Over recent decades, there has been a substantial increase in the proportion of women in the workforce with dependent children. However, this trend is not evident for mothers of children with disabilities. Their employment levels are greatly reduced. The present paper examines the nature of the restrictions which affect the employment participation of these mothers and explores the meaning work has for them. The data presented in this paper were derived from qualitative interviews with 18 mothers of children with disabilities aged between 5 and 15 years. These mothers found employment difficult. They encountered unusual time demands, and a lack of adequate and affordable child care. Furthermore, they felt that their employment opportunities were restricted by attitudes prevalent in society concerning appropriate roles for women, especially mothers of children with disabilities. The lack of opportunities to engage in employment led, in varying degrees, to feelings of isolation, a lack of fulfilment and low self‐esteem. The mothers felt that they were on the periphery of society with little release from the pressures of caring. Mothers who had part‐time jobs often did poorly paid work of low status, thereby encountering few opportunities to use their skills and abilities to the full. Those who attempted a full‐time job experienced stress from the dual demands of home and work, and from a fear that they were failing as mothers. The present paper highlights areas which require attention to improve the employment experience of these mothers.

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Citation: Nollett CL, Bray N, Bunce C, et al. Depression in visual impairment trial (DEPVIT): a randomized clinical trial of depression treatments in people with low vision. Invest Ophthalmol Vis Sci. 2016;57:4247-4254. DOI:10.1167/iovs.16-19345 PURPOSE. The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms.METHODS. This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n ¼ 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waitinglist control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory.RESULTS. At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London.CONCLUSIONS. Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.Keywords: low vision, depression, clinical trial, mental health, intervention A growing body of evidence suggests that low vision is associated with depression. Results from several studies in North America suggest that the prevalence of depression and depressive symptoms in those accessing visual rehabilitation centers ranges from 22% to 38%. 1-4 Untreated depression has a profound negative impact on quality of life and reduces life expectancy. [5][6][7] What is less clear, however, is how to treat the depressive symptoms in this vulnerable group.In otherwise healthy adults, about 50% of those who receive psychological treatments or antidepressants recover fully. 8,9 However, the effects of depression treatment in people with chronic health conditions are somewhat less clear. For example, a recent meta-analysis of psychological interventions for depression in people with coronary heart disease concluded that although psychological treatments work, the effects are only small (typical effect size 0.3). 10A myriad of psychological interventions have been developed for depression,...

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