Major and Subthreshold Depression Among Older Adults Seeking Vision Rehabilitation Services

Arlene R. Gordon Research Institute, Lighthouse International, 111 East 59th St., New York, NY 10022, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 3.52). 04/2005; 13(3):180-7. DOI: 10.1176/appi.ajgp.13.3.180
Source: PubMed

ABSTRACT Authors examined the potential risk factors of major and subthreshold depression among elderly persons seeking rehabilitation for age-related vision impairment.
Participants (N=584), age 65 and older, with a recent vision loss, were new applicants for rehabilitation services. Subthreshold depression was defined as a depressive syndrome not meeting criteria for a current major depression (i.e., minor depression, major depression in partial remission, dysthymia) or significant depressive symptomatology.
Seven percent of respondents had a current major depression, and 26.9% met the criteria for a subthreshold depression. Poorer self-rated health, lower perceived adequacy of social support, decreased feelings of self-efficacy, and a past history of depression increased the odds of both a subthreshold and major depression, versus no depression, but greater functional disability and experiencing a negative life event were significant only for a subthreshold depression. Only a history of past depression was significant in increasing the odds of having a major versus a subthreshold depression.
Results highlight similarities in characteristics of, and risk factors for, subthreshold and major depression. Future research is needed to better understand both the trajectory and treatment of subthreshold depression, relative to major depressive disorders.

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    • "Some studies have shown that interventions aimed at preventing major depression and/or reducing subthreshold symptoms of depression in the visually impaired can be effective. Horowitz et al. (2005) found that variable low vision rehabilitation services, such as counselling and use of optical devices had a small positive effect on the decline of depressive symptoms after two years [5] [19]. In another trial, with a follow-up period of six months, Horowitz et al. (2006) showed that optical devices that optimise residual vision, as apposed to adaptive aids that involve learning new methods to compensate for lost functions, had a positive effect on the course of depressive symptoms [20]. "
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    ABSTRACT: Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group.Method/design: A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in the Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI). Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step.Trial registration: identifier: NTR3296.
    BMC Psychiatry 08/2013; 13(1):209. DOI:10.1186/1471-244X-13-209 · 2.24 Impact Factor
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    • "Thus, we conclude that ApoE4 contributed to neither DSC nor MDE. Lower education (Beekman et al., 2001; Jang et al., 2002; Azar et al., 2005) and functional limitation (Blumstein et al., 2004; Horowitz et al., 2005; Jorm et al., 2005) have been pointed out as risk factors by many of the previous studies. Although there are several previous studies (Strawbridge et al., 2002; van der Wurff et al., 2004; Heun and Hein, 2005) reporting the relationship between depressive disorder and female gender, this relationship has been controversial . "
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    ABSTRACT: OBJECTIVE: The aim of the study was to examine the relationship between apolipoprotein E4 allele (ApoE4) and depression among an older Japanese population. Mild cognitive impairment (MCI) was taken into consideration. METHODS: This is a community-based cross-sectional study. We assessed the mood and cognitive function of Japanese community-dwelling individuals aged 65 years or older. In the first phase of the study, we evaluated the mood and cognitive function. In the second phase, face-to-face structured interviews were conducted. Individuals with dementia and other mental diseases were excluded on the basis of a consensus meeting of psychiatrists and neuropsychologists; 738 subjects with full data were included in the analyses. We subdivided depression into major depressive episode (MDE) and depressive symptoms cases (DSCs). DSC was defined as a score of 6 or more on the Geriatric Depression Scale but not having a diagnosis of MDE. The relationship between depression (MDE and DSC) and ApoE4 was examined by multivariate logistic regression. RESULTS: The adjusted odds ratio (OR) of ApoE4 on DSC was not significant (OR = 0.82, 95%CI = 0.48-1.39, p < 0.46). Sex (OR = 2.53, 95%CI = 1.33-4.79, p < 0.01), MCI (1.95, 1.21-3.14, p < 0.01), years of education (0.87, 0.79-0.95, p < 0.01), and Nishimura's activities of daily living scores (0.75, 0.63-0.89, p < 0.01) significantly correlated with prevalence of DSC. There were no significant risk factors for MDE. CONCLUSION: Apolipoprotein E4 allele contributed to neither DSC nor MDE. The association of MCI with ApoE4 and DSC suggested that MCI is a confounder for the association between ApoE4 and DSC. Copyright © 2012 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 02/2013; 28(2). DOI:10.1002/gps.3803 · 3.09 Impact Factor
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    • "Vision impairment has been identified as the second most common disability among middle-aged and older adults, affecting 16.5 million Americans aged 45 years and older. Although the prevalence of vision loss increases with age, as many as 15% of adults aged 45– 64, representing 9.3 million middle-aged Americans, report having some type of vision problem even when using corrective lenses (Horowitz, Brennan, & Reinhardt, 2005). Given this prevalence, vision rehabilitation agencies provide myriad services—including establishing rehabilitation goals, conducting eye examinations, training on the use of optical aids, and providing orientation and mobility services—and are charged with the challenges of meeting the needs of diverse clients (Owsley, McGwin, Lee, Wasserman, & Searcey, 2009). "
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    ABSTRACT: Purpose: This study examined the role of assimilative and accommodative coping dimensions for the mental health of people with visual impairment, with the aim of informing rehabilitation planning. Research Method: Telephone interviews were conducted with 216 middle-aged adults with vision loss. Assimilative and accommodative coping were assessed both in terms of general coping tendencies and goal-specific coping. Results: Assimilation was used more than accommodation in goal-specific coping. In contrast, endorsement levels of general coping tendencies were higher for accommodative compared with assimilative coping. The strongest beneficial effects on mental health emerged for accommodative coping as a general coping tendency and assimilative coping as a goal-specific strategy. Conclusions: Results suggest that vision rehabilitation programs should encourage accommodative coping as a general life approach. However, for specific goals, rehabilitation should help individuals determine their feasibility, and focus on developing assimilative strategies for feasible goals, while reevaluating and letting go of unfeasible goals. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Rehabilitation Psychology 11/2012; 57(4):320-7. DOI:10.1037/a0030787 · 1.91 Impact Factor
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