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: 4.24). 04/2005; 13(3):180-7. DOI: 10.1176/appi.ajgp.13.3.180
Source: PubMed


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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    • "With regard to mental health, our results show a clear association between visual impairment and depression. Although visual impairment and depression have been associated in working age adults [66], there is controversy on this topic in older adults [2, 22, 24, 25, 67, 68]. Variability in the studies arises with regard to the type of visual assessment used, including objective visual acuity, medical-record review, presence of age-related eye-disease or vision-loss severity with functional screening. "
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    ABSTRACT: Background In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. Methods Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. Results The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. Conclusions Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.
    BMC Public Health 08/2014; 14(1):815. DOI:10.1186/1471-2458-14-815 · 2.26 Impact Factor
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    • "Rates ranged from 14.3% for those with minimal vision loss to 25% for those with severe vision loss. The prevalence of depression was also high among older adults who sought low vision rehabilitation services [36]. "
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    ABSTRACT: Purpose. To evaluate association between erectile dysfunction (ED) and neovascular age-related macular degeneration (AMD). Methods. 195 men enrolled in this cross-sectional study. 90 of them had neovascular AMD and 105 of them were healthy volunteers. The International Index of Erectile Function (IIEF) questionnaire's erectile function (EF) domain was used to assess ED. The patients in the study and control groups were statistically compared according to visual acuity, EF score, and body mass index. Results. The mean ages were 62 (54.5-73) and 60 (54-68), in the neovascular AMD and control groups, respectively. The total EF scores were 9 (6-16) in neovascular AMD and 18 (9.5-27) in control group. The results of IIEF questionnaire on neovascular AMD patients revealed that 85 men (94.4%) had some degree of ED, whereas 68 men (64.8%) had some degree of ED on control group. Patients with neovascular AMD had a significantly higher incidence of ED than control patients (P < 0.01). There was a significant association between ED and neovascular AMD (P < 0.01). Conclusions. Our results suggested that neovascular AMD has a high association with ED.
    Journal of Ophthalmology 09/2013; 2013:589274. DOI:10.1155/2013/589274 · 1.43 Impact Factor
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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 · 2.21 Impact Factor
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