Clinical Gerontologist

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9/Geriatric Depression Scale (GDS)

Jerome A. Yesavage MD & Javaid I. Sheikh MD

To cite this article: Jerome A. Yesavage MD & Javaid I. Sheikh MD (1986) 9/Geriatric Depression
Scale (GDS), Clinical Gerontologist, 5:1-2, 165-173, DOI: 10.1300/J018v05n01_09

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SIGERIATRIC DEPRESSION
SCALE (GDS)
Recent Evidence
and Development
of a Shorter Version
Javaid I. Sheikh, MD
Jerome A. Yesavage, MD

Editor's Introduction

Sheikh and Yesavage review the depression scale specif-

ically designed on, with, and for the aged. CG has had three
previous articles discuss the G D S (v. 1, #1, pp. 3 7 - 4 3 ; v.
2, #3, pp. 60-61; v. 3, #4, pp. 57-60). The authors of
this chapter review the unique features of the GDS (e.g., a
yeslno format, no somatic items) and consider the data of
other researchers published in other journals. Of special in-
terest is the section on the use of the G D S with special
populations (e.g., arthritics, demented) and the develop-
ment of a shorter form.
It may be premature to tout the superiority of the G D S .
Although its: utility as a screening device is fairly well
established, evidence on its ability to monitor changes in
depression during treatment, or over a long period, is still
limited.

Javsid 1. Sheikh is affiliated with Veterans Administration Medical Ccnter. Palo Alto.
CA 94304. Jerome A. Ycsavage is affiliated with Department of Psychiatry and Behavioral
Sciences, Stanford University School of Medicine, Stanford. CA 94305.
This research was supported by the Medical Research Service of the Veterans Ad-
ministration, and NlMH grant MH 35182-02. Dr. Sheikh is supported by rcsearch training
grant MH 16744-04.
Clinical Gerontologist. Vol. 5(1/2). June 1986
@ 1986 by The Haworth Press, Inc. All rights resewed. 165
 CLINICAL GERONTOLOGIST

INTRODUCTION
Depressive disorders are presently the most common psycho-
pathologic syndromes afflicting the elderly (Butler & Lewis, 1982).
However, in that age group, a very common reason for failure to
treat them is a failure of recognition (Gurland, 1982). Considering
the fact that the percentage of elderly amongst the general popula-
tion is increasing rapidly, the need for prompt recognition of symp-
toms of depression is readily apparent. Development of the GDS
(GDS) was a step in this direction. In this article, we provide data on
the GDS from recent studies and introduce a shorter version.

BRIEF REVIEW OF VALIDATION STUDIES OF THE GDS

As the GDS was designed specifically for the elderly, its items
were developed after careful consideration of unique characteristics
of depression in the elderly (Coleman et al., 1981; Jarvik, 1976;
Kahn, Zarit, Hilbert, & Niederehe, 1975; Wells, 1979), as well as
of other sensitive issues relevant to this age group (Salzman &
Shader, 1978). The scale was developed and validated in two phases
which have been described in detail elsewhere (Brink, Yesavage,
Owen, Heersema, Adey, & Rose, 1982; Yesavage & Brink, 1983)
and will be alluded to briefly here for the purpose of providing
background information for the reader.
In the first phase, 100 widely varied yeslno questions were
selected and tested for their potential for distinguishing elderly
depressives from normals.
Of the original 100 items, the 30 with the highest correlaton with
depression were chosen for inclusion in the final version of the
GDS. A second phase of validation included two of the more
established depression measures, the Zung Self Rating Scale for
Depression or SDS (Zung, 1965; Biggs, 1978; Hedlund, & Vieweg
19791, and the Hamilton Rating Scale for Depression or HRS-D
(Hamilton, 1960, 1967; Carroll, Fielding & Bl'ashki, 1973;
Knesevich, Biggs, Clayton & Ziegler, 1977) All three scales were
found to be internally consistent, reliable, and valid as depression
measuring scales amongst the elderly. Moreover, as a measure of
convergent validity, correlations between the scales were also com-
puted and found to be statistically significant at or beyond the .001
level.
 Depression Scales for Use in Later Life 167

Information regarding the sensitivity and specificity of the GDS

was provided in a later study (Brink et al., 1982). They found that
a cut-off score of 11 on the GDS yielded a 84% sensitivity rate and a
95 % specificity rate. A more stringent cut-off score of 14 yielded a
slightly lower, 80%, sensitivity rate, but resulted in the complete
absence of nondepressed persons being incorrectly classified as
depressed, i.e., a 100% specificity rate. Based on these findings
Brink et al. (1982) suggested that a score of 0-10 be viewed as
within the normal range while a score of 1 1 or greater taken as a
possible indicator of depression.
These findings suggest that the GDS is a promising screen for
detecting depression in the elderly. It is also worth mentioning that
the various forms of reliability measurements of the GDS have con-
sistently been higher than those found in the HRS-D and SDS
(Brink, Curran, Dorr, Janson, McNulty, & Messina, 1985;
Yesavage & Brink, 1983).

COMPARISON OF GDS WITH CES-D, HRS-D, & D-CAL

In a recent study conducted at the Department of Psychology,

Wake Forest University, Winston-Salem, North Carolina (Best,
Davis, Morton, & Romeis, 1984), 334 subjects, male and female,
were given four depression scales as part of a general health and at-
titude survey for adults. The scales included the Hamilton Rating
Scale for Depression (HRS-D), the Center for Epidemiological
Studies Depression Scale (CES-D), the Depression Adjective Check
List (DACL), and the Geriatric Depression Scale (GDS). Almost
half of these subjects were taken from a Family Practice Clinic and
were randomly selected from patient records. This selection
resulted in a younger group, aged from 45 to 60 years with a mean
of 52.7, and an older group aged 66 to 87 with a mean of 73.1. The
remainder of the subjects (174) were taken from different communi-
ty settings with an age range of 52 to 98 with a mean of 77.2. An in-
dependent measure of depression, the Rockliff Rating Scale of
Depression (Best et al., 1984) which is composed of ten rating
scales covering common behavioral manifestations of depression,
was also included. The researchers expected the Rockliff scaled
scores to correlate with the selected measures of depression. Each
scale discriminated between depressed and nondepressed subjects.
However, the GDS and the HRS-D were the best predictors of ma-
168 CWNICAL GERONTOLOGIST

jor depression among the elderly, while the CES-D and the GDS
were the best in the younger subjects. The authors make the follow-
ing recommendation: "Researchers who are primarily interested in
assessing depression in the elderly would be advised to use the GDS,
which is not heavily weighted toward health concerns, and which
seems to be especially sensitive to the aspects of depression ex-
perienced by the older adults." Since the purpose of this study was
to evaluate the appropriateness of assessment scales for particular
populations, it has important implications for future research in this
area.

USE OF THE GDS WITH SPECIAL POPULATIONS

As a large proportion of the elderly suffer from some kind of
physical ailment at any given point in time, a geriatric depression
scale should be applicable to both the physically well and the ill.
Furthermore, it should have the potential for use with select popula-
tions in which the aged are more heavily represented, e.g., the
cognitively impaired. There is some evidence that the GDS may
satisfy these needs. Using data from a study by Gallagher, Slife, and
Yesavane (unpublished manuscript), we found that the GDS dif-
ferentiated depressed from nondG&ssed elderly subjects suffering
from physical illness. These subjects were elderly arthritics who had
been &en the GDS after having been classified-as either depressed
or nondepressed based on a comprehensive clinical interview. The
mean score of the depressed arthritic subjects (13.1, s. d. = 7.14)
was significantly higher than that of the nondepressed subjects
(5.10, s.d. = 4.21), t(47) = 4.94, p < ,001). These data indicate
that the GDS has validity with the physically ill also.
In another study (Yesavage, Rose, & Lapp, 1981), the usefulness
of the GDS was tested in a group of elderly subjects undergoing
cognitive treatment for senile dementia. These subjects were
classified as demented by criteria of Folstein's (1975) Mini-Mental
Status exam. The subjects categorized as depressed by a therapist
blind to GDS scores received a mean score of 14.72 (s.d. = 6.13)
on the GDS versus a mean of only 7.49 (s.d. = 4.26) for
nondepressed subjects, t(41) = 4.4, p < .001. However, Brink
(1984) has shown that in severe cases of dementia the subjects may
fail to comprehend the questions. This suggests that the usefulness
of the GDS might be limited to subjects with mild to moderate
degree of dementia.
 Depression Scales for Use in Later Life 169

These studies then provide preliminary evidence that the GDS has
potential for application with the physically ill as well as the
cognitively impaired elderly.

DEVELOPING A SHORTER VERSION OF THE GDS

(SHORT FORM)
Much has already been written about unique problems of measur-
ing depression in the elderly (Coleman et al., 1981; Jarvik, 1976;
Kahn et al., 1975; Salzman & Shader, 1978; Wells, 1979). In addi-
tion, some other nonspecific factors such as fatigue and poor con-
centration can interfere with such a measurement by making it dif-
ficult for the elderly to remain focused while filling out lengthy
scales. The GDS was devised to minimize such possibilities. We
feel that the ease of administration and the relatively less time re-
quired to complete it compared to most other scales are its important
advantages. Extending this line of reasoning further, especially to
further cut down on time requirement, we recently developed a
shorter version of the GDS. We selected 15 questions from the GDS
which had the highest correlation with depressive symptoms in our
validation studies. These questions were then arranged in a 15-item,
one page, easy-to-understand yeslno format (GDS, Short Form,
Table l), similar to the regular version (Long Form) of the GDS.
Furthermore, these were ordered so as to maximize the acceptance
of the questionnaire. Of the 15 items, 10 indicated the presence of
depression when answered positively, while the rest (Nos. 1, 5, 7,
11, 13,) indicated depression when answered negatively. We then
conducted a validation study to compare the Long Form of the GDS
with the Short Form. Thirty-five elderly subjects were included in
this study. They consisted of 18 normal elderly from the communi-
ty, and 17 elderly patients in a variety of treatment settings for com-
plaints of depression. The latter group of elderly met the DSM-III
criteria of either a major depression or a dysthymic disorder. Both
male and female subjects were included and all were above 55 years
of age. The subjects were given both versions of the GDS, the Long
and the Short Form for self-rating of symptoms of depression. Both.
forms were successful in differentiating depressed from non-
depressed subjects with a high correlation (r = .84, p < .001). This
initial data suggests that the the Short Form of GDS can also be used
successfully as a screening device for depression. We think that it
 CLINICAL GERONTOLOGIST

TABLE I: GERIATRIC DEPRESSION SCALE (SHORT FORM)

CHOOSE W E BEST ANSWER FOR HOW YOU FELT OVER lWE PAST WEEK

1. Are you b a s i c a l l y s a t i s f i e d with your l i f e ? ......................y e s I no

2. Have you dropped many of your a c t i v i t i e s and i n t e r e s t s ? y e s I no

3. DO you f e e l t h a t your l i r e i s empty? y e s I no

4. Do you o f t e n g e t bored? y e s I no

5. Are you i n good s p i r i t s most of t h e time? ........................ y e s I no

6. Are you a f r a i d t h a t something bad i s going t o happen t o you? y e s I no

7. Do you f e e l happy most of t h e time? y e s I no

8. Do you o f t e n f e e l h e l p l e s s ? y e s I no

9. Do you p r e f e r t o s t a y a t home, r a t h e r Ulan going o u t y e s I no

and doing new t h i n g s ?

10. DO you f e e l you have more problems with memory Ulan most? ........y e s I no

11. Do you t h i n k i t i s wonderful t o be a l i v e ? yes I no

12. Do you f e e l p r e t t y u o r t h l e s s t h e way you a r e n w ? y e s I no

13. Do you f e e l full of energy? y e s I no

1 4 . Do you f e e l t h a t Your s i t u a t i o n i s h o p e l e s s ? y e s Ino

15. Do you t h i n k t h a t most people a r e b e t t e r o f f than you a r e ? .......yes I no

should be especially useful for physically ill and demented patients

who are likely to feel fatigued and are usually limited in their ability
to concentrate for any length of time. (The Short Form takes an
average of five to seven minutes to complete.) Further studies with
the Short form of GDS are being planned.

Ease of Administration and Other Desirable Characteristics

As described above, ease of administration, and economy of time

are among the desirable features for a depression scale for the elder-
ly. In this regard the Short Form of GDS is especially desirable. In
both versions of the GDS, however, the items are tailored for use
with the elderly. Questions that might increase the defensiveness of
subjects or otherwise reduce cooperation and rapport were avoided.
 Depression Scales for Use in Later Life 171

In addition, the yeslno format provides a simpler task for elderly

subjects than the response required in some other scales, where the
subjects must estimate the frequency of particular symptoms. Not
only does the yestno format undoubtedly shorten the time required
for a scale's administration, it may also bolster reliability to the ex-
tent additional choices for the individual simply lead to greater er-
rors of measurement rather than heightened sensitivity.
As elsewhere described (Yesavage et a]., 1983), the GDS com-
pares very favorably with the observer-rated HRS-D with respect to
the task of differentiating between various degrees of depression.
This means that the GDS provides a reasonable substitute when
economy of administration is an issue. This is not meant to imply
that the GDS provides a substitute for the HRS more generally.
Given the emphasis on the subjective aspects of depression, the
-
GDS should not be used for vumses of diaenostic
L su
classification. It
should be followed up by a clinical interview or a measure of endog-
enous depression such as the HRS-D if significant levels of depres-
sive symptomatology are found and further treatment indicated. It
remains to be determined, however, if the GDS may be useful for
measuring changes in the severity of depression following treat-
ment.

CONCLUSION
The data cited show that the GDS (both the Long and the Short
form) represents a reliable and valid screening device for measuring
depression with elderly individuals. The GDS is also sensitive to de-
pression among elderly persons suffering from mild to moderate
dementia and physical illness. Furthermore, the Short Form of GDS
is particularly useful in situations where economy of time is re-
quired. Although not a substitute for observer-rated scales such as
the HRS-D or for in-depth interviews, recent data suggest that it
might be the self-rating scale of choice for depression in the elderly.

REFERENCES
Best, D. L . , Davis, S.. Morton. K . , & Romeis, J . Measuring Depression in the Elderly: Psy-
chomctric and Psychosocial Issucs. Presented at the Annual meeting of American Geron-
tological Association, Houston, October 1984.
Biggs, 1. T., Wylie, L. T., Ziegler, & V . E. Validity of the Zung Self-Rating Depression
Scale. Br. I . of Psychiar., 1978, 132, 381-385.
rn CLINICAL GERONTOLOGIST

Brink, T. L. Limitations of the GDS in cases of pscudodementia. Clin. Geron., 1984,2(3),

60-61.
Brink, T . L., Yesavage, J. A,, Owen, L., Heersema, P. H., Adey, M., & Rose, T. L.
Screening Tests for Geriatric Depression. Clin. Geron., 1982, !(I), 37-43.
Brink, T. L., Curran, P., Dorr, M. L., Janson, E., McNulty, U., Messina, M. Geriatric
Depression Scale Reliability: Order, Examiner and Reminiscence Effects. Clin. Geron.,
1985, 3(4), 57-59.
Butler, T., & Lewis, M., Aging and mental health (3rd ed.). St. Louis: Mosby, 1982.
Carroll, B. I., Fielding, 1. M.. & Blashki. T. G. Depression Rating Scales: A Critical Re-
view. Arch. Cen. Psychiat., 1973, 28. 361-366.
Coleman, R. M.. et al. Sleep-Wake disorders in the elderly: A polysomnographic analysis.
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Folstein, M. F., Folstein, S. E., McHugh, P. R.: Mini-Mental State: A Practical Method for
Grading the Cognitive State of Patients for the Clinician. Journal of Psychiarric Re-
search, 1975, 12. 189-198.
Gallagher, D., Slife, B., & Yesavage, J. Impact of Physical Health Status on Hamilton Rat-
ing Scale Depression Scores. Under editorial review.
Gurland, B. J., & Toner, 1. A. Depression in the Elderly: A Review of Recently Published
Studies. In Eisdorfer, C. (Ed.), Annual Review of Gerontology and Geriatrics, vol. 3.
New York: Springer Publishing Co.. 1982, 228-265.
Hamilton, M. A Rating Scale for Depression. J. Neurol. Neurosurg. Psychiat.. 1960, 23,
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Hamilton, M. Development of a Rating Scale for Primary Depressive Illness. Br. J. of Soc.
and Clinical Psychology. 1967, 6. 278-296.
Hedlund, J. L., & Vieweg, B. W. The Zung Self-Rating Deprcssion Scale: A Comprehen-
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324-326.
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Questions

1) What are the main differences between the GDS and the
other tests for depression?
 Depression Scales for Use in Later Life 173

2 )What reasons would there be for using any other depres-

sion test with the aged?
3 ) What kinds of research design would be appropriate to
further demonstrate the utility of the GDS?