Letters to the Editor ____^_ Ir J Psych Med 2002; 19(4): 132-133 The Geriatric Depression Scale: feasibility of cardbased-administration Editor - Depression is common in the elderly, and is an important cause of morbidity. Routine screening in healthcare settings may aid in detection. 1 It can affect cognitive status, well being, recovery from illness and compliance with medications. The Geriatric Depression Scale (GDS) is an effective questionnaire, which was originally designed to be self- administered.* 3 This, however, can be difficult in the elderly. 4 Previously the use of laminated cards to administer another depression scale, the BASDEC, was shown to be reliable. 5 The aim of our study was to determine if card-based administration of this scale correlated with verbal administration. We asked 42 patients attending the Age Related Health- care Day Hospital to take part in our study. The inclusion criteria were aged over 65 years, MMSE of 16/30 or more, and English speaking. We excluded those who had dyspha- sia, dyslexia, illiteracy or visual impairment such that they could not read large print. A history of depression did not affect selection. The patients were randomised, using a standard random sequence, as to whether they underwent verbal or card- based administration of the GDS first. An MMSE was performed. The GDS was then administered to each patient, by two interviewers in succession, both verbally and using cards. All those with a score of >11 were followed up in rela- tion to treatment of depression. Three people were excluded from the study. Two could not read the large print and one patient could not complete the interview due to fatigue. Using a paired t test (p = 0.13), there was no significant difference between card-based and verbal administration of the GDS. Both methods of adminis- tration correlated well (r = 0.84). Equity and the multidisciplinary team: four developments for clinical psychology Editor - Psychiatry has traditionally dominated mental health services in the Republic of Ireland. Most commentators will agree that this has led to an over-reliance on pharmaco-ther- apy in this field. This approach has sustained continuing criticism over time because of its biological reductionist tendencies. The force of the movement calling for a more holistic approach to mental health has developed so strongly over time that the very term 'medical model' has become a term of abuse in many circles. However although psychiatry We found that a card-based GDS correlates well with a verbally administered GDS, and could be used in a similar manner to the BASDEC scale. The use of a card based depression scale allows for administration in a general hospital ward without the ques- tions and answers being overheard. It may allow for a degree of standardisation and can also be conveniently carried in a white coat pocket. However, the assessors in this study all reported feeling constrained by use of the card based tech- nique. It was felt that older people were unable to express their exact feelings about each of the questions, leading to frustration on their part. Perhaps rather than muting the questions, we should more seriously consider that when sensitive questions are being asked, both cognitive and affective, an interview should not take place at the bedside, but rather in a separate interview room. Future studies might explore older peoples' preference for the mode of administration of screening questionnaires. Linda Brewer, MB, Roisin Connolly, MB, Danny Smith, MB, interns, Desmond O'Neill, MD Associate Professor, Department of Gerontology, Trinity College Dublin, Dublin 2, Ireland. This letter was published in the September issue without the full list of authors included. References 1. Bums A, Lawlor B, Craig S: Rating scales in old age psychiatry. BJ Psych 2002; 180:161-167 2. Koenig GH, Meador KG, Cohen HI, Blazer DG: Self-rated depression scales and screening for major depression in the older hospitalised patient with medical illness. JAGS 1998; 36: 699-706 3.0'Riordan T, Hayes J, O'Neill D, Walsh JB, Coakley D. The effect of mild to moderate dementia on the Geriatric Depression Scale and on the General Health Questionnaire in the hospitalised elderly. Mt J Geriatr Psychiatr 1990; 4:17-21 4. O'Neill D, Rice I, Blake P, Walsh JB, Coakley D. The Geriatric Depression Scale: rater administered or self administered? Int J Geriatr PsychiatM 992; 7:511-515 5. Adshead F, Cody DD, Pitt B. BASDEC: a novel screening instrument for depression in elderly medical inpatients. BMJ 1992; 305: 397. appears unable to reform itself, contemporary developments in Ireland, outside of psychiatry, appear to be forcing a more equitable and holistic mental health service. The main force of this reforming impetus is coming from clinical psychology. Four significant developments have occurred in the last few years that have in effect challenged the hegemony of psychi- atry and 'prescription pad therapy'. The first of these relates to the upgrading of clinical psychology courses from post- graduate diploma and masters level to doctorate status. These developments have included a lengthening of the dura- tion of some courses, as well as an increased research component. Such moves follow a trend in the UK, and all three clinical psychology courses on the island of Ireland (Queen's, TCD and UCD) have been of doctorate status for some years now. Two of the other three developments are related to pay 132