Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person

Stefan Grund; Michael Kilb; Eva Breitinger; Wilfried Hundsdörfer; Hans G Schäfer; Jos M G A Schols; Adam L Gordon; Jürgen M Bauer; Georg W Alpers

doi:10.1007/s41999-021-00554-9

Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person

Eur Geriatr Med. 2022 Feb;13(1):243-251. doi: 10.1007/s41999-021-00554-9. Epub 2021 Sep 12.

Authors

Affiliations

¹ Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany. stefan.grund@bethanien-heidelberg.de.
² Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
³ Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany.
⁴ Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
⁵ Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
⁶ Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
⁷ School of Health Sciences, City University of London, London, UK.
⁸ Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany.

PMID: 34510385
DOI: 10.1007/s41999-021-00554-9

Abstract

Purpose: Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients.

Methods: In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress.

Results: Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703).

Conclusion: The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.

Keywords: Geriatric assessment; Mental health; Older person; Postacute rehabilitation; Psychological distress; Single-item screener.

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Male
Mass Screening*
Psychological Distress*
ROC Curve
Surveys and Questionnaires