Objective:

To compare the Elderly Symptom Assessment Scale (ESAS) to the 15-Item Geriatric Depression Scale (GDS-15) in measuring depressive symptoms.

Design:

Cross sectional study of a random sample of elderly outpatients. 

Materials and Methods:

147 cognitively intact elderly (age ³ 65) outpatients at a VA Medical Center were simultaneously administered the Elderly Symptom Assessment Scale (ESAS) and the 15-item Geriatric Depression Scale (GDS-15). These patients were part of an ongoing trial aimed at improving geriatric prescribing practices in primary care.

The ESAS is a recently developed self-administered scale for assessment of common symptoms in the elderly.  Each symptom is scored as present or absent then rated on a 5-point scale for severity if present. The 9 depression-related items (sadness, anxiety, irritability, restlessness, concentration, memory, fatigue, sleep, appetite) were analyzed as a depression subscale. The results are reported as a symptom count (range 0-9) and a total depressive score (range 0-45) based on severity.

Findings from the ESAS were then correlated with the GDS-15.  A score of ³ 5 was used for defining depression, which has been shown to have a sensitivity approximating 90% and specificity of 70% in elderly outpatient populations. Frequency of symptom reporting on the ESAS was also assessed.

Results:

The subjects were all Caucasian and predominantly male (96%).  31 (21%) patients scored 5 or greater on the GDS-15. Overall correlations between the ESAS depressive subscale and the GDS-15 were high for both the number of symptoms endorsed (r=0.641) and total depressive score (r=0.648). The mean (SD) number of ESAS symptoms in the depressed group was 5.7 (2.5) versus 3.0 (2.5) for the non-depressed; total depressive score was 17.4 (9.2) versus 7.8 (6.9), respectively (p<0.001).

Of the 116 subjects classified as non-depressed by the GDS-15, 19 subjects reported 6 or more depressive symptoms on the ESAS. Overall symptom reporting was high among these patients as illustrated in Table 1.  

Table 1: Positive Symptom Response on the ESAS Depression Subscale

Patient Group	n	Sadness*	Anxiety*	Irritability*	Restless-ness*	Concen-tration*	Memory*	Fatigue*	Sleep*	Appetite*
Non-depressed ( ³ 6 ESAS symptoms)	19	89%	100%	90%	100%	74%	84%	95%	89%	42%
Non-depressed (< 6 ESAS symptoms)	97	11%	20%	14%	21%	18%	43%	63%	40%	9%

*p<0.01

Conclusion:

The depressive symptom subscale of the ESAS correlated highly with the GDS-15. Depressed patients scored higher than non-depressed. The pattern of symptoms among subjects classified as non-depressed by the GDS suggests that the ESAS depressive subscale identifies a group of patients with significant depressive symptoms, which may represent minor depression or anxiety disorders. Since multi-symptom scales are not explicitly focused on depression they may avoid systematic underreporting of symptoms by elderly patients who don’t see themselves as depressed. The utility of multi-symptom questionnaires like the ESAS in screening for depression in primary care warrants further investigation.