Symptom profile of depression in elderly: Is assessment with geriatric depression rating scale enough?

Aim of the Study: This study aimed to evaluate the symptom profile, including somatic symptoms among elderly patients with first episode depression using the Geriatric depression scale (GDS-30) and Patient Health Questionnaire-15 (PHQ-15) items version scale. Additional aims were to carry out the factor analysis of symptoms reported on GDS-30 and PHQ-15 among elderly. Methodology: Seventy-nine elderly patients (age ≥60 years) were evaluated on GDS-30 item Hindi version and Hindi version of the PHQ-15. Results: As per GDS-30, the most common symptom noted among elderly was “dropped many of your activities and interests” (91.1%), mind not as clear as it used (88.6%), feeling that life is empty (86.1%), bothered by thoughts you cannot get out of your head (86.1%) and hard to get started on new projects (86.1%), prefer to avoid social gatherings (86.1%). All patients reported at least one somatic complaint as per PHQ-15. The most common somatic symptoms were trouble sleeping (97.5%), feeling tired or having little energy (96.2%), feeling that the heart is racing (52.9%), constipation, loose bowels, or diarrhea (49.6%), shortness of breath (46.8%), nausea, gas or indigestion (45.6%), pain in the arms, legs, or joints (43.3%), and back pain (41.8%). The prevalence of somatic symptoms was not influenced to a large extent by the demographic variables, clinical variables and presence or absence of physical comorbidity. However, the severity of somatic symptoms correlated positively with GDS-30 score. Factor analysis of Hindi version of GDS-30 yielded a four-factor solution, which was similar to many studies across the world. The addition of items of PHQ-15 items of factor analysis still yielded a four-factor solution. Factor 1 of combined GDS-30 and PHQ-15 items included items only from GDS-30 and Factor 3 and 4 included items only from PHQ-15. There was some overlap of items on Factor 2. Conclusion: The present study suggests that GDS-30 does not tap all the symptoms of depression among elderly in the Indian context. Further, the present study shows that GDS-30 is not a one-dimensional scale. Accordingly, the symptom evaluation among elderly depressed patient should go beyond GDS-30