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·2026
Revisiting the Geriatric Depression Scale: An IRT-Based 10-Item Screen Outperforms the GDS-15 in Diagnostic Accuracy and Efficiency
Ji Won Han, Dae Jong Oh, Tae Hui Kim, Kyung Phil Kwak, Bong Jo Kim, Shin Gyeom Kim, Jeong Lan Kim, Seok Woo Moon, Joonhyuk Park, Seungho Ryu, Jong Chul Youn, Dong Young Lee, Dong Woo Lee, S. A. Lee, Jung Jae Lee, Jin Hyeong Jhoo, Ki Woong Kim
Journal of Clinical Medicine
초록

<b>Background/Objective</b>: Existing abbreviated Geriatric Depression Scales (GDSs), derived via Classical Test Theory (CTT), often sacrifice accuracy for brevity and retain non-specific items. We aimed to develop a minimum-item GDS maintaining diagnostic performance equivalent to the full 30-item scale (GDS30) using Item Response Theory (IRT). <b>Methods</b>: This cross-sectional study employed rigorous 5:5 split-sample cross-validation. Participants included 6525 older adults (aged ≥60 years) from community-based (Korean Longitudinal Study on Cognitive Aging and Dementia) and clinical settings (geropsychiatry clinic). Depression was diagnosed through standardized clinical interviews based on DSM-IV criteria. Two-parameter logistic IRT models estimated item discrimination and difficulty parameters. Sequential item reduction with DeLong tests identified the minimum number of items required to maintain GDS30-equivalent area under the curve (AUC). <b>Results</b>: The 10-item IRT-optimized scale (GDS10-IRT) achieved an AUC of 0.856 (95% CI: 0.809-0.895) in the validation set, showing no significant difference from GDS30 (AUC = 0.883; <i>p</i> = 0.396). Conversely, the 15-item GDS (GDS15) demonstrated significantly lower AUC than GDS30 (<i>p</i> < 0.001) despite having more items. GDS10-IRT achieved a 234% improvement in efficiency ratio (AUC/items) over GDS30. Notably, Item 16 ("feeling downhearted and blue"), identified as the most discriminating symptom (a = 2.53), is absent from the GDS15 but included in GDS10-IRT. <b>Conclusions</b>: IRT-based item selection achieves GDS30-equivalent diagnostic accuracy with only 10 items, outperforming the widely used GDS15. By recovering high-discrimination items excluded by CTT, the GDS10-IRT offers a more efficient, specific screening tool for late-life depression.

키워드
Item response theoryGeriatric Depression ScaleDepression (economics)Logistic regressionDiagnostic accuracyScale (ratio)Receiver operating characteristicPsychometricsArea under the curve
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2026

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