Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-29T02:13:14.708Z Has data issue: false hasContentIssue false
  • English
  • Français

The Brief Anxiety and Depression Scale (BADS): a new instrument for detecting anxiety and depression in long-term care residents

Published online by Cambridge University Press:  18 November 2014

William E. Mansbach ,
Ryan A. Mace  and
Kristen M. Clark
William E. Mansbach*
Affiliation:
Mansbach Health Tools, LLC P.O. Box 307 Simpsonville, Maryland 21150, USA
Ryan A. Mace
Affiliation:
Mansbach Health Tools, LLC P.O. Box 307 Simpsonville, Maryland 21150, USA
Kristen M. Clark
Affiliation:
Mansbach Health Tools, LLC P.O. Box 307 Simpsonville, Maryland 21150, USA
*
Correspondence should be addressed to: William E. Mansbach, Mansbach Health Tools, LLC P.O. Box 307 Simpsonville, Maryland 21150, USA. Phone: +443-896-7409; Fax: +855-850-8661. E-mail: [email protected].
Get access

Abstract

Background:

Depression and anxiety are common among long-term care residents, yet both appear to be under-recognized and under-treated. In our survey of 164 geriatric health care professionals from 34 U.S. states, 96% of respondents reported that a new instrument that rapidly assesses both depression and anxiety is needed. The Brief Anxiety and Depression Scale (BADS) is a new screening tool that can identify possible major depressive episodes (MDE) and generalized anxiety disorders (GAD) in long-term care residents.

Methods:

The psychometric properties of the BADS were investigated in a sample of 224 U.S. long-term care residents (aged 80.52 ± 9.07). Participants completed a battery of several individually administered mood and cognitive tests, including the BADS. MDE and GAD were diagnosed based on the DSM-IV-TR criteria.

Results:

Adequate internal consistency and construct validity were found. A principle component analysis (PCA) revealed an Anxiety Factor and a Depression Factor, which explained 50.26% of the total variance. The Anxiety Factor had a sensitivity of 0.73 and specificity of 0.81 for identifying GAD (PPV = 0.69, NPV = 0.84). The Depression Factor had a sensitivity of 0.76 and a specificity of 0.73 for identifying MDE (PPV = 0.77, NPV = 0.72).

Conclusions:

The BADS appears to be a reliable and valid screening instrument for MDE and GAD in long-term residents. The BADS can be rapidly administered, is sensitive to mood diagnoses in both patients without dementia and with dementia, and produces separate depression and anxiety factor scores that can be used clinically to identify probable mood diagnoses.

Keywords

depressionanxietylong-term carescreeningpsychometrics
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 4 , April 2015 , pp. 673 - 681
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: Author.Google Scholar
Beekman, A. T. et al. (1998). Anxiety disorders in later life: a report from the Longitudinal aging study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Callahan, C. M., Hendrie, H. C. and Tierney, W. M. (1995). Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine, 122, 422–429. doi: 10.7326/0003-4819-122-6-199503150-00004.CrossRefGoogle ScholarPubMed
Cheng, T., Chen, T., Yip, P., Hua, M., Yang, C. and Chiu, M. (2009). Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients. International Psychogeriatrics, 21, 1134–1141. doi: 10.1017/S1041610209990767.CrossRefGoogle ScholarPubMed
Clark, L. A. and Watson, D. B. (1995). Constructing validity: basic issues in objective scale development. Psychological Assessment, 7, 309–319. Reprinted in Kazdin, A. E. (ed.) (1998 & 2003). Methodological Issues and Strategies in Clinical Research, 2nd edn, (pp. 215–240) & 3rd edn, (pp. 207–232). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
de Beurs, E., Beekman, A. T., van Balkom, A. J., Deeg, D. J., van Dyck, R. and van Tilburg, W. (1991). Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychological Medicine, 29, 583–593.CrossRefGoogle Scholar
de Craen, A. J., Heeren, T. J. and Gussekloo, J. (2003). Accuracy of the 15-item geriatric depression scale in a community sample of the oldest of old. International Journal of Geriatric Psychiatry, 18, 63–66. doi: 10.1002/gps.773.CrossRefGoogle Scholar
Givens, J. L., Sanft, T. B. and Mercantoni, E. R. (2008). Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. Journal of the American Geriatrics Society, 56, 1075–1079. doi: 10.1111/j.1532-5415.2008.01711.x.CrossRefGoogle ScholarPubMed
Kieffer, K. M. and Reese, R. J. (2002). A reliability generalization study of the geriatric depression scale. Educational and Psychological Measurement, 62, 969–994. doi: 10.1177/0013164402238085.CrossRefGoogle Scholar
Lenze, E. J. et al. (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International Journal of Psychiatry in Medicine, 15, 472–478. doi: 10.1002/gps.1116.Google Scholar
Lyness, J. M., Cox, C., Curry, J., Conwell, Y., King, D. A. and Caine, E. D. (1995). Older age and the underreporting of depressive symptoms. Journal of the American Geriatric Society, 43, 216–221.CrossRefGoogle ScholarPubMed
Mansbach, W. E. and MacDougall, E. E. (2012). Development and validation of the short form of the brief cognitive assessment tool (BCAT-SF). Aging and Mental Health, 16, 1065–1071. doi: 10.1080/13607863.2012.702729.CrossRefGoogle ScholarPubMed
Mansbach, W. E., Mace, R. A. and Clark, K. M. (2014). Story recall and word lists: differential and combined utilities in predicting cognitive diagnosis. Journal of Clinical and Experimental Neuropsychology, 36, 596–576. doi: 10.1080/13803395.2014.916656.CrossRefGoogle ScholarPubMed
Mendlowicz, M. V. and Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Geriatric Psychiatry, 157, 669–682. doi:10.1176/appi.ajp.157.5.669.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Neville, C. and Teri, L. (2011). Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. International Journal of Mental Health Nursing, 20, 195–201. doi: 10.1111/j.1447-0349.2010.00724.x.CrossRefGoogle ScholarPubMed
Nunnally, J. and Bernstein, I. H. (1994). Psychometric Theory, 3rd edn. New York, NY: McGraw-Hill.Google Scholar
Østbye, T., Yarnall, K. S. H., Krause, K. M., Pollak, K. I., Gradison, M. and Michener, J. L. (2005). Is there time for management of patients with chronic diseases in primary care? Annals of Family Medicine, 3, 209–214. doi: 10.1370/afm.310.CrossRefGoogle ScholarPubMed
Parmelee, P. A., Katz, I. R. and Lawton, M. P. (1989). Depression among institutionalized aged: assessment and prevalence estimation. Journals of Gerontology, 44, 22–29. doi: 10.1093/geronj/44.1.M22.CrossRefGoogle ScholarPubMed
Saint Onge, M. S., Krueger, P. M. and Rogers, R. G. (2014). The relationship between major depression and nonsuicide mortality for U.S. adults: the importance of health behaviors. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69, 622–632. doi: 10.1093/geronb/gbu009.CrossRefGoogle ScholarPubMed
Saliba, D. et al. (2012). MDS 3.0: brief interview for mental status. Journal of the American Medical Directors Association, 13, 611–617.CrossRefGoogle ScholarPubMed
Samus, Q. M. et al. (2013). Cohort differences in dementia recognition and treatment indicators among assisted living residents in Maryland: did a change in the resident assessment tool make a difference? International Psychogeriatrics, 25, 2047–56. doi: 10.1017/S1041610213001610.CrossRefGoogle Scholar
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clinical Gerontology: A Guide to Assessment and Intervention. NY: The Haworth Press.Google Scholar
Smallbrugge, M., Pot, A. M., Jongenelis, L., Beekman, A. T. and Eefsting, J. A. (2005). Comorbidity of depression and anxiety in nursing home patients. International Journal of Geriatric Psychiatry, 20, 218–226. doi: 10.1002/gps.1269.CrossRefGoogle Scholar
Smith, M. et al. (2008). Anxiety symptoms among assisted living residents: implications of the “no difference” finding for participants with and without dementia. Research in Gerontological Nursing, 1, 97–104. doi: 10.3928/19404921-20080401-06.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Korenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi:10.1001/archinte.166.10.1092.CrossRefGoogle ScholarPubMed
Wagenaar, D., Coleenda, C. C., Kreft, M., Savade, J., Gardner, J. and Povereja, E. (2003). Treating depression in nursing homes: practice guidelines in the real world. Journal of the American Osteopathic Association, 103, 464–469.Google ScholarPubMed
Watson, L. C., Garrett, J. M., Sloane, P. D., Gruber-Baldini, A. L. and Zimmerman, S. (2003). Depression in assisted living: results from a four-state study. American Journal of Geriatric Psychiatry, 11, 534–542. doi: 10.1097/00019442-200309000-00008.CrossRefGoogle ScholarPubMed
Watson, L. C. et al. (2006). Depression in assisted living is common and related to physical burden. American Journal of Geriatric Psychiatry, 14, 876–883. doi: 10.1097/01.JGP.0000218698.80152.79.CrossRefGoogle ScholarPubMed
Wild, B. et al. (2013). Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. American Journal of Geriatric Psychiatry, 22, 1029–1038. doi: 10.1016/j.jagp.2013.01.076.CrossRefGoogle ScholarPubMed
Yarnall, K. S., Pollak, K. I., Østbye, T., Krause, K. M. and Michener, J. L. (2003). Primary care: is there enough time for prevention? American Journal of Public Health, 93, 635–641.CrossRefGoogle ScholarPubMed