Preventing Depression in Age-Related Macular Degeneration

Abstract

Context: Age-related macular degeneration is a prevalent disease of aging that may cause irreversible vision loss, disability, and depression. The latter is rarely recognized or treated in ophthalmologic settings.Objective: To determine whether problem-solving treatment can prevent depressive disorders in patients with recent vision loss.Design: Randomized, controlled trial.Setting: Outpatient ophthalmology offices in Philadelphia, Pennsylvania.Patients: Two hundred six patients aged 65 years or older with recent diagnoses of neovascular age-related macular degeneration in one eye and pre-existing age-related macular degeneration in the fellow eye.Intervention: Patients were randomly assigned to problem-solving treatment (n = 105) or usual care (n=101). Problem-solving treatment therapists delivered 6 sessions during 8 weeks in subjects' homes. Main Outcome Measures:Outcomes were assessed at 2 months for short-term effects and 6 months for maintenance effects. These included DSM-IV-defined diagnoses of depressive disorders, National Eye Institute Vision Function Questionnaire-17 scores, and rates of relinquishing valued activities.Results: The 2-month incidence rate of depressive disorders in problem-solving-treated subjects was significantly lower than controls (11.6% vs 23.2%, respectively; odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P=.03). Problem-solving treatment also reduced the odds of relinquishing a valued activity (odds ratio, 0.48; 95% confidence interval, 0.25-0.96; P =.04). This effect mediated the relationship between treatment group and depression. By 6 months, most earlier observed benefits had diminished, though problem-solving treatment subjects were less likely to suffer persistent depression ( 2 1,3 =8.46; P =.04). Conclusions: Problem-solving treatment prevented depressive disorders and loss of valued activities in patients with age-related macular degeneration as a shortterm treatment, but these benefits were not maintained over time. Booster or rescue treatments may be necessary to sustain problem-solving treatment's preventative effect. This study adds important new information to the emerging field of enhanced-care models to prevent or treat depression in older persons.Trial Registration: clinicaltrials.gov Identifier: NCT00042211 Arch Gen Psychiatry. 2007;64(8):886-892

Path Analysis of Depression and Quality Of Life Among Nurses

“…This difference is probably due to more emotionally engagement of female nurses as well as their hormonal differences (26,27). Rovner et al found in their study that there is a significant relationship between nurses' age and depression, which is similar with findings of the present study (28).…”

A prospective study of the bi-directional association between vision loss and depression in the elderly

“…However, in the same population, cataract surgery did not appear to have a similar effect (Owsley et al, 2007b). Age-related macular degeneration has also previously been demonstrated to be associated with high rates of depression, anxiety and emotional distress (Berman and Brodaty, 2006) and in a randomized controlled clinical trial that compared the efficacy of problem-solving treatment with usual care in patients, treatment of depression was found to be effective in the short-term but the benefits were not maintained over time (Rovner et al, 2007). The impact of visual impairment on depression may depend on the severity and the origin of visual impairment and the duration of visual loss.…”

Trajectories of depressive symptoms in old age: Integrating age-, pathology-, and mortality-related changes.

“…Although some dimensions of emotional well-being may be maintained or improved through advanced old age, age-related vulnerabilities such as chronic health conditions may render the implementation of coping and self-regulation strategies difficult if not impossible, thus leading to the age-related increase in depressive symptoms (Charles, 2010). Some interventions, such as problem-solving treatment, may alleviate the effect of chronic health conditions for a short-term (Rovner et al, 2007).…”

“…six months later (Rovner et al, 2007). Future studies are needed to evaluate the long-term effect of treatment to alleviate depressive symptoms in older adults.…”

“…Some interventions, such as problem-solving treatment, may alleviate the effect of chronic health conditions for a short-term (Rovner et al, 2007).…”