Geriatric Depression Scale — administration and interpretation

Purpose. A screening — not diagnostic — instrument for depression in older adults, developed by Yesavage and Brink (1982). Its defining feature is that it deliberately excludes somatic items (appetite, sleep, weight, libido, energy) that overlap with physical illness in old age, and instead asks about mood, satisfaction and outlook.

Format and administration. Simple yes/no answers referring to the past one week. Versions: the original GDS-30, the widely used GDS-15, and ultra-brief GDS-10, GDS-5 and GDS-4. It may be self-administered or interviewer-administered (read aloud for visual impairment or low literacy); GDS-15 takes about 5 minutes, GDS-30 about 10.

Scoring. One point for each answer in the depressed direction; some items are positively worded and reverse-scored (a "no" scores the point). GDS-15: 0–4 normal, 5–8 mild, 9–11 moderate, 12–15 severe — the usual screen-positive cut-off is ≥5. GDS-30: a score ≥11 suggests depression.

Interpretation. A positive score is not a diagnosis — it mandates a full diagnostic interview against DSM-5 / ICD-11 criteria, plus explicit assessment of suicidal ideation (asking about suicide does not increase risk and usually relieves the patient). Serial scores are useful to monitor treatment response.

Advantages. The yes/no format suits cognitive and sensory impairment; validated across community, outpatient, hospital and long-term-care settings; free of cost, brief, and translated and validated in multiple Indian languages; sensitivity and specificity around 80–90% for GDS-15. The GDS-3A subset of three items can also screen for apathy.

Limitations. Unreliable in moderate-to-severe dementia (MMSE below about 15) — the Cornell Scale for Depression in Dementia (CSDD), which uses informant input, should be used instead. Performance is affected by education, literacy, culture and language; it is not valid in delirium; and it does not assess severity for treatment selection or cover psychotic features.

Screening policy (2023–2025). The USPSTF (2023, JAMA) reaffirmed with a Grade B recommendation that all adults, including older adults, be screened for depression wherever systems exist for accurate diagnosis, treatment and follow-up. Current evidence supports PHQ-2/PHQ-9 and GDS-15 as interchangeable first-line tools, with the Cornell Scale reserved for those with dementia. In India, the NPHCE and Ayushman Arogya Mandirs now include routine depression screening of older adults at the primary-care level, with referral through Tele-MANAS (14416).