Major and Subthreshold Depression Among Older Adults Seeking Vision Rehabilitation Services

ArticleinAmerican Journal of Geriatric Psychiatry 13(3):180-7 · April 2005with19 Reads
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.
    • "A list of further examples is provided inTable 1. There is evidence that impaired functional status in individuals with visual loss is associated with depression789, psychosocial impact101112 , risk of falls, decreased mobility131415 and higher rates of mental and physical health comorbidities. Partial evidence exists of improved health-related quality-of-life outcomes following visual rehabilitation intervention [16, 17] and improvement in vision-related quality-of-life following visual rehabilitation [16,181920 . "
    [Show abstract] [Hide abstract] ABSTRACT: Visual Rehabilitation Officers help people with a visual impairment maintain their independence. This intervention adopts a flexible, goal-centred approach, which may include training in mobility, use of optical and non-optical aids, and performance of activities of daily living. Although Visual Rehabilitation Officers are an integral part of the low vision service in the United Kingdom, evidence that they are effective is lacking. The purpose of this exploratory trial is to estimate the impact of a Visual Rehabilitation Officer on self-reported visual function, psychosocial and quality-of-life outcomes in individuals with low vision. In this exploratory, assessor-masked, parallel group, randomised controlled trial, participants will be allocated either to receive home visits from a Visual Rehabilitation Officer (n = 30) or to a waiting list control group (n = 30) in a 1:1 ratio. Adult volunteers with a visual impairment, who have been identified as needing rehabilitation officer input by a social worker, will take part. Those with an urgent need for a Visual Rehabilitation Officer or who have a cognitive impairment will be excluded. The primary outcome measure will be self-reported visual function (48-item Veterans Affairs Low Vision Visual Functioning Questionnaire). Secondary outcome measures will include psychological and quality-of-life metrics: the Patient Health Questionnaire (PHQ-9), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Adjustment to Age-related Visual Loss Scale (AVL-12), the Standardised Health-related Quality of Life Questionnaire (EQ-5D) and the UCLA Loneliness Scale. The interviewer collecting the outcomes will be masked to the group allocations. The analysis will be undertaken on a complete case and intention-to-treat basis. Analysis of covariance (ANCOVA) will be applied to follow-up questionnaire scores, with the baseline score as a covariate. This trial is expected to provide robust effect size estimates of the intervention effect. The data will be used to design a large-scale randomised controlled trial to evaluate fully the Visual Rehabilitation Officer intervention. A rigorous evaluation of Rehabilitation Officer input is vital to direct a future low vision rehabilitation strategy and to help direct government resources. Trial registration The trial was registered with (ISRCTN44807874) on 9 March 2015.
    Full-text · Article · Dec 2016
    • "Few studies have investigated the impact of vision loss on depression compared to normal sight in general populations (Evans et al. 2007; Tournier et al. 2008; Jones et al. 2009;). Depending on the population characteristics and the questionnaires used, the prevalence of depressive symptoms is reported to range from 14 to 44% in visually impaired persons in general populations, in outpatient low-vision clinics and in populations with specific eye diseases (Rovner et al. 2002; Horowitz et al. 2005; Evans et al. 2007; Huang et al. 2010; Rees et al. 2010; van der Aa et al. 2015). That these percentages are high is confirmed by data from a systematic review in which prevalence rates of depressive symptoms in general older populations were shown to fluctuate around 10–15% (Beekman et al. 1999). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Although the prevalence of depression in visually impaired older persons is high, the association between vision loss and depression seems to be influenced by factors other than visual impairment. In this study, the role of vision loss, functional limitations and social network characteristics in relation to depressive symptoms was investigated. Methods: Cross-sectional data (N = 1237) from the Longitudinal Aging Study Amsterdam were used to investigate the prevalence of depression (Center of Epidemiological Studies-Depression scale) within subgroups with increasing vision loss. In linear regression models, functional limitations and social network characteristics were examined as possible mediators in the association between vision loss and depression. Having a partner was considered to be a potential moderator. Results: Although a significant linear trend was found in the presence of depressive symptoms with 14% in normally sighted, 23% in mild and 37% in severe vision loss (χ(2) (1) = 14.9; p < 0.001), vision loss was not an independent determinant of depression. Mediators were functional limitations (p < 0.001) and social network size (p = 0.009). No interaction with partner status was found. Conclusion: In the presence of depression, a trend was found with increasing severity of vision loss, indicating the need for more attention in (mental) health care and low-vision rehabilitation. In the general older population, vision loss was not an independent determinant of depression but was mediated by functional limitations and social network size. Rather than receiving actual social support, the idea of having a social network to rely on when needed seemed to be associated with lower levels of depression.
    Full-text · Article · Nov 2015
    • "In contrast, a reasonably high percentage (18 %) of our study population developed a major depressive, dysthymic, and/or anxiety disorder during watchful waiting. Female patients with more symptoms of depression and/or anxiety, more problems with adjustment to vision loss, and a history of major depressive, dysthymic, and/or panic disorder had higher odds of developing a disorder during watchful waiting, which is in line with previous studies [27][28][29]. For these patients, watchful waiting may not be an appropriate step. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month 'watchful waiting' period. Methods: A pretest-posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results: After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28-0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00-1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02-1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28-4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions: Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.
    Full-text · Article · Jun 2015
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