The Geriatric Depression Screening Scale (GDS) is a self-report questionnaire specifically designed to screen for depression in elderly patients.
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Brief Overview of the GDS
In 1983, Dr. Yesavage J. A., et al began work on the development and validation of a geriatric depression screening instrument, culminating in the creation of the GDS. The Journal of Psychiatric Research published their preliminary findings.
Shortly thereafter, Sheikh and Yesavage committed to creating a shorter version, derived from the long-form GDS questions with the highest correlation with depressive symptoms, and introduced it in 1986.
Both screening procedures are described in depth later in this article.
The GDS has been translated into more than twenty languages and is one of the most widely used screening instruments for depression in older adults.
The GDS has a high degree of reliability and validity for detecting depression in this population.
It is also sensitive to change and can detect major depressive disorder symptoms early on (MDD).
Due in part to U.S. government funding for its development, both versions of the GDS are public domain and freely accessible to the public.
The GDS is applicable in every clinical setting, including primary and long-term care.
Versions of the GDS
There are a few versions of the GDS:
- GDS long form (GDS-30)
- GDS short form (GDS-15)
- Four-item (GDS-4)
- Five-item (GDS-5)
Of these, the GDS-30 and GDS-15 are reliable and consistent.
In terms of monitoring the severity of depressive episodes, the GDS-4 and GDS-5 versions have low reliability and lack clinical relevance.
The GDS-30 long form
The 30-item Geriatric Depression Scale (GDS-30) is the most frequently used instrument for assessing depression in older adults.
Some clinicians prefer to use the GDS-30 in clinical practice as a result.
The long form can be used to assess depression in older adults with greater precision, especially those with cognitive impairment.
It is also useful for tracking mood changes over time.
How is the geriatric depression scale long form administered?
The GDS takes approximately 5-10 minutes to complete, depending on the version used. The GDS takes very little training and can be self-administered.
Below is the complete list of questions found in the GDS-30 (30-item questionnaire):
Choose the best answer for how you felt over the past week.
- Are you basically satisfied with your life? Yes/No
- Have you dropped many of your activities and interests? Yes/No
- Do you feel that your life is empty? Yes/No
- Do you often get bored? Yes/No
- Are you hopeful about the future? Yes/No
- Are you bothered by thoughts you can t get out of your head? Yes/No
- Are you in good spirits most of the time? Yes/No
- Are you afraid that something bad is going to happen to you? Yes/No
- Do you feel happy most of the time? Yes/No
- Do you often feel helpless? Yes/No
- Do you often get restless and fidgety? Yes/No
- Do you prefer to stay at home, rather than going out and doing new things? Yes/No
- Do you frequently worry about the future? Yes/No
- Do you feel you have more problems with memory than most? Yes/No
- Do you think it is wonderful to be alive now? Yes/No
- Do you often feel downhearted and blue? Yes/No
- Do you feel pretty worthless the way you are now? Yes/No
- Do you worry a lot about the past? Yes/No
- Do you find life very exciting? Yes/No
- Is it hard for you to get started on new projects? Yes/No
- Do you feel full of energy? Yes/No
- Do you feel that your situation is hopeless? Yes/No
- Do you think that most people are better off than you are? Yes/No
- Do you frequently get upset over little things? Yes/No
- Do you frequently feel like crying? Yes/No
- Do you have trouble concentrating? Yes/No
- Do you enjoy getting up in the morning? Yes/No
- Do you prefer to avoid social gatherings? Yes/No
- Is it easy for you to make decisions? Yes/No
- Is your mind as clear as it used to be? Yes/No
How is the GDS-30 long form scored?
The GDS-30 is scored according to the below-listed answer key by adding each item from 0 to 30.
If your responses correspond to the depression-related responses, you will receive one point per response.
Scoring for the GDS-30
For instance, if your response to question 1 was “No,” you would assign yourself a score of 1 for that question.
If you respond affirmatively to question 2, you would earn an additional point.
If you respond “No” to question 3, you will receive no credit.
You will continue until all of your answers to the 30 questions have been scored.
The cut-off scores and their interpretation are as follows:
- 0-9: No depression present
- 10-19: Mild Depression likely
- 20-30: Severe Depression likely
A printable version of the GDS-30 can be found here.
The GDS-15 short form
The GDS-15 is a brief, self-report measure of depressive symptoms that is frequently used in research studies.
The short version of the GDS is more appropriate for physically ill older adults and those with mild to moderate dementia. The shorter list of questions allows them to complete the examination within 5 to 7 minutes, despite their propensity to tire quickly.
The GDS-30 and GDS-15 are valid and reliable depression measures for older adults.
Both versions of the GDS, however, have certain limitations and weaknesses.
Below is the complete list of questions found in the short form GDS:
Choose the best answer for how you have felt over the past week.
- Are you basically satisfied with your life? YES /NO
- Have you dropped many of your activities and interests? YES / NO
- Do you feel that your life is empty? YES / NO
- Do you often get bored? YES / NO
- Are you in good spirits most of the time? YES / NO
- Are you afraid that something bad is going to happen to you? YES / NO
- Do you feel happy most of the time? YES / NO
- Do you often feel helpless? YES / NO
- Do you prefer to stay at home, rather than go out and doing new things? YES / NO
- Do you feel you have more problems with memory than most? YES / NO
- Do you think it is wonderful to be alive now? YES / NO
- Do you feel pretty worthless the way you are now? YES / NO
- Do you feel full of energy? YES / NO
- Do you feel that your situation is hopeless? YES / NO
- Do you think that most people are better off than you are? YES / NO
How is the GDS-15 short form scored?
The 15-question screening instrument is scored similarly to the GDS-30. You would receive one point for every response that demonstrates depression.
If you answered “No” to question 1, for instance, you would earn one point.
If you answered “No” to question 2, you would receive no credit for that question and proceed to the next one.
As with the GDS-30, you must answer all 15 questions and total your score.
Here is the answer key:
Scoring for the GDS-15
The score-cut off and interpretation short form of the geriatric depression scale is as follows:
- 0-4: Depression is unlikely
- Greater than 5: Suggestive of depression and a more comprehensive assessment with your doctor should be done
- Greater than or equal to 10: almost always indicative of major depression
A printable version of the GDS-15 can be found here.
Limitations of the geriatric depression scale
Both versions of the GDS are limited in several ways.
First, the depression scales lack items that assess cognitive sOrganicsymptoms of depression, such as forgetfulness and inability to concentrate.
Second, because the GDS is a self-report instrument, cognitive impairment or poor health status may introduce bias.
Thirdly, the scales do not take into account cultural factors that may influence depressive symptoms in older populations.
The GDS is a useful screening instrument, but it does not provide information about the severity of depressive symptoms, nor is it a diagnostic instrument.
Therefore, it is not a substitute for a comprehensive diagnostic interview and psychological evaluation conducted by a trained and qualified mental health or healthcare professional.
Notably, it cannot explain suicidality.
Follow-up to a positive symptom screen for depression
If the GDS is administered and a positive screen is verified for elderly subjects, prompt intervention and treatment are warranted to prevent further progression of their mental health.
It is important to note that a positive screen is NOT a diagnosis. Rather, it should prompt you to schedule an appointment with a mental health practitioner or physician so they can thoroughly evaluate you for depression.
Most importantly, a more comprehensive assessment of depression should be made for suicidality. This is because depression is a major predictor of suicidality in older adults.
Seniors make up approximately 13% of the current U.S. population, but 20% of ALL suicide deaths in the country are attributed to older adults aged 65 and over! This number is truly staggering and sobering.
Treatment for depression should not be delayed and must be taken seriously. If you have a firm diagnosis, prompt, effective, and individualized non-pharmacological and pharmacological management of your depression must be started. This is especially important for you as an older adult because you are at increased risk for misdiagnosis and undertreatment.
That’s why I have written a very comprehensive article on the causes, symptoms, and treatment of depression in older adults and you can read it here.
The GDS and cognitive impairment or dementia
The GDS can accurately identify depression in older patients with unimpaired cognition whose mini-mental state exam scores were 15 or higher (mild to moderate dementia).
However, recent evidence suggests that the GDS is inaccurate in older adults who are cognitively impaired or have dementia.
Dementia can be very challenging to manage. You can read my article on the causes, symptoms, types, and treatment of dementia here.
For depressed individuals with dementia, another screening tool called the Cornell Scale for Depression appears to be more accurate.
Summary of the GDS
- The Geriatric Depression Screening Scale (GDS) is a self-report questionnaire that was specifically designed to screen for depression in older people
- There are two versions of the GDS: A 30-item long form and a 15-item short form
- The GDS can easily be self-administered or given by family members and does not require much training
- The GDS can be used in primary care and long-term care settings
- A positive screen with the GDS must be followed up with a qualified mental health professional or clinical gerontologist for further assessment and diagnosis
- A positive screening on the GDS does not assess for suicidality