Importance of Screening for Irritability When Assessing for Geriatric Depression

Objective: Geriatric depression is a common and disabling mental health condition that often goes undetected, possibly due to complaints that are less typical and more somatic in nature. Irritability is neither a formal criterion for depression in adults nor a component of routine screening instruments; however, it is commonly expressed by older adults. The objective of this study was to establish the frequency of irritability in adults aged 60 and older and determine its utility in detecting geriatric depression. Methods: Retrospective data were derived from a chart review of 2,300 individuals referred to our clinic from January 2015 to February 2023. Depression was established using the Beck Depression Inventory-II (BDI-II). Irritability was determined using a screening instrument containing 2 items assessing subjective experience of irritability and observations of irritability by others. Results: Of 1,317 study participants meeting inclusion criteria, 514 (40%) responded positive for irritability. This group had significantly higher BDI-II scores compared to individuals denying irritability (P< .001). Using the recommended cut point for the BDI-II in primary care settings, participants meeting criteria for depression (n = 488, 37%) reported significantly greater levels of irritability than those without depression (P < .001). Conclusions: In our sample, irritability was associated with higher levels of depression. In addition to employing traditional screening instruments for depression, practitioners working with a geriatric population should inquire as to the presence of irritability, either subjectively experienced or observed by others. Irritability appears to be a useful marker to facilitate detection and subsequent treatment of geriatric depression. Prim Care Companion CNS Disord 2025;27(1):24m03808. Author affiliations are listed at the end of this article.