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Arabic version geriatric depressive scale-15 for Iraqi elderldwellers in Al-Najaf

city: Validity and reliability

Article in Indian Journal of Public Health Research and Development · August 2018
DOI: 10.5958/0976-5506.2018.00894.X

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Arabic version Geriatric Depressive Scale -15 For Iraqi Elderly
Dwellers in Al-Najaf City: Validity and Reliability

Ashwan Abulzahra Hashim

Lecturer Psychiatrist at Medical Collage, University of Kufa, Head of Department of Psychiatry\
Al-Hakeem General Hospital, Iraq

ABSTRACT

The Geriatric Depression Scale (GDS-15) is regarded as the most widely used screening tools and easy
to administer. The Geriatric Depressive Scale -15 short version was translated to the Arabic language by
a researcher and was assessed by psychiatric specialists, then retranslated to the English language by an
English language specialist, and after acceptance of the last form, and elderly was selected (samples size
was (n=279) elderly persons (138 male and 141 female) form hospitals and general community setting,
each elderly was assessed by using GDS-15 and then assessed by using the ICD-10 criteria for major
depressive episode to detect presence or absence of depression. The average age of study group were (71.84)
years, diagnosis of major depression according to Arabic GDS-15 short version for Iraqi elderly (44.4%
for positive and 55.6 for negative) and according to ICD-10 criteria for depression (38% for positive and
62% for negative). Also, the study found that Arabic GDS-15 for Iraqi elderly had high specificity and
sensitivity and interrater reliability (k= 0.72). This type of Arabic version GDS-15 is valid and reliable in the
assessment of depression among Iraqi elderly dwellers in Alnajaf city for different marital status, educational
levels, residencies, and occupations.

Keywords: Elderly, depression, Arabic, Iraqi, GDS-15, validity, reliability.

INTRODUCTION person not adherent to health centers or medication when

he/she had chronic physical illnesses, which increase the
Iraqi elderly was suffer from may stressful events suffering of the patient and the caregiver 1-4. Depression
like wars, terrorism, and as we now that the rate of is more common in elderly, with a prevalence about 10%
depression was higher in elderly than in other age in 65 years age and older, and up to 30% in inpatient that
groups, so it is important to assess presence or absence had at least a mild form of depression 2,5, it reaches up to
of this serious disorder to prevent its consequences and 15-30% in elderly that found in community residents and
prevent or decrease disability and prevent premature nursing home patients 1,5 ; where old person was more
mortality. In late life of any person; one of the most prone to be exposed to frequent stressful events, losses,
common psychiatric disorders is depression, where it is bereavement, decrease support, isolation, physical
important subject in all age groups (especially elderly), disability, medical conditions and medications 1,6. As
its effect appears in several aspects of elder life; as a well as poverty increase in a patient with mental illness
part of depressive symptoms like disturbance of sleep with increase age was reported 1, 7-9, which heighten the
and appetite, self-neglect, wishes and attempt to die, level of suffering and may increase suicide. The high
psychomotor retardation. These symptoms make the rate of suicide was reported in elderly 1,10. Researchers
defined elderly as those persons that aged 60 or 65 years,
Corresponding author: this study depends on age 65 years and above as elderly
Ashwan Abulzahra Hashim. Lecturer Psychiatrist persons 1,2,11. The assessment of an elderly person for
at Medical Collage, University of Kufa, Head of depression usually had difficulty and challenge, due to
Department of Psychiatry\ Al-Hakeem General co-morbidities that usually occurs in such age group like
Hospital, Iraq. cognitive decline and dementia, or sensory impairment 12.
 Indian Journal of Public Health Research & Development, August 2018, Vol. 9, No. 8 1203

Hence, it is crucial to recognize this problem, assessment study, having a hearing impairment, using antidepressant
of severity, and treatment, to prevent its consequences and/or mood stabilizer medication, with a recent CVA in
to prevent or decrease disability and prevent premature the last month, and suffering from psychotic or manic
mortality. Although many screening tools were used to symptoms. All those elderly are excluded at beginning of
identify depression in elderly, the Geriatric Depression this study. Data of all patients were entered and analyzed
Scale (GDS) is regarded as the most widely used. The by using SPSS version 24 software for windows; where,
GDS was a depressive scale in 30-items or questions sensitivity, specificity, accuracy, the predictive value of
with (yes/no) answer in its original form 13, also found positive, the predictive value of negative, the percentage
in 15-items, 8-items and 4-items 14, GDS 15-items were of false positive, the percentage of false negative,
depended in this study. The aim of our study is to assess interrater reliability (Kappa), percent agreement, and
the effectiveness of Geriatric Depressive Scale-15 other calculations were evaluated.
Arabic version in the detection of depressive disorder in
Iraqi elderly.
RESULTS AND DISCUSSION

The average age of study group was (71.84) years

MATERIALS AND METHOD
ranges from 65 to 83 years. Where the average age for
It is a cross sectional study that conducted on Jun male and female are (72.8) and (70.8) years respectively.
2016 through Dec 2016 in Iraq Annajaf Al-Ashraf city However, the elderly in study samples were high in
center, The Geriatric Depressive Scale -15 short version the age group 65-69 years (38%). female and male
13
was translated to Arabic language by a researcher and samples were approximately equal (49.5% for male
was assessed by psychiatric specialists, where they gave and 50.5% for female), while 57.7% of the samples
their notes and after correction of the scale language to were married. the percentage of samples that living in
be more understandable by the native Arabic language the rural area is 52% which is dominant. illiterate level
Iraqi persons, then retranslated to English language of samples education was more than other levels which
by an English language specialist and also reassesses are 28.3%. Most female were housewives, and most
by psychiatric specialist, and after acceptance, the last of the male were retired. Distribution of diagnosis of
form of the Arabic language of GDS-15 short version major depression according to Arabic GDS-15 short
was adopted to be assessed in comparison with ICD-10 version for Iraqi elderly (44.4% for positive and 55.6
criteria for major depressive episode as standard. The for negative) and according to ICD-10 criteria for
samples were selected (persons aged 65 years or above) depression (38% for positive and 62% for negative).
from both outpatient (in Al-Hakeem general hospital The difference percentage in (diagnosis or exclusion) of
and Al-Sader medical city) and community setting, the depression between Arabic GDS-15 for Iraqi elderly and
samples size was (n=279) elderly persons (138 male and ICD-10 criteria according to the distribution of variables
141 female). All selected subjects are provided a verbal was shown in Table 1. Also, the study found that Arabic
consent to participate in this study. Each elderly person GDS-15 for Iraqi elderly had high specificity and
was given Geriatric depression scale short version in a sensitivity and interrater reliability (k= 0.72) as shown
paper. The patient would read the scale by his own and in Table 2. By using appropriate statistical methods to
respond by indicating the statement which best describes measure validity and reliability of this study, the results
how he/she has been felt over the past weeks. For those showed that the Arabic version of GDS-15 which used
how can’t administer the test by their own either because in assessing depression has excellent characteristics as
they were illiterate or that they had a poor vision, the a screening scale for detection of depression in Iraqi
interviewer would read the scale on his paper, allowing elderly dwellers in Alnajaf city. Although, it’s necessary
the patient to respond by indicating the statement to use this assessment scale for conducting a national
which best describes how he/she has felt over the past epidemiological study for elderly in the whole Iraq from
weeks. Then each elderly person clinically interviewed north to south to cover all accents. Having an Arabic
by the investigator using the ICD-10 criteria for the version of GDS-15 for the elderly is a helpful instrument
major depressive episode to detect presence or absence in the assessment the presence of depression or treats
of depression. Elderly with cognitive impairment or it as a co-morbid condition. The validity of this study
dementia as assessed with the Mini-Mental Status showed a high sensitivity, specificity, accuracy, positive
Examination score ≤ 23, unwilling to participate in this and negative predictive values as (83.8%, 90.6%, 86%,
1204 Indian Journal of Public Health Research & Development, August 2018, Vol. 9, No. 8

93.5%, 77.4%) respectively, and this reveals that this elderly or using another slandered (which use DSM-IV
scale had a good validity and goes with finding of other criteria). However, it goes with the finding of the Greek
language versions like Iranian version (Seyed et. al 2006) version specificity 95.24 20. According to distribution
15
, Indian version ( Ewe, 2004) 16, Korean version (Jae of variables, the differences of diagnosis and exclusion
and Maeng, 2004) 17, German version (Bach et al. 1995) of depression between Arabic GDS-15 for Iraqi elderly
18
, and Arabic version that used to evaluate older adult in and ICD-10 criteria of Major depressive disorder, the
Lebanon (Monique et al. 2008) in cut/off point 5/6 (this study result show relative similarity and no significant
research study used different cut/off points for GDS- difference in effect of independent variables (sex, marital
15 starting from 3/4 and ending at 8/9, it differs from state, education level, residency and occupation) on the
this study in that this research study the cut/off point 6 effectiveness of scale assessment, While it dislikes the
and more and also differ in an accent that used) 19 also result shown by (Iranian version) where it found that
it differs in specificity (0.76) at 5/6 cut/off point, where level of education affect the result of scale 15. The socio-
its much lower than this study (90.6) and this may be economic state was not examined in this study and need
due to effect of sample size, different culture of assessed to be assessed.

Table 1. Depression status according to Arabic GDS-15 and ICD-10 criteria distributed by demographic
variables of the study subjects.

Variable Depression No depression

GDS ICD-10Q GDS ICD-10Q
No. % No. % No. % No. %
Age (year) 65 - 69 33 21.3 35 20.2 73 58.9 71 67.0
70 - 74 65 41.9 70 40.5 28 22.6 23 21.7
75 - 79 25 16.1 34 19.7 18 14.5 9 8.5
≥ 80 32 20.6 34 19.7 5 4.0 3 2.8
Sex Male 95 61.3 102 59.0 43 34.7 36 34.0
Female 60 38.7 71 41.0 81 65.3 70 66.0
Single 20 12.9 21 12.1 3 2.4 2 1.9
Marital status
Married 78 50.3 87 50.3 83 66.9 74 69.8
Divorced 23 14.8 27 15.6 6 4.8 2 1.9
Widow 34 21.9 38 22.0 32 25.8 28 26.4
Residency Urban 81 52.3 92 53.2 64 51.6 53 50.0
Suburban 43 27.7 46 26.6 37 29.8 34 32.1
Rural 31 20.0 35 20.2 23 18.5 19 17.9
Education Illiterate 28 18.1 31 17.9 51 41.1 48 45.3
Read and write 21 13.5 27 15.6 24 19.4 18 17.0
Primary 24 15.5 27 15.6 13 10.5 10 9.4
Secondary 37 23.9 36 20.8 11 8.9 12 11.3
Institute 25 16.1 27 15.6 14 11.3 12 11.3
College or higher 20 12.9 25 14.5 11 8.9 6 5.7
Occupation Unemployed 20 12.9 21 12.1 9 7.3 8 7.5
Housewife 35 22.6 40 23.1 72 58.1 67 63.2
Government
16 10.3 20 11.6 13 10.5 9 8.5
employee
Worker 8 5.2 8 4.6 1 0.8 1 0.9
Retired 60 38.7 65 37.6 23 18.5 18 17.0
Other 16 10.3 19 11.0 6 4.8 3 2.8
 Indian Journal of Public Health Research & Development, August 2018, Vol. 9, No. 8 1205

Table 2. Cross-tabulation and validity of Arabic GDS-15 and ICD-10 criteria

ICD-10 Q
Depression No depression
GDS
No. % No. %
Depression 145 (83.8) 10 (9.4)
No depression 28 (16.2) 96 (90.6)
Total 173 (100.0) 106 (100.0)
Measure of Agreement (Kappa) = 0.720
Percent agreement = 86.4%
measurement of Validity of GDS
Level 95%CI
Sensitivity 83.8% %89 - %77
Specificity 90.6% 83% - 95%
Accuracy 86% 82% - 90%
Predictive value of positive 93.5% 88% - 97%
Predictive value of Negative 77.4% 69% - 84%
Percentage of false positive 9.4% 5% - 17%
Percentage of false Negative 16.2% 11% - 23%

CONCLUSION OX2 6DP United Kingdom, chapter: 14, Old age

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