Development of a Nomogram for Predicting Depression in the Elderly Using Patient Health Questionnaire-9 among a Nationwide Sample of Korean Elderly

Abstract

This cross-sectional study developed a nomogram that could allow medical professionals in the primary care setting to easily and visually confirm high-risk groups of depression. This study analyzed 4011 elderly people (≥60 years old) who completed a health survey, blood pressure, physical measurement, blood test, and a standardized depression screening test. A major depressive disorder was measured using the Korean version of the Patient Health Questionnaire (PHQ-9). This study built a model for predicting major depressive disorders using logistic regression analysis to understand the relationship of each variable with major depressive disorders. In the result, the prevalence of depression measured by PHQ-9 was 6.8%. The results of multiple logistic regression analysis revealed that the major depressive disorder of the elderly living alone was significantly (p < 0.05) related to monthly mean household income, the mean frequency of having breakfast per week for the past year, moderate-intensity physical activity, subjective level of stress awareness, and subjective health status. The results of this study implied that it would be necessary to continuously monitor these complex risk factors such as household income, skipping breakfast, moderate-intensity physical activity, subjective stress, and subjective health status to prevent depression among older adults living in the community.

Keywords: depression; epidemiological survey; high-risk group; multiple risk factors; nomogram; patient health questionnaire.

Figure 1

The nomogram for predicting depression in older adults in the community based on multiple risk factors.

Figure 2

Application Example of Depression Prediction Nomogram for Older adults Living Alone: older adults who responded that mean monthly household income was less than KRW 1.5 million, mean frequency of having breakfast per week for the past year was 5–7 times a week, did not do moderate-intensity physical activity, and hardly felt stressed.

Figure 3

The AUC of the developed nomogram for predicting depression in older adults.AUC:the area under the curve.

Figure 4

Calibration plot for test data: X-axis represents the predicted probability of major depressive disorder; Y-axis represents the actual major depressive disorder. An ideal (perfectly accurate) nomogram model would result in a plot in which the observed and predicted probabilities for given groups fall along the 45-degree line.