Development and Validation of a Short Version of the Cornell Scale for Depression in Dementia for Screening Residents in Nursing Homes

Yun-Hee Jeon; Zhixin Liu; Zhicheng Li; Lee-Fay Low; Lynn Chenoweth; Daniel O'Connor; Elizabeth Beattie; Tanya E Davison; Henry Brodaty

doi:10.1016/j.jagp.2016.05.012

Development and Validation of a Short Version of the Cornell Scale for Depression in Dementia for Screening Residents in Nursing Homes

Am J Geriatr Psychiatry. 2016 Nov;24(11):1007-1016. doi: 10.1016/j.jagp.2016.05.012. Epub 2016 May 20.

Authors

Yun-Hee Jeon¹, Zhixin Liu², Zhicheng Li³, Lee-Fay Low⁴, Lynn Chenoweth⁵, Daniel O'Connor⁶, Elizabeth Beattie⁷, Tanya E Davison⁶, Henry Brodaty²

Affiliations

¹ Sydney Nursing School, University of Sydney, Australia. Electronic address: yun-hee.jeon@sydney.edu.au.
² Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing, University of New South Wales, Australia.
³ Sydney Nursing School, University of Sydney, Australia.
⁴ Faculty of Health Sciences, University of Sydney, Australia.
⁵ Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing, University of New South Wales, Australia; Faculty of Health, University of Technology, Sydney, Australia.
⁶ Department of Psychiatry, Southern Clinical School, Monash University, Melbourne, Australia.
⁷ Faculty of Health, School of Nursing, Queensland University of Technology, Australia.

PMID: 27538349
DOI: 10.1016/j.jagp.2016.05.012

Abstract

Objectives: To develop and validate a short version of the Cornell Scale for Depression in Dementia (CSDD-19) for routine detection of depression in nursing homes.

Setting: Australian nursing homes.

Methods: A series of cross-sectional studies were conducted involving: 1) descriptive analysis of pooled data from five nursing home studies that used the CSDD-19 (N = 671) to identify patterns of responses and missing data on individual CSDD items; 2) analysis of four of the five studies (N = 556) to assess CSDD-19 for unidimensionality, item fit, and differential item functioning using Rasch modeling to develop a shorter version, the CSDD-4; 3) validation of the CSDD-4 against the DSM-IV using the fifth study of 115 residents and through expert consultations; and 4) evaluation of the clinical utility of CSDD-4 using an independent cohort of 92 nursing home residents.

Results: Four items from the original CSDD-19 were found to be most suitable for depression screening: anxiety, sadness, lack of reactivity to pleasant events, and irritability. The CSDD-4 highly correlated with the original scale (N = 474, r = 0.831, p < 0.001), with acceptable internal consistency (Cronbach's alpha = 0.70). At the cutoff score of less than 2, sensitivity and specificity of CSDD-4 were 81% and 51%, respectively, for the independent cohort (N = 92), of whom 50% had dementia. The CSDD-4 had an area under the curve (AUC) of 0.73 (z = 3.47, p < 0.001), which was compatible with the CSDD-19 (AUC = 0.69, z = 2.89, p < 0.01).

Conclusions: The CSDD-4 is valid for routine screening of depression in nursing homes. Its adoption is feasible and practical for nursing home staff, and may facilitate more comprehensive assessment and management of depression in nursing home residents.

Keywords: Cornell Scale for Depression in Dementia; depression; nursing homes; screening.

Publication types

Validation Study

MeSH terms

Aged
Aged, 80 and over
Australia
Cross-Sectional Studies
Dementia / psychology*
Depression / diagnosis*
Depression / psychology
Depressive Disorder / diagnosis*
Depressive Disorder / psychology
Female
Humans
Male
Mass Screening
Nursing Homes*
Sensitivity and Specificity