What is the Geriatric Depression Scale (GDS)?

The Geriatric Depression Scale (GDS)

The Geriatric Depression Scale (GDS) is a validated screening tool specifically designed for assessing depression in older adults, focusing on affective symptoms rather than somatic complaints, with the 15-item version (GDS-15) being the most widely used format that demonstrates excellent sensitivity and specificity for detecting depression in elderly populations. 1

Overview and Versions

The GDS was originally developed in 1982 as a 30-item questionnaire specifically designed for rating depression in elderly populations 2. It has since been adapted into several shorter versions:

• GDS-30: The original 30-item scale (score ≥19 indicates depression)
• GDS-15: The most commonly used short form (score ≥5 indicates depression)
• GDS-10: A 10-item version (score ≥4 indicates depression)
• GDS-4: A 4-item ultra-short version

Key Features and Advantages

• Elderly-Focused Design: Unlike general depression scales, the GDS was specifically created for older adults and avoids somatic symptoms that might be confounded with normal aging or medical conditions 1
• Simple Format: Uses a yes/no response format that is easier for older adults to complete compared to scales with more complex rating options 3
• Multiple Language Availability: Available in several languages, making it accessible for diverse populations 4
• Strong Psychometric Properties: The GDS has demonstrated excellent internal consistency and validity when compared with diagnostic criteria for depression 2

Diagnostic Accuracy

Meta-analysis data shows impressive diagnostic properties:

• GDS-15: Sensitivity of 86% and specificity of 79% with high diagnostic accuracy (AUC = 0.90) 5
• GDS-30: Sensitivity of 82% and specificity of 76% (AUC = 0.85) 5
• GDS-10: Sensitivity of 87% and specificity of 75% (AUC = 0.83) 5
• GDS-4: Sensitivity of 74% and specificity of 71% 5

Clinical Application

When to Use the GDS

• During initial evaluation of older adults, especially those with chronic medical conditions like diabetes 4
• When there is an unexplained decline in clinical status in elderly patients 4
• As part of routine screening for mental health conditions in primary care settings for older adults

Recommended Cut-off Points

• GDS-30: Score ≥19 indicates depression 1
• GDS-15: Score ≥5 indicates depression in elderly patients 1, 3

Implementation in Practice

1. Administer the GDS (preferably the 15-item version for efficiency)
2. Score the responses (1 point for each depressive response)
3. Interpret based on established cut-off scores
4. For scores indicating depression, follow up with comprehensive assessment

Important Considerations

• While originally designed for older adults, research suggests the GDS-15 also shows good diagnostic sensitivity and specificity for adults of all ages (AUC = 0.92 for adults aged 18-54) 6
• The GDS primarily measures trait depression (stable characteristics) rather than state depression (temporary mood), with research showing approximately 69% stable trait variance and only 9% state variance 7
• The U.S. Preventive Services Task Force notes that most depression screening instruments have good sensitivity (80-90%) but only fair specificity (70-85%) 4

Clinical Implications

• Positive GDS screens should prompt further evaluation, as screening alone without follow-up has not been shown to improve outcomes 4
• The American Geriatrics Society recommends that older adults who screen positive for depression should be treated or referred within 2 weeks of presentation, or sooner if the patient is at risk of self-harm 4
• Depression screening is particularly important in older adults with diabetes, who have higher rates of depression and poorer outcomes when depression goes unrecognized 4

The GDS remains one of the most valuable tools for identifying depression in older adults, with the 15-item version offering an optimal balance between brevity and diagnostic accuracy for clinical practice.