University of Oulu

Jari Jokelainen, Markku Timonen, Sirkka Keinänen-Kiukaanniemi, Pirjo Härkönen, Heidi Jurvelin & Kadri Suija (2019) Validation of the Zung self-rating depression scale (SDS) in older adults, Scandinavian Journal of Primary Health Care, 37:3, 353-357, DOI: 10.1080/02813432.2019.1639923

Validation of the Zung self-rating depression scale (SDS) in older adults

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Author: Jokelainen, Jari1,2; Timonen, Markku1; Keinänen-Kiukaanniemi, Sirkka1,2,3;
Organizations: 1Center for Life Course Health Research, University of Oulu, Oulu, Finland
2Unit of General Practice, Oulu University Hospital, Oulu, Finland
3Health Center of Oulu, Oulu, Finland
4Department of Family Medicine, University of Tartu, Tartu, Estonia
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Informa, 2019
Publish Date: 2020-04-21


Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population.

Design: A population-based study

Setting: Community

Subjects: 520 adults, aged 72–73 years, living in the city of Oulu, Finland.

Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression.

Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8–92.9) and 72.2% (95% CI 67.9–76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7–18.8) and 98.6% (95% CI 96.7–99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77–0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p = 0.137).

Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable.

Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level.

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Series: Scandinavian journal of primary health care
ISSN: 0281-3432
ISSN-E: 1502-7724
ISSN-L: 0281-3432
Volume: 37
Issue: 3
Pages: 353 - 357
DOI: 10.1080/02813432.2019.1639923
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
112 Statistics and probability
Copyright information: © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.