JAGS 51:694–698, 2003 © 2003 by the American Geriatrics Society 0002-8614/03/$15.00 Validation of the Five-Item Geriatric Depression Scale in Elderly Subjects in Three Different Settings Patrizia Rinaldi, MD, Patrizia Mecocci, MD, PhD, Claudia Benedetti, MD, Sara Ercolani, MD, Mario Bregnocchi, MD, Giuseppe Menculini, MD, Marco Catani, MD, Umberto Senin, MD, and Antonio Cherubini, MD, PhD OBJECTIVES: To test the effectiveness of a five-item version of the Geriatric Depression Scale (GDS) for the screening of depression in community-dwelling older subjects, hospitalized older patients, and nursing home residents. DESIGN: A cross-sectional study. SETTING: A geriatric acute care ward, a geriatric outpa- tient clinic, and a nursing home. PARTICIPANTS: One hundred eighty-one cognitively in- tact older subjects. MEASUREMENT: All the participants had a comprehen- sive geriatric assessment including a neuropsychological evaluation by a geriatrician experienced in the manage- ment of depression. The five-item GDS was compared with the 15-item version of the GDS using the clinical di- agnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as the crite- rion standard. The sensitivity, the specificity, the overall accuracy, positive and negative predictive values, and pos- itive and negative likelihood ratios were calculated. The agreement between each of two different versions of the GDS and the clinical diagnosis and the test-retest and the interrater reliability of the five-item scale were also evaluated. RESULTS: In the whole sample, 48.1% of the subjects were depressed. The five-item GDS had a sensitivity of 0.94 (0.91–0.98), a specificity of 0.81 (0.75–0.87), a posi- tive predictive value of 0.81 (0.75–0.87), a negative pre- dictive value of 0.94 (0.90–0.97), a positive likelihood ra- tio of 4.92 (4.39–5.5), and a negative likelihood ratio of 0.07 (0.06–0.08). The five-item GDS and the 15-item GDS showed a significant agreement with the clinical diagnosis of depression ( = 0.74 for both scales). The five-item GDS had good interrater reliability ( = 0.88) and test- retest reliability ( = 0.84). Similar values were obtained in each setting and in both sexes. CONCLUSION: The five-item GDS is as effective as the 15-item GDS for the screening of depression in cognitively intact older subjects. J Am Geriatr Soc 51:694–698, 2003. Key words: depression; Geriatric Depression Scale; elderly; effectiveness epression is a major public health problem in the elderly population. The prevalence of depressive disorders var- ies depending on the setting, being highest in hospitalized sub- jects and nursing home residents. 1 Of community-dwelling el- derly subjects, 1% to 3% suffer from major depression, rising to 10% to 15% in hospitalized elderly patients and nurs- ing home residents. 2,3 In each setting, depressive symptoms are two to four times more prevalent than major depres- sive disorder. Depression is associated with a higher preva- lence and risk of disability 4–6 and is projected to become the second-leading cause of disability by 2020. 7 Moreover, the outcome of several diseases, such as cardiovascular diseases, stroke, and Parkinson’s disease, is worse when they are associated with depression. 8 Finally, depression is associated with increased use of medical services. 9 Al- though depression is a common and burdensome mental disorder in the elderly, fewer than 50% of older depressed subjects receive a correct diagnosis, and even fewer are ad- equately treated. 1,10 Therefore, screening for depressive symptoms should always be part of comprehensive geriat- ric assessment. 11 Several screening questionnaires for de- pression have been developed. Among them are the Beck Depression Inventory for Primary Care (BDI-PC), 12 the Zung Self Rated Rating Scale, 13 the Center for Epidemio- logical Studies Depression Scale (CES-D) 14 and the Geriat- ric Depression Scale (GDS). The original version of GDS had 30 different items. 15 A 15-item form has been vali- dated and is now widely used, 16 but even the short form of the GDS takes some minutes to be completed, and it is often not well received by elderly patients. Recently Hoyl From the Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy. Address correspondence to Antonio Cherubini, MD, PhD, Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Via Eugubina 42, 06122, Perugia, Italy. E-mail: cherubin_9@yahoo.com; acherub@unipg.it D