphasis is given to subjective evaluation:

responses refer to questions about one's perception of one's quality of life.

Even the axes that would account for multiple dimensions are influenced by

the individual's perception about himself , his state of anxiety and

excitement.

Thus, it follows from the subjective concept of quality of life its close

relationship to mental health, particularly depression.

BACKGROUND

MOTIVATION

Instruments designed to assess quality of life have been applied to trace mental conditions:

-> anxiety (SANDERSON et al 2001),

-> panic disorder, agoraphobia, social phobia (SANDERSON, ANDREWS, 2002)

->depression (GILL et al 2007)

MOTIVATION

The Short Form Health Survey (SF-12) with one of its two areas relating to the perception of mental health (MCS-12) may be useful to trace conditions such as depressive symptoms.

But its validity as a measure of mental problems in general populations has received little attention (GILL et al 2007).

MOTIVATION

Gill and colleagues (2007) evaluated the utility of the MCS-12 as screening instrument for depression and anxiety disorders diagnosed in a sample of the general population from the National Survey of Mental Health in Australia.

The results confirmed the validity of using the MCS-12 in epidemiological research in Mental Health and its suitability as a screening tool for depression.

MOTIVATION

These findings lead to a widening of interest in MCS-12 as a resource to assess indicators of depression, particularly in more susceptible individuals such as the elders.

OBJECTIVE

To select a cutoff point of the MCS-12 scale

that leads to an adequate discrimination

of severe depressive symptoms with good

sensitivity and specificity.

METHODS: SAMPLE

Data was gathered by the SABE Study - Health Welfare and

Ageing: in 2006, 1115 survivors of the first round (2000)

were interviewed.

A two-stage sample drawn in 2000 with clusters selected

through probabilities proportional to the size was adjusted

in 2006 to accurately represent the population of elders

living in the city of São Paulo, Brasil.

METHODS: INSTRUMENTS

Depressive symptoms were assessed using the Geriatric Depression Scale - GDS – (SHEIKH AND YESAVAGE, 1986). Cutoff score of 11 was used for severe symptoms.

Mental Health component of the SF-12 (MSC-12). (WARE, KOSINSKY & KELLER, 1996).

METHODS: ANALYSIS

Indications of cutoff points for the MSC12 were found by Receiver Operating Characteristic curve (ROC) analysis. The area under the ROC curve (AUC) is an indication of the diagnostic power of the scale.

This ROC analysis does not support weighting for effects of the Sample Design. Thus, final cutoff points were selected by examining the suggested points in weighted 2x2 tables.

RESULTS - SAMPLE

TOTAL SAMPLE N0 = 1115

REFUSED TO ANSWER GDS

N2 = 15

INCOMPLETE ANSWERS TO SF-12

N3 = 28

TOTAL NUMBER ANSWERING BOTHS SCALES

N = 905

PROBABLE DEMENTIA (MMSE + PFAQ )

N1 = 167

RESULTS: PREVALENCE

RESULTS: SELECTION OF A CUTTING POINT.

The ROC curve analysis indicated the points from 41 to

46 as possible good choices for cutoff.

AUC was estimated as 89,4% . According to SWETS

(1988) an AUC value of 90% or higher indicates a

highly accurate scale, and between 80% and 90%

indicates a useful scale for screening.

RESULTS: SELECTION OF A CUTTING POINT.

RESULTS

In the analysis of double entry tables with weighting for sampling effects the score of 43 was chosen as the cutoff for severe depressive symptoms in both sexes.

This score provided a good balance between the desirable values for sensitivity and specificity. We did focus on specificity, since the objective is to use the instrument for screening.

RESULTS: SELECTION OF A CUTTING POINT

RESULTS: VALIDATION RESULTING FROM THE CHOICE OF 43 AS CUTOFF

Percentage of individuals classified as having severe depressive

symptoms in MCS-12 and GDS and validation parameters.

Severe depressive symptoms

MCS-12

Severe depressive symptoms - GDS

PARAMETERS YES NO TOTAL

YES 1,9 10,0 11,9 SENSIBILITY = 0,73 SPECIFICITY = 0,90 ACCURACY = 0,89 AREA UNDER CURVE = 0,89 CONFIDENCE INTERVAL (95%): (0.83 - 0.94)

NO 0,8 87,4 88,1

TOTAL 2,6 97,4 100,0

RESULTS: VALIDATION BY SEXPercentage of individuals classified as having severe depressive

symptoms in MCS-12 and GDS and validation parameters.

DISCUSSIONGill and colleagues (2007) found similar values for the

MCS-12 when compared to the CIDI-2.1: The area under

the ROC curve was slightly higher (0.92), showed better

sensitivity (87%) but lower specificity (83%). Their cutoff

point was 45, which can be considered a similar

result, since the population involved was older than 18

years, mean age 45, and in our sample we dealt with

seniors aged 65 and over, mean age 73.7years.

CONCLUSIONS

The mental component of SF-12 showed good

performance for the screening of depression in

an elderly population. It properly allocated 86% of

females and 93% of men. The specificity was

higher than sensitivity, which is convenient for

screening instruments, and ranged from 87% to

94%.

CONCLUSIONS

The SF-12 scale is widely used in epidemiologic

research. These results indicate that its mental

component MCS-12 is a useful screening

instrument for depression among the elderly, and

thus, a useful tool in epidemiological research in

mental health.

LIMITATIONSMCS-12 was studied in comparison to only one other scale, also used

for screening, the GDS. It would be important to evaluate the discriminatory

properties of the MCS-12 in a population of elderly people diagnosed by the CIDI

2.1.

This study refers to a population of elderly people in São Paulo - Brazil,

and generalization of its application to other populations should take into

account any cultural differences.

The weights used in the analysis aimed to ensure representation of the

senior community in general and were designed to apply in epidemiological

studies. Thus, clinical studies or researches in primary care may achieve

incomplete benefits from these results.

REFERENCESFLECK MPA; LIMA AFBS; LOUZADA S; SCHESTASKY G; HENRIQUES A; BORGES VR; CAMEY S. Associação entre sintomas depressivos e funcionamento social em cuidados primários à saúde. Rev. Saúde Pública 2002 ; 36(4): 431-438.

GILL SC; BUTTERWORTH P; RODGERS B; MACKINNON A. Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Research 2007; 152 (1): 63-71.

SANDERSON K; ANDREWS ; JELSNA W. Disability measurement in the anxiety disorders: comparison of three brief measures. Journal of Anxiety Disorders 2001; 15:333-344.

SANDERSON K, ANDREWS G. Prevalence and severity of mental health related disability and relationship to diagnosis. Psychiatric Services 2002; 53:80-86.

SHEIKH JI; YESAVAGE JA. Geriatric Depression Scale (GDS): recent evidence and development of a short version. Clin Gerontol 1986; 5: 165-73.

SEWTS, JA. Measuring the accuracy o diagnostic systems. Science, 240. 1988:1285-1292.

WARE JE; KOSINSKI W; KELLER SD. A 12-item Short-Form Health Survey: construction os scales and preliminary tests of reliability and valididty. Medical Care 34, 1996: 220-233.

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