Article Text

Download PDFPDF

Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis
  1. Andrea Benedetti1,2,3,
  2. Yin Wu1,4,5,
  3. Brooke Levis1,4,
  4. Machelle Wilchesky4,6,
  5. Jill Boruff7,
  6. John P A Ioannidis8,9,
  7. Scott B Patten10,11,
  8. Pim Cuijpers12,
  9. Ian Shrier1,4,
  10. Simon Gilbody13,
  11. Zahinoor Ismail10,11,14,
  12. Dean McMillan13,
  13. Nicholas Mitchell15,
  14. Roy C Ziegelstein16,
  15. Brett D Thombs1,3,4,5,17,18
  1. 1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  2. 2 Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
  3. 3 Department of Medicine, McGill University, Montreal, QC, Canada
  4. 4 Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  5. 5 Department of Psychiatry, McGill University, Montreal, QC, Canada
  6. 6 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
  7. 7 Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
  8. 8 Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford School of Medicine, Stanford, California, USA
  9. 9 Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, USA
  10. 10 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  11. 11 Department of Psychiatry, University of Calgary, Calgary, Canada
  12. 12 Department of Clinical, Neuro and Developmental Psychology and Amsterdam Public Health research institute, VU University Amsterdam, Amsterdam, The Netherlands
  13. 13 Hull York Medical School and Department of Health Sciences, The University of York, York, UK
  14. 14 Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  15. 15 Department of Psychiatry, University of Alberta, Edmonton, Canada
  16. 16 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
  17. 17 Department of Psychology, McGill University, Montreal, Canada
  18. 18 Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Brett D Thombs; brett.thombs{at}


Introduction The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting).

Methods and analysis Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Ethics and dissemination The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy.

PROSPERO registration number CRD42018104329.

  • depression
  • geriatric depression scale
  • gds
  • individual participant data meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AB, YW, BL, MW, JB, JPAI, SBP, PC, IS, SG, ZI, DM, NM, RCZ and BDT contributed to the conception and design of the systematic review and meta-analysis. JB developed the database search strategy. AB, YW, BL, MW, JB and BDT will be involved in acquisition of data. AB, YW, BL and BDT will analyse the data. All authors will contribute to the interpretation of results. AB, YW and BDT drafted this protocol. All authors provided critical revisions of the protocol and approved submission of the final manuscript. AB is the guarantor.

  • Funding This research is supported by a grant from the Canadian Institutes of Health Research (CIHR; Funding Reference Number PJT-156365; PIs = Benedetti, Thombs, Wilchesky). Drs Benedetti and Thombs are supported by the Fonds de recherche du Québec - Santé (FRQS) researcher salary award. Dr Wu is supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec. Ms Levis is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Dr Patten is a Senior Health Scholar with Alberta Innovates, Health Solutions. Dr Ismail receives funding from the Alzheimer Society Calgary via the Hotchkiss Brain Institute. Dr Wilchesky is supported by the Donald Berman Maimonides Medical Research Foundation. No funding body had any input into any aspect of this protocol.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The IPDMA does not require ethics review because the objectives of the IPDMA are consistent with the objectives of the primary studies, which already received ethics approval.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.