Screening for Depressive Illness and Related

• Topics in Outcome Assessment by Ellen A. Dornelas, Ph.D., 9/24/96
  • Looking for screening tools by Steven Locke, MD, 10/16/96
    
    

I have had experience in selecting depressive illness scales in the late seventies. I implemented and supervised a community based program for the assessment of depressive illness among the community elderly. At that time I reviewed several scales including the Beck and the Wakefield (now the Hamilton). At that time (1977) we selected the Wakefield for its ease of adminstration. Since we were administering this scale in the community (random/door to door) I was concerned over several of the more intrusive questions on the Wakefield. I was able to contact Max Hamilton at Wakefield Hospital and discussed my concerns with him. My major concern was the minimal capacity for follow up that my project had relative to providing services. At thattime I identified two items of concern,one regarding harming oneself and one regarding suicide attempts. We modified these two items at that time. A word of caution, if you are screening a population please make sure the instrument you select does not have the potential of eliciting a response that you do not have the capacity to address within your research project. Its been a long time since I have done research but here are some of the results (appoximate) that I can recall from that project. We interviewed 774 community residing elderly individuals (over 60 yo). Of this group 35.5% exhibited symptoms of depressive illness (mild - severe) as defined by the modified Wakefield Scale (Hamilton). The vast majority of those depressed were in the mild range (approx. 75%). Most of this depression was identified as exogenous and related to such factors as: medical problems,socio-economics, enviorment, family contact(lack). About 20% fell in the moderate range of depression. About 5% fell into the severe level of depression based on the scale. Of those approximately 25% that fell into the moderate + range there was a mix of exogenous and endogenous variables. It appears, as I recall, that sustained exogenous variables that wer compounded with other variables that were concommitments of the aging process tended to slowly progress the depression toward the endogenous. Once becomming incorporated into the perceptual field of the individual (overlay) the depression tended to develop a mind of its own. The mechanics of this movement from exogenous toward endogenous would be a good area for study. I applied for a continuation grant to NIA and NIMH to no avail. The goals of this study would have been to study this process (exogenous-endogenous) and to develop intervention techniques. I hope these ramblings have helped you in your selection process and how you develop your research technique.

• Thanks for the response by Steven Locke, MD, 10/21/96