Poster from 2010 RCPsych meeting Edinburgh

1. International Congress of the
Royal College of Psychiatrists
21-24 June 2010, EICC, Edinburgh
Recognition of Late-Life Depression in Nursing and Residential homes
Settings by Nursing Staff – A Meta-analysis of Clinical Accuracy
Alex J Mitchell Consultant in Psychiatry, Department of Cancer & Molecular Medicine, University Hospitals Leicester (UK) ajm80@le.ac.uk
Venkatraghavan Kakkadasam LAS ST4 in General Adult Psychiatry, St Charles Mental Health Unit, Exmoor Street, London
vkakkadramaswamy@nhs.net
AIMS
To clarify the ability of nurses working in nursing and residential homes to identify late-life depression using their own clinical skills.
BACKGROUND REVIEW
There is great concern about the proportion of older people in nursing homes with depression that is overlooked (Psychiatric
Services 2009; 60:958–964
METHODS Meta-analysis of clinical accuracy against a continuum (severity scale) or categorically (semi-structured interview)..
RESULTS We located 11 studies involving staff of nursing or residential homes. The prevalence of depression in this setting was
28.8% (95% CI = 20.2% to 38.3%), not statistically different from comparative studies in hospital or primary care settings.
Staff nursing homes correctly identified 47.8% (95% CI = 40.4% to 55.2%) of people with depression and 79.4% (95% CI = 69.6% to
87.7%) of the non-depressed. This was comparable to GPs who have a sensitivity of 47.3% and specificity of 81.3% (Lancet. 2009
374(9690):609-19).
Using an area under the curve calculation, staff in nursing homes were somewhat less able to identify depression than those in
primary care. AUCpc = 0.7485 (0.726 to 0.770) vs AUCnurs = 0. 6370 (CI 0.613 to 0.661). This difference was explained by inferior
case-finding ability with no difference in screening.
Fig. Plot of Conditional Probability – Comparing Nursing Staff
1
Post-test Probability
0.9
0.8
0.7
0.6
0.5
Baseline Probability
0.4
NH Nurses+
0.3
NH Nurses-
0.2
0.1
Pre-test Probability
0
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
CONCLUSIONS Nursing home staff often failed to recognize depression. Home health nurses do not have regular access to
mental health expertise. Some studies have concluded that depressed residents are primarily referred for disruptive behaviours
and referrals for depression may be a secondary concern. For residents noted to display depressive symptoms, attributions that
depressive symptoms are an expected reaction to illness or placement may interfere with appropriate referral to the
consultation service. Problems in differentiating somatic symptoms of depression and physical illnesses may contribute to low
detection rates of depression. Staff in nursing and residential homes have considerable difficulty identifying late-life depression
and would probably benefit from simple screening strategies implemented locally.