Does the Geriatric Depression Scale (GDS) Distinguish Between Older Adults With High Versus Low Levels of Suicidal Ideation?

Abstract

Objective The Geriatric Depression Scale (GDS) is a common screening measure for late-life depression, but it does not directly assess thoughts of death or suicide. The present study asked whether 30-item (GDS) and 15-item (GDS–SF) GDS scales differentiate older adults with high versus low levels of suicidal ideation. Methods This cross-sectional study included a sample of 105 adults age 65 or older recruited from medical and psychiatric inpatient and outpatient practices, nursing and retirement residences, and community-based seniors' programs. Results GDS scores were associated positively with self-report and clinician-administered measures of suicidal ideation. Fifteen of 30 GDS items and 7 of 15 GDS–SF items distinguished groups high or low in self-reported suicidal ideation. Receiver Operating Characteristic curve analyses indicated criterion validity for the GDS measures with respect to suicidal ideation at cut-off scores of 12 for the GDS and 6 for the GDS–SF. Five internally consistent GDS items were identified that were highly associated with suicidal ideation, assessing hopelessness, worthlessness, emptiness, an absence of happiness, and absence of the perception that it is “wonderful to be alive.” Conclusion Long and short forms of the GDS may be used to screen older patients at risk for suicide. Clinicians using the GDS for this purpose are advised to further assess suicide risk with measures designed specifically to assess presence and severity of suicidal ideation. The Geriatric Depression Scale (GDS) is a common screening measure for late-life depression, but it does not directly assess thoughts of death or suicide. The present study asked whether 30-item (GDS) and 15-item (GDS–SF) GDS scales differentiate older adults with high versus low levels of suicidal ideation. This cross-sectional study included a sample of 105 adults age 65 or older recruited from medical and psychiatric inpatient and outpatient practices, nursing and retirement residences, and community-based seniors' programs. GDS scores were associated positively with self-report and clinician-administered measures of suicidal ideation. Fifteen of 30 GDS items and 7 of 15 GDS–SF items distinguished groups high or low in self-reported suicidal ideation. Receiver Operating Characteristic curve analyses indicated criterion validity for the GDS measures with respect to suicidal ideation at cut-off scores of 12 for the GDS and 6 for the GDS–SF. Five internally consistent GDS items were identified that were highly associated with suicidal ideation, assessing hopelessness, worthlessness, emptiness, an absence of happiness, and absence of the perception that it is “wonderful to be alive.” Long and short forms of the GDS may be used to screen older patients at risk for suicide. Clinicians using the GDS for this purpose are advised to further assess suicide risk with measures designed specifically to assess presence and severity of suicidal ideation.