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Journal of the Korean Academy of Family Medicine 2006;27(5):364-369.
Published online May 10, 2006.
Comparing Various Short-Form Geriatric Depression Scales in Elderly Patients.
Hyun Seok Park, Young Jak Deung Jung, Cha Im Lee, Jeong Eun Oh, Sung Ho Hong, Choo Yon Cho
Department of Family Medicine, Soonchunhyang University College of Medicine, Seoul, Korea. hpv019@hanmail.net
노인 환자에서 다양한 단축형 노인우울척도의 비교
박현석,등정영작,이차임,오정은,홍성호,조주연
순천향대학교 의과대학 가정의학교실
Abstract
Background
: A 15-item GDS form is now widely used to screen for depressive symptoms in elderly patients, but even the 15-item version seems fairly long for routine use in busy outpatient settings. This study was conducted to determine which of the three short-form GDS tools with four or five questions extracted from the 15-item GDS tool could be a valid alternative to the 15-item GDS.

Methods : This study was performed using a questionnaire survey of 102 elderly patients over sixty-five, who had either visited or had been admitted in either one of the two universities hospitals in Seoul or ChungCheong district from October 1999 to June 2004. Questionnaire contained demographic and statistical characteristics, items related to health behavior, 15-item GDS, Mini-Mental State Examination Korean (MMSE-K) and activities of daily living. Three scales, namely, D'Ath GDS-4, Van Marwijk GDS-4, and Hoyl GDS-5 were compared to the 15-item GDS. Sensitivity, specificity, positive predictive value and the area under the ROC curves were calculated for each short-form GDS scales.

Results : The mean 15-item GDS score was 7.4±3.3 and 69.6% of the subjects were to have suggested depression. Hoyl GDS-5 instrument had the highest sensitivity of 87.3%, specificity of 80.6%, and positive predictive value of 91.1% among the three short-form alternatives. The 5-item Hoyl GDS version had the highest area under the curve (0.84), compared to 0.76 for the 4-item Van Marwijk and 0.66 for the 4-item D'Ath GDS version.

Conclusion : The 5-item Hoyl GDS had superior validity over the D'Ath GDS-4 and Van Marwijk GDS-4. The GDS5/15 may be an effective alternative screening tool.
Key Words: depression, GDS, elderly, screening
초록
연구배경 : 15개 항목의 노인우울척도(15-item Geriatric Depression Scale, GDS)는 노인 환자의 우울증을 선별하는 평가 도구로 널리 인정받고 있으나 외래에서 일상적으로 사용하기에는 충분한 시간을 필요로 한다. 이에 15-item GDS에서 4개 내지 5개 항목을 뽑은 GDS 단축형의 임상적 유용성을 비교하고자 하였다.

방법 : 1999년 10월부터 2004년 6월까지 서울 및 충청지역 2개 대학병원의 노인병 클리닉을 내원하였거나 입원하였던 102명의 65세 이상 환자를 대상으로 인구통계학적 특성 및 건강 행태에 관한 사항, 15-item GDS, MMSE-K, 일상생활 수행능력 등을 조사하였다. 15-item GDS에서 뽑은 세 개의 평가 척도, 즉 D'Ath GDS-4, Van Marwijk GDS-4, 그리고 Hoyl GDS-5를 15-item GDS와 비교하였다. 민감도, 특이도, 양성예측도와 ROC curve 아래의 영역(AUC) 등을 계산하였다.

결과 : 15-item GDS의 평균점수는 7.4±3.3점이었으며 우울증을 의심할 수 있는 6점 이상은 71명(69.6%)이었다. Hoyl GDS를 이용하였을 때에 민감도와 특이도가 각각 87.3%, 80.6%이었으며 양성예측도는 91.1%로 세 개의 평가 척도 중 가장 타당도가 높았다. AUC를 비교해 보면 Hoyl GDS가 0.84, Van Marwijk GDS가 0.76, D'Ath GDS가 0.66으로 Hoyl GDS가 가장 높았다.

결론 : 세 개의 단축형 노인우울척도, 즉 D'Ath GDS-4, Van Marwijk GDS-4, 그리고 Hoyl GDS-5 중 가장 타당도 높은 조합은 Hoyl GDS-5이었다. 또한 우울증 선별검사로 GDS-5/15이 유용할 수 있겠다.
중심 단어: 우울증, 노인우울척도, 노인, 선별검사
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