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How the Question Is Asked Makes a Difference in the Assessment of Depressive Symptoms in Older Persons

Received June 3, 2003; revised September 29, 2003; accepted October 2, 2003. From the Veterans Administration, Greater Los Angeles Healthcare System (JC) and the Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles (JC, TES); the Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (JGB); and the Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging, Duke University Medical Center, Durham, NC (DGB). Send correspondence to Joshua Chodosh, M.D., M.S.H.S., UCLA Division of Geriatrics, School of Medicine, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA 90095-1687. e-mail: jchodosh{at}mednet.ucla.edu

Objective: The authors examined whether older adults respond comparably to two standard depression instruments rating symptoms by frequency/duration or degree of severity/"bother." Methods: Data for this cross sectional analysis of a prospective cohort came from 699 community-dwelling individuals within the communities of Durham, North Carolina, and New Haven, Connecticut. Differences in response between the Center for Epidemiological Studies–Depression (CES–D) survey, emphasizing symptom frequency, were compared with the Hopkins Symptom Checklist (HSCL) subscale, emphasizing bother or discomfort related to those symptoms. Socioeconomic, demographic, and clinical characteristics for subjects with the greatest difference between standardized scale scores were analyzed with multivariable logistic regression. Results: Older persons differed in their responses between the two instruments, despite similar content. Individuals in the highest quartile of difference between the two scales (indicating more bother than symptom frequency) had significantly more education, higher income, and were less often African American, with no differences in health conditions. Moreover, these specific socioeconomic and ethnic characteristics remained significant in multivariable analyses. Conclusions: Older persons not only differed significantly in their responses between depression instruments based on one dimension or the other, although with similar content, but response was significantly associated with specific subject characteristics. The heterogeneity of older patient populations suggests that recognition of depressive symptoms should include both constructs of symptom-associated discomfort and symptom frequency to achieve more accurate assessment.

Key Words: Depression • Assessment • Interviews

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