Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-030The Development of the EURO-D ScaleMartin PrinceInstitute of Psychiatry, London, UKBACKGROUNDThe 11 country EURODEP consortium, assembled an unprecedentedbody of data; 14 population-based surveys of mentalhealth in late life, including 21 724 older Europeans aged 65 yearsand over. Most centres had used either GMS/AGECAT 1 or thevery similar SHORT-CARE 2 as their index of clinical case-leveldepression. However, three centres had used the Centre forEpidemiological Studies Depression scale (CES-D) 3 , one the ZungSelf-rating Depression Scale (ZSDS) 4 and one the ComprehensivePsychopathological Rating Scale (CPRS) 5 . Our challenge, therefore,was to derive from these instruments a common depressionsymptom scale, allowing risk factor profiles to be comparedbetween centres 6 .METHOD 6The instruments were scrutinized for common items. Algorithmsfor fitting items from other instruments to GMS were derived byeither: (a) empirical observation of the nature of the relationshipbetween items in different scales where they had been administeredtogether; or (b) expert opinion. The resulting 12-item scale(see Table 30.1) was checked in each centre for internalconsistency, criterion validity and uniformity of factor analyticprofile.RESULTS 6,7The EURO-D, however derived, is an internally consistent scale.Cronbach alphas for the 14 centres ranged from 0.58 to 0.80. Itseemed also to capture the essence of its parent instrument.Correlations with the CES-D in all four centres using thatmeasure exceeded 0.90, and the correlation with the Zung was0.84. A cut-point of 3/4 on the EURO-D scale predicted a GMS/AGECAT computerized diagnosis of depression with 70–80%sensitivity at 80–95% specificity. Principal components factoranalysis demonstrated that a very similar two-factor solutionseemed appropriate in all centres, however the scale had beenderived; depression, tearfulness and wishing to die loaded on thefirst factor (affective suffering) and loss of interest, poorconcentration and lack of enjoyment on the second (motivation).In general, EURO-D scores increased with age, women scoredhigher than men, and widowed and separated subjects higher thanothers. The gender effect was negligible among the never-marriedbut was not modified by age. In most centres EURO-D could bereduced into two well-characterized factors; affective suffering,responsible for the gender difference, and motivation, accountingfor the positive association with age.CONCLUSIONSLarge between-centre differences in depression symptoms asassessed by EURO-D were explained neither by demographynor by the depression measure used in the survey. Consistent,small effects of age, gender and marital status were observedacross Europe. Depression may be overdiagnosed in older personsTable 30.1 EURO-D Scale.The Geriatric Mental State (from which EURO-D is derived) is a semistructuredclinical interview. The following instructions apply:1. Each question should be asked as it is written. The sections inparentheses are additional prompts to clarify the question if it has notbeen understood.2. Sections in italic script provide the criteria by which the interviewerjudges from the response whether the symptom is present or absent.EURO-D itemCorresponding GMS question1. Depression Have you been sad (depressed, miserable inlow spirits, blue) recently?2. Pessimism How do you see your future?Pessimistic, empty expectations or bleakfuture3. Wishing death Have you ever felt that you would rather bedead?Has ever felt suicidal or wished to be dead4. Guilt Do you tend to blame yourself or feel guiltyabout anything?Obvious guilt or self blame5. Sleep Have you had trouble sleeping recently?Trouble with sleep or recent change in pattern6. Interest What is your interest in things?Less interest than is usual7. Irritability Have you been irritable recently?8. Appetite What has your appetite been like?Diminution in the desire for food9. Fatigue Have you had too little energy (to do thethings you want to do)?Listlessness or subjective energy restriction10. Concentration How is your concentration?Difficulty in concentrating on entertainmentor reading11. Enjoyment What have you enjoyed doing recently?Almost nothing enjoyed12. Tearfulness Have you cried at all?Principles and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd