This study uses the GMS-AGECAT package in order to assess the prevalence and outcome of anxious depression in elderly persons living in the community. The Geriatric Mental State (GMS) is a semistructured standardized clinical in­terview for assessing the mental state of elderly persons and for facilitating the making of a reliable psychiatric diagnosis. The full interview, which consists of 500 symptom items, was developed in response to the needs of our epidemio­logical studies in New York and London (2,5). Symptom profiles can be derived from this interview that show changes in levels over time, especially in response to treatment. The GMS items have been shown to be reliable between interviewers interviewing the same subject, and a clinical or intuitive diagnosis made by psychiatrists on the basis of the interview reaches good reliability. The full GMS interview was shortened using a series of linear discriminant function analyses to form the community version suitable for screening for mental illness, describing the mental state by symptom profiles and deriving a psychiatric diagnosis on community samples (GMSA) (6).In order to compare psychiatric diagnosis and prevalence levels of different studies, it was important not only to measure reliably the level of symptoms, but also to standardize the selection of a diagnosis and the decision whether the subject represented a case of illness. As a consequence the computerized diag­nostic system AGECAT, which runs to several thousand lines of FORTRAN, was developed (4). This system condenses the 157 symptom components of the mental state into 38 symptom subclusters that are in turn assembled under eight diagnostic clusters according to their importance for determining the certainty of diagnosis for that cluster. Each subject is allotted a level of confidence of disgnosis from 0 to 6 on each diagnostic cluster. Clusters are then compared level for level according to a hierarchy starting with organic disorder, including depression and ending with anxiety. At the end of this process the subject emerges with a main diagnosis, an alternative diagnosis if appropriate, the levels of con­fidence on all eight clusters, levels on 19 symptom components forming a profile of illness, depression and organic scores for quick case identification, and an organic/depression index, which our preliminary follow-up studies indicate has some success in predicting which subcases will become cases in later years (3) Cases of illness are not, of course, to be found in nature; they must therefore be defined for each study. However, psychiatrists generally seem to recognize a certain level or cluster of symptoms as forming a syndrome. When that point is reached we define it as a syndrome case. A subject may reach case level on several syndromes. The AGECAT method has the value that it allows us to examine subjects who reach case confidence levels on both the depression and anxiety clusters. The depression cluster is split into depressive psychosis (roughly equivalent to endogenous depression) and depressive neurosis (roughly equivalent to reactive depression). Syndrome case levels are at confidence level 3 and above. Levels 1 and 2 represent subcases. The AGECAT diagnostic system has been tested for validity against psychiatric diagnosis on a consecutive series of 150 hospital admissions and 396 community subjects, and in a replication sample on a additional 647 community subjects. Kappa values for the agreement between AGECAT and psychiatrists’ diagnosis reached 0.80 and above for organic disorders and 0.76 for depression. The data from our other interviews, the History and Aetiology Schedule for an informant, Social Status Schedule, and the Physical Status Schedule, are not reported here. The subjects described here formed part of a random community sample in Liverpool of 1,070, derived from general practitioners’ lists and interviewed in their own homes using the GMS-AGECAT package. The initial interviews were undertaken by four psychologists and one senior nurse trained in the method, whose ratings were shown to reach satisfactory reliability against those of the project psychiatrists (1). The follow-up study three years later was undertaken by psychiatrists interviewing the whole of the surviving sample using similar methods. Not all the data have been entered into the computer for the 3 year follow-up, and only the first 80 subjects with depression are reported here.

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