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Auditing Depression in the elderly population using GDS-15 in a

General Practice Clinic in Hong Kong长者抑郁症 -

于普通科诊所使用 GDS-15问卷

Dr. CHOI KinHonorary Clinical Associate Professor

Department of Community & Family Medicine, Chinese University of Hong Kong

蔡坚医生 香港中文大学社区及家庭医学系名誉临床副教授

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Geriatric population in Hong Kong香港的长者人口

1996: 10.2% population >65

一九九六年： 10.2% 人口超过六十五岁

2001: 11.2% population >65

二零零一年： 11.2% 人口超过六十五岁

2031: 24% population >65

二零三一年： 24% 人口超过六十五岁

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Depression in the elderly – Size of the problem in USA长者抑郁症问题–于美国的严重性

Depression affects 5 million out of 31 million Americans aged over 65.

在三千一百万 65 岁以上的美国人当中，有五百万人受抑郁症影响

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13% of community dwelling older adults suffers from major or minor depression

13% 于社区居住的长者受不同程度的抑郁症困扰

24% of older medical outpatients, 30% of older acute care patients, 43% of nursing home dwelling older adults suffers from depression

24% 的年长门诊病人， 30% 年长重症患者，及 43% 居于疗养院的长者受到抑郁症困扰

• Kurlowicz et al Try This: best practices in nursing care to older adults Issue no. 4 2007

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Depression –Size of the problem – world-wide抑郁症问题 – 对全球的严重性 The World Health Organization estimates that

depression will become the second most important cause of disability worldwide (after ischemic heart disease) by 2020.

世界卫生组织估计抑郁症将于二零二零年 ( 继缺血性心脏病 ) 成为全球第二个致残主因。

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World-wide prevalence of elderly depression长者抑郁症于全球的普及性

9 – 35%

Inner London 18% (1994)

内伦敦 ( 一九九四年 ): 18%

Rural Malaya 18% of elderly with chronic illness

马来亚偏远地区 : 18% 有长期病患的长者

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Rural China 26% over 65 screened positive中国偏远地区：在六十五岁以上人士当中， 26% 被评定为阳性

Hong Kong 1994 over 75 using GDS – 15, 29.2% for men and 41.1% for women are depressed (Woo et al)香港 ( 一九九四年 ) ：向七十五岁以上人士使用GDS-15 问卷调查， 29.2% 男性及 41.1% 女性有抑郁症 (Woo et al)

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The Prevalence of depressive symptoms in a regional geriatric day hospital 抑郁症征状于地区性长者日间医院的普遍性

Wong et Chao 2004

The prevalence of depressive symptoms in patients in the geriatric day hospital was as high as 37.8%. Depressive symptoms were more commonly found in female (45.3%) patients than in male (27.4%) patients. Depressive symptoms were common in patients with financial constraints.

长老人日间医院病人出现抑郁征状的普及程度为 37.8% 。抑郁征状较常出现于女病人 (45.3%) ，男病人有27.4% 。抑郁征状常见于有财政问题的病人身上。

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‘Despite the high epidemiological relevance of depressive disorder in daily clinical practice, they are insufficiently diagnosed’.‘纵使与日常临床运作有重大的疫学关连，抑郁问题没有得到足够的诊断’

Grulke N et al Wien Med Wochenschr 2005 July

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US Preventive Service Task Force

美国预防医学特别委员会 ‘Overall, screening and feedback reduced the risk for persistent depression’

‘ 总括来说，普查和响应减低持续抑郁的风险’

‘Compare with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow up. ’

‘跟一般的照顾比较，抑郁症普查可以改善结果，尤其当该普查能配合制度上的转变，以确保适当的治疗和跟进。’ Pignone et al Ann Inern Med. 2002 May 21

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Screening for Depression普查抑郁症 Lack of effective of antidepressants?

没有有效的抗抑郁药 ?

Potential harms of screening?

普查的潜在伤害 ?

Which screening instruments?

选用那一个普查工具 ?

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Impact on detection of depression?

侦查抑郁症的影响 ?

Borderline higher intervention rate amongst those who received feedback of screening instrument (Gilbody; Cochrane Database 2007)

对使用普查工具并收到响应的一群，有较高的介入率 (Gilbody; Cochrane Database 2007)

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Geriatric Depression Scale老人抑郁症量表 1/6 elderly treated in general medical practice

are depressed, prevalence higher in hospitals & nursing homes

六分之一在普通科诊所接受治疗的长者有抑郁病状，在医院及疗养院的情况更为普遍。

Elderly has highest suicide rate of any group

长者的自杀率为其它组别之首

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GDS was developed 1982 by J.A. Yesavitch老人忧郁量表由 J.A. Yesavitch 于一九八二年设计

Score affected by dementia受老年痴呆症影响

Score affected by less education受低教育程度影响

84% sensitive and 95% specific for a depression diagnosis对诊断抑郁症有 84% 灵敏度和 95% 特异度

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GDS –15 老人忧郁量表 – 简化版

Arthur, Jagger, Lindesay et al. Using an annual over-75 health check to screen for

depression: validation of the short Geriatric Depression Scale (GDS 15) within general practice.

以 75 岁以上人士的年度身体检普查抑郁症：验证于普通科诊所使用简化版老人忧郁量表的准确性。 Int’l Geriatric Psychiatry 1999 June

‘The 15 item GDS had perfect sensitivity but low specificity for detecting depression in elderly people’

只十五个项目的简化版老人忧郁量表对侦测老人抑郁有很高的灵敏度，但特异度较低。

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C-GDS-15中文老人抑郁量表 – 简化版

老人抑鬱量表：

1. 你基本上對自己的生活感到滿意嗎？ --------------------------------------------------------------------------------------------------- 是 / 否

2. 你是否已放棄了很多以往的活動和嗜好？---------------------------------------------------------------------------------------------- 是 / 否

3. 你是否覺得生活空虛？---------------------------------------------------------------------------------------------------------------------- 是 / 否

4. 你是否常常感到煩悶？---------------------------------------------------------------------------------------------------------------------- 是 / 否

5. 你是否很多時感到心情愉快呢？---------------------------------------------------------------------------------------------------------- 是 / 否

6. 你是否害怕將會有不好的事情發生在你身上呢？------------------------------------------------------------------------------------- 是 / 否

7. 你是否大部份時間感到快樂呢？---------------------------------------------------------------------------------------------------------- 是 / 否

8. 你是否常常感到無助？ (即是沒有人能幫助自己) ------------------------------------------------------------------------------------ 是 / 否

9. 你是否寧願晚上留在家裡，而不愛出外做些有新意的事情？ (譬如：和家人到一新開張酒樓吃晚飯) ------------------ 是 / 否

10.你是否覺得你比大多數人有多些記憶的問題？ --------------------------------------------------------------------------------------- 是 / 否

11.你認為現在活著是一件好事嗎？ --------------------------------------------------------------------------------------------------------- 是 / 否

12.你是否覺得自己現在一無是處呢？ ------------------------------------------------------------------------------------------------------ 是 / 否

13.你是否感到精力充沛？ --------------------------------------------------------------------------------------------------------------------- 是 / 否

14.你是否覺得自己的處境無望？ ------------------------------------------------------------------------------------------------------------ 是 / 否

15.你覺得大部份人的境況比自己好嗎？ --------------------------------------------------------------------------------------------------- 是 / 否

註： 有一分

總分_________ (八分或以上請轉介)

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AMT-10 Chinese version 简易记忆力测试 - 中文版

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Objective 目的 To audit records of patients over the age of 65 seen

from December 2003 to September 2007 in a general practice clinic in Wong Tai Sin, Kowloon, HongKong

核对在二零零三年十二月至二零零七年九月期间，在香港九龙黄大仙区一间普通科诊所求诊的六十五岁以上病人的病历

To study the prevalence rate of depressed elderly in that population and the associated demographic data

研究该区人口中抑郁长者的普遍情况，以及相关的人口资料

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Design 设计 1,495 elderly patients were seen from December

2003 to September 2007.

2003 年 12 月至 2007 年 9 月期间有 1,495 名长者求诊 All of them were administered the Chinese version of

GDS-15 items previously validated in Hong Kong.

全部求诊者都接受在香港得到验证的中文简化版老人忧郁量表的普查

All of them were given a structured psychiatric interview by a general physician with training in community psychiatry

全部求诊者都得到一个由接受过社区精神医学训练的普遍科医生进行的有系统精神科面谈

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Setting 背景 The clinic is a general clinic catered for general

patients

诊所是为一般病人而设的普通诊所 Patients are seen for undifferentiated problems such

as upper respiratory infections, gastroenteritis, hypertension, diabetes mellitus, chronic obstructive airway disease, skin ailments, emotional disorders, orthopedic problems and cancers

病人因一般没有分类的问题求诊，例如上呼吸道感染、肠胃炎、高血压、糖尿病、慢性阻塞性呼吸道疾病、皮肤疾病、情绪失调、骨科问题及癌症等

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Participants 参加者 From December 2003 onwards, all patients

over 65 are invited to answer the CGDS-15 and participate in a structured psychiatric interview by the doctor

由二零零三年十二日起，所有六十五岁以上求诊人士都被邀请回答简化版老人忧郁量表，并接受医生有系统的精神科面谈

All data are recorded

所有数据都被记录

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A total of 1,495 patients were studied

一千四百九十五位求诊者参与研究 31 patients were diagnosed to have dementia

and excluded from analysis

其中三十一位求诊者因被诊断出患有老人痴呆症，所以被括除于研究之外

25 patients were known to have depression and also excluded from analysis

二十五位求诊者因有抑郁症的记录，所以亦被惕除于研究之外

Participants 参加者

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Participants 参加者 4 patients were deaf and unable to participate in

the psychiatric interview

四个求诊者为失聪人士，故不能参与精神科面谈

11 patient records were incomplete and hence invalid

十一个求诊者的访问因记录不全而作废 1,424 records remained for analysis

余下的一千四百二十四个记录用作分析

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Participants 参加者 787 patients were between 65-75 year old

七百八十七名求诊者介乎六十五至七十五岁 632 patients were over 75

六百三十二名求诊者超过七十五岁 490 patients were male and 928 female

四百九十名求诊者为男性，九百二十八名是女性

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Participants 參加者 190 patients live alone while 1,231 live with

their families or in old age home 一百九十名求诊者独居，而一千二百三十一名

跟家人同住或于安老院居住 316 patients have no faith, while 1,102 believe

in one religion or another 三百一十六名求诊者并无宗教信仰，而一千一百

零二名有最少一个宗教信仰

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Patient demographic 求诊者统计 636 patients were single, divorced or

widowed while 782 were married

六百三十六个求诊者为单身，离婚人士或寡妇(鳏夫 ) ，而七百八十二人为已婚人士

1,297 patients were financially independent of government while 120 were on public subsidy

一千二百九十七个求诊者财政独立于政府，而一百二十人倚靠公共援助

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Measurements 量度 136/1,424 (9.6%) of patients interviewed were

diagnosed with major depression

于一千四百二十四名接受访问的求诊者中，一百三十六名 (9.6%) 被诊断出患有抑郁症

36/489 (7.4%) male were diagnosed with major depression and 99/927(10.7%) female were depressed

四百八十九个男性中有三十六个 (7.4%) 被诊断出有患抑郁症，九百二十七个女性中有九十九个(10.7%) 有抑郁的情况

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Measurements 量度 Of the group between age 65-75, 78/787 (9.9%) were

depressed while for >75, 58/632 (9.2%) were depressed

在六十五至七十五岁的组别里，七百八十七名求诊者中有七十八人 (9.9%) 有抑郁情况 ; 而于七十五岁以上组别里，六百三十二个求诊者中有五十八人 (9.2%) 有抑郁情况

Of those living alone 19/190 (10%) were depressed while for those living with family or in homes, 117/1,231 (9.5%) were depressed

一百九十名独居人士中，十九人 (10%) 有抑郁情况 ; 而一千二百三十一名跟家人同住的求诊者中， 一百一十七人 (9.5%) 有抑郁情况

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Measurements 量度 For those receiving public assistance, 16/120

(13.3%) were depressed, while those dependent on themselves or on their children, 120/1297 (9.3%) were depressed

对于正在接受公共援助的一百二十名收访者， 十六人 (13.3%) 有抑郁情况 ; 而财政独立或倚靠子女的一千二百九十七人中，则有一百二十人 (9.3%) 有抑郁情况

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Measurements 量度 For those with chronic illnesses (487) like

coronary heart disease, blindness, stroke, cancer, cirrhosis etc., 78 (16%) were diagnosed with major depression while others without such chronic illness only 58/935 (6.2%) had major depression

有慢性疾病如冠心病、失明、中风、癌症、肝硬化等的四百八十七名受访者中，七十八人 (16%) 被诊断出患有抑郁症 ; 而没有慢性疾病的九百三十五人中则只有五十八人 (6.2%) 患有抑郁症

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CGDS-15 and major depression中文简化版老人忧郁量表 与 抑郁症 The following results compared CGDS-15

with the gold standard of a structured diagnostic interview.

以下结果比较了中文简化版老人忧郁量表 以及有系统诊断面谈

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GDS Mark vs MDD

0

10

20

30

40

50

60

70

80

90

100

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0GDS Mark

%non-MDD

MDD

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Summary 概要 Screening for depression in primary care may

facilitate early diagnosis and management of a debilitating illness in the community

在基层医疗系统中进行抑郁症普查，有助及早诊断及治疗社会上引致自理能力减退的病症。

Depression is more common in the elderly female, the poor, the single person, those without religious belief and those with major chronic illness

抑郁症最为常见于女性长者、贫穷、单身、没有宗教信仰，以及长期病患者的身上。

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Summary 概要 Depression is so common that 300

psychiatrists in Hong Kong cannot provide enough manpower to screen for this condition and screening should be delegated to primary care doctors.抑郁症十分普遍，三百名精神科专科医生没有足够的人手去普查这个病症，所以普查的工作应该由基层医生进行。

GDS-15 can be a useful screening tool for depression in primary care for chinese patients在基层医疗层面，将 GDS-15 应用于华裔病人，是一项有效的抑郁症普查工具。

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多谢！ Thank you!