Improving the diagnostic accuracy of depression in older persons: the Depression in the Aged Female National Evaluation cluster randomized trial

Abstract

Objectives: To evaluate whether a training intervention can improve the ability of geriatricians to recognize depression in older persons.

Design: Multicenter, cluster randomized clinical trial.

Setting: Fourteen geriatric outpatient clinics in Italy, each representing the unit of randomization.

Participants: After training, a total of 1,914 outpatients aged 65 years and older in both arms, not on antidepressant at entry, were blindly evaluated by the clinic geriatrician, in charge of routine clinical management, and by a field researcher, who formally diagnosed depression by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), taken as the criterion standard.

Intervention: After randomization, geriatricians belonging to the intervention arm were assigned to receive a residential 3-day educational program on depression. Those in the control arm received a generic course on disease management in elderly people.

Measurements: Sensitivity and specificity of the diagnosis of depression made by geriatricians, compared with the DSM-IV diagnosis.

Results: Sensitivity and specificity were significantly higher in trained than in untrained geriatricians (49 vs 35% and 91 vs 88%, respectively; P=.002 in marginal regression models). Effectiveness of training was confirmed, adjusting for age, sex, and cognitive performance (P=.02).

Conclusion: The ability of geriatricians to diagnose depression in older outpatients can be improved with a specific training intervention. Improvement of diagnostic performance might translate into more-appropriate clinical management.