Open Access Highly Accessed Research article

Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study

Melissa Koehler1, Terry Rabinowitz2, John Hirdes3, Michael Stones4, G Iain Carpenter5, Brant E Fries6, John N Morris7 and Richard N Jones78*

Author Affiliations

1 New Hanover Regional Medical Center, 2131 S 17th Street, Wilmington, NC 28401, USA

2 University of Vermont College of Medicine, Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401-1473, USA

3 Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada

4 Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada

5 The University of Kent, Canterbury, Center for Health Service Studies, George Allen Wing, Kent, CT2 7NF, UK

6 University of Michigan Institute of Gerontology, 300 North Ingalls Ann Arbor, MI 48109-2007, USA

7 Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, 1200 Centre Street, Massachusetts 02131 USA

8 Division of Gerontology, Beth Israel Deaconess Medical Center, Division on Aging, Harvard Medical School, Boston, MA USA

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BMC Geriatrics 2005, 5:1  doi:10.1186/1471-2318-5-1

Published: 1 January 2005



The objective of this study was to examine the Minimum Data Set (MDS) and Geriatric Depression Scale (GDS) as measures of depression among nursing home residents.


The data for this study were baseline, pre-intervention assessment data from a research study involving nine nursing homes and 704 residents in Massachusetts. Trained research nurses assessed residents using the MDS and the GDS 15-item version. Demographic, psychiatric, and cognitive data were obtained using the MDS. Level of depression was operationalized as: (1) a sum of the MDS Depression items; (2) the MDS Depression Rating Scale; (3) the 15-item GDS; and (4) the five-item GDS. We compared missing data, floor effects, means, internal consistency reliability, scale score correlation, and ability to identify residents with conspicuous depression (chart diagnosis or use of antidepressant) across cognitive impairment strata.


The GDS and MDS Depression scales were uncorrelated. Nevertheless, both MDS and GDS measures demonstrated adequate internal consistency reliability. The MDS suggested greater depression among those with cognitive impairment, whereas the GDS suggested a more severe depression among those with better cognitive functioning. The GDS was limited by missing data; the DRS by a larger floor effect. The DRS was more strongly correlated with conspicuous depression, but only among those with cognitive impairment.


The MDS Depression items and GDS identify different elements of depression. This may be due to differences in the manifest symptom content and/or the self-report nature of the GDS versus the observer-rated MDS. Our findings suggest that the GDS and the MDS are not interchangeable measures of depression.