1
|
Donato UM, Nguyen OT, Alishahi Tabriz A, Hong YR, Turner K. Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms. Disabil Health J 2024; 17:101619. [PMID: 38555256 DOI: 10.1016/j.dhjo.2024.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Although individuals with vision impairment are at greater risk for depression and anxiety, there has been limited study of mental healthcare utilization among this population. OBJECTIVES To address this gap, this pooled cross-sectional study estimates the prevalence of mental healthcare utilization among individuals with vision impairment during the COVID-19 pandemic. METHODS We calculated adjusted relative risk ratios and 95% confidence intervals of depression and/or anxiety symptoms and mental healthcare utilization using multinomial logistic regression, accounting for demographics, social determinants of health, and survey week. The population-based, U.S. Census Bureau Household Pulse Survey was administered April 2021-March 2022. Participants included 800,935 US adults (weighted population: 174,598,530) RESULTS: Adjusting for other factors, adults with vision impairment were more likely to report depression symptoms (RRR: 2.33; 95% CI: 2.03-2.68), anxiety symptoms (RRR: 2.12; 95% CI: 1.94-2.33, and comorbid depression and anxiety symptoms (RRR: 3.77; 95% CI: 3.51-4.04) compared with individuals with no vision impairment. Among individuals reporting anxiety or depression symptoms, individuals with vision impairment (RRR: 1.46; 95% CI: 1.35-1.59) were more likely to lack of mental healthcare utilization compared with individuals with no vision impairment. CONCLUSION Findings suggest that individuals with vision impairment are at increased risk for depression and/or anxiety symptoms and report reduced mental healthcare utilization compared with individuals without vision impairment. Additional programs and policies are needed to improve mental healthcare utilization among individuals with vision impairment and depression and/or anxiety symptoms, such as increased telehealth accessibility and coordination of behavioral health and ophthalmology services.
Collapse
Affiliation(s)
- Umberto M Donato
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL, 33602, USA; Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| |
Collapse
|
2
|
Stolwijk ML, Meyer I, van der Pas SL, Twisk JWR, van Nispen RMA, van Rens GHMB. Low vision aids provision in an urban setting in Germany between 2014 and 2017: a regional population based study with healthcare claims data. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06541-7. [PMID: 38888805 DOI: 10.1007/s00417-024-06541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE Little is known about the utilization of low vision services (LVS) in Germany. To understand which persons and how often these services would be utilized, this study aimed to investigate low vision aids (LVAs) provision in an urban setting and to describe user characteristics and trends in their characteristics. METHODS A retrospective study based on a population-based healthcare claims database in Cologne (N = ~ 500,000), Germany. The study population comprised individuals, who were continuously insured at four large statutory health insurers and who redeemed a prescription for visual aids or aids for blindness between January 2014 and December 2017. We examined their socio-demographic and clinical characteristics. Trends in characteristics were examined with logistic and linear regression models over time. RESULTS Out of ~ 500,000 persons, 781 unique individuals (~ 0.2%) redeemed an LVA prescription. They were mainly female (68.7%), 60 years or older (75.3%) and had macular degeneration (50.6%) and/or glaucoma (25.9%). In the working-age subgroup, 33.8% were employed. Visual aids were most often prescribed (74.1%) and of all types of LVAs, individuals most commonly redeemed a prescription for magnifiers (35.8%), screen readers (34.3%) and/or canes (17.1%). Of the entire study population, 75.4% received their prescription from an ophthalmologist, 5.3% from a general practitioner and 7.1% from other medical specialists. Significant trends in characteristics of individuals who redeemed an LVA prescription were not found. CONCLUSIONS Between 2014 and 2017, 781 individuals in Cologne redeemed an LVA prescription. They had characteristics which mostly can be explained by the epidemiology of VI. Results indicate that individuals that redeemed LVAs have a magnification requirement of ≥ 1.5-fold and ≥ 6-fold. Furthermore, next to ophthalmologists, general practitioners and other medical specialists seem to play a role in LVA provision as well, which should be taken into account by policy makers when planning interventions for increasing LVS provision. Our findings provide a starting point to examine LVS provision in Germany.
Collapse
Affiliation(s)
- M L Stolwijk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, The Netherlands.
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - I Meyer
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S L van der Pas
- Amsterdam UMC, Vrije Universiteit, Epidemiology and Data Science, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - J W R Twisk
- Amsterdam UMC, Vrije Universiteit, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - R M A van Nispen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - G H M B van Rens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Hanna K, Lomas E, Rimmer S, Rowe F. Perceptions of vision care following neurological impairment: a qualitative study. BMC Health Serv Res 2024; 24:626. [PMID: 38745300 PMCID: PMC11095032 DOI: 10.1186/s12913-024-11079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Visual impairment is a common consequence of neurological impairments, and can impact a person's ability to undertake everyday tasks, affecting their confidence and mental health. Previous qualitative research in the UK has shown inequalities to exist where patients are accessing vision care after stroke, but little is known around the experiences of accessing vision care following other neurological impairments, and a lack of national guidelines prevent standardised care planning. The aim of this qualitative study is to explore the perceptions of vision care after neurological impairment, and to identify possible inequalities and support mechanisms, where it has been possible to access vision care. METHODS University ethical approval was obtained, and adults with a visual impairment as a result of a neurological impairment were offered an in-depth interview to explore their vision care experiences. Data were collected between April and November 2021 and analysed using iterative, thematic analysis (TA), informed by a social constructionist ideology. RESULTS Seventeen participants were recruited. Three overarching themes were conceptualised in relation to the participants' perception of vision care: Making sense of the visual impairment; The responsibility of vision care; and Influential factors in care quality perception. CONCLUSION Inequalities were noted by participants, with most reporting a lack of suitable vision care offered as part of their neurological rehabilitation. Participants were thus burdened with the task of seeking their own support online, and encountered inaccurate and worrying information in the process. Participants noted changes in their identity, and the identity of their family carers, as they adjusted to their vision loss. The findings from this research highlight a need for clinicians to consider the long-term impact of vision loss after neurological impairment, and ensure patients are provided with adequate support and information, and appropriate referral pathways, alleviating this patient burden.
Collapse
Affiliation(s)
- Kerry Hanna
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Elizabeth Lomas
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK
| | - Stephen Rimmer
- Patient and Public Involvement Representative, Liverpool, UK
| | - Fiona Rowe
- Institute of Population Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
4
|
van Munster EPJ, van Nispen RMA, Hoogland J, van der Aa HPA. Feasibility and potential effectiveness of the IdentifEYE training programmes to address mental health problems in adults with vision impairment. Ophthalmic Physiol Opt 2024; 44:399-412. [PMID: 38063259 DOI: 10.1111/opo.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Two training programmes about depression and anxiety in adults with vision impairment were developed to support eye care practitioners (ECPs) and low vision service (LVS) workers in identifying and discussing mental health problems. The purpose of this study was to evaluate the training programmes' potential effectiveness and feasibility. METHODS The training programmes were offered to ECPs (n = 9) and LVS workers (n = 17). All participants completed surveys pre-, mid- and post-training, and at a 4 week follow-up about the training programmes' content, effectiveness, feasibility and implementation. The Kirkpatrick model was used as a theoretical framework; linear mixed models were used to determine the potential effectiveness, and outcomes were explored during three focus group meetings. RESULTS Expectations were met in the majority of the participants (84.6%). Post-training, both ECPs and LVS workers reported increased confidence (β = 3.67, confidence interval (CI): 0.53-6.80; β = 4.35, CI: 1.57 to 7.14, respectively) and less barriers (β = -3.67, CI: -6.45 to -0.89; β = -1.82, CI: -4.56 to 0.91). Mental health problems were more likely addressed in both the groups (ECP β = 2.22, CI: -0.17 to 4.62; LVS β = 4.18, CI: 2.67 to 5.68), but these effects did not last in ECPs (β = -3.22, CI: -7.37 to 0.92). Variations of these learning effects between individual participants were found within both the groups, and LVS workers indicated a need to focus on their own profession. Participants provided information on how to improve the training programmes' feasibility, effectiveness and implementation. CONCLUSION The training programmes seemed feasible and potentially effective. Transfer of the lessons learned into daily practice could be enhanced by, for example, specifying the training programmes for healthcare providers with the same profession, introducing microlearning and incorporating mental health management into organisation policies.
Collapse
Affiliation(s)
- Edine P J van Munster
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
| | - Jeroen Hoogland
- Epidemiology & Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
- The Lighthouse Guild NYC, New York, New York, USA
| |
Collapse
|
5
|
van Munster EPJ, van Nispen RMA, Nollett CL, Holloway EE, Maarsingh OR, Heymans MW, van der Aa HPA. Discussing depression in patients with visual impairment differs across countries: Validation of a prediction model in healthcare providers. Acta Ophthalmol 2023; 101:766-774. [PMID: 36959419 DOI: 10.1111/aos.15663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Healthcare providers often experience difficulties in discussing depression with adults with visual impairment (VI), obstructing timely referral. The purpose of this study was to examine predictors of routine discussions of depression with adults with VI from the perspective of different healthcare providers from different countries. METHODS Cross-sectional survey data from Welsh (N = 122), Australian (N = 94) and Dutch (N = 100) healthcare providers, that is eye care practitioners (ECPs) and low-vision care providers (LVCPs), were analysed. Multivariable logistic regression analysis was performed in the Welsh sample to determine predictors for discussing depression. Internal validation was conducted by using a bootstrap method, and the recalibrated model was externally validated in the Australian and Dutch sample. RESULTS Work experience in eye care services (OR 0.95; 95% confidence interval (CI) 0.92 to 0.99) and perceived barriers (OR 0.95; 95% CI 0.92 to 0.98) was found to predict discussing depression with patients. The area under the curve (AUC) of 0.73 reflected good discrimination of the model. The model showed a slightly better fit in the Australian sample (AUC = 0.77), but a poor fit in the Dutch sample. CONCLUSION The final prediction model was not generalizable to Dutch healthcare providers. They perceived less barriers in depression management than Welsh and Australian healthcare providers. This could be explained by differences in ECPs and LVCPs roles and responsibilities, increased attention on mental health and differences in organizing health care. Differences between healthcare providers' responsibilities and support needs should be taken into account while creating a facilitating environment to discuss depression.
Collapse
Affiliation(s)
- Edine P J van Munster
- Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
| | | | - Edith E Holloway
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Otto R Maarsingh
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology & Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
- Robert Coppes Foundation, Expertise Innovation and Knowledge, Vught, the Netherlands
- The Lighthouse Guild NYC, New York City, New York, USA
| |
Collapse
|
6
|
Besagar S, Yonekawa Y, Sridhar J, Finn A, Padovani-Claudio DA, Sternberg P, Patel S. Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US. JAMA Ophthalmol 2022; 140:1219-1226. [PMID: 36326732 PMCID: PMC9634598 DOI: 10.1001/jamaophthalmol.2022.4566] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Importance Approximately 13% of US adults are affected by visual disability, with disproportionately higher rates in groups impacted by certain social determinants of health (SDOH). Objective To evaluate SDOH associated with severe visual impairment (SVI) to ultimately guide targeted interventions to improve ophthalmic health. Design, Setting, and Participants This quality improvement study used cross-sectional data from a telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) that was conducted in the US from January 2019 to December 2020. Participants were noninstitutionalized adult civilians who were randomly selected and interviewed and self-identified as "blind or having serious difficulty seeing, even while wearing glasses." Exposures Demographic and health care access factors. Main Outcomes and Measures The main outcome was risk of SVI associated with various factors as measured by odds ratios (ORs) and 95% CIs. Descriptive and logistic regression analyses were performed using the Web Enabled Analysis Tool in the BRFFS. Results During the study period, 820 226 people (53.07% female) participated in the BRFSS survey, of whom 42 412 (5.17%) self-identified as "blind or having serious difficulty seeing, even while wearing glasses." Compared with White, non-Hispanic individuals, risk of SVI was increased among American Indian/Alaska Native (OR, 1.63; 95% CI, 1.38-1.91), Black/African American (OR, 1.50; 95% CI, 1.39-1.62), Hispanic (OR, 1.65; 95% CI, 1.53-1.79), and multiracial (OR, 1.33; 95% CI, 1.15-1.53) individuals. Lower annual household income and educational level (eg, not completing high school) were associated with greater risk of SVI. Individuals who were out of work for 1 year or longer (OR, 1.78; 95% CI, 1.54-2.07) or who reported being unable to work (OR, 2.90; 95% CI, 2.66-3.16) had higher odds of SVI compared with the other variables studied. Mental health diagnoses and 14 or more days per month with poor mental health were associated with increased risk of SVI (OR, 1.87; 95% CI, 1.73-2.02). Health care access factors associated with increased visual impairment risk included lack of health care coverage and inability to afford to see a physician. Conclusions and Relevance In this study, various SDOH were associated with SVI, including self-identification as being from a racial or ethnic minority group; low socioeconomic status and educational level; long-term unemployment and inability to work; divorced, separated, or widowed marital status; poor mental health; and lack of health care coverage. These disparities in care and barriers to health care access should guide targeted interventions.
Collapse
Affiliation(s)
- Sonya Besagar
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Avni Finn
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul Sternberg
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
7
|
Volz HP, Stirnweiß J, Kasper S, Möller HJ, Seifritz E. Subthreshold depression - concept, operationalisation and epidemiological data. A scoping review. Int J Psychiatry Clin Pract 2022; 27:92-106. [PMID: 35736807 DOI: 10.1080/13651501.2022.2087530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: In diagnostic systems (e.g., DSM-5, ICD-10), depression is defined categorically. However, the concept of subthreshold depression (SD) has gained increasing interest in recent years. The purpose of the present paper was to review, based on a scoping review, the relevant papers in this field published between October 2011 and September 2020.Materials and methods: Of the 1,160 papers identified, 64 records could be included in further analysis. The scoping review was conducted using both electronic and manual methods.Results: The main result of the analysis is that the operationalisation criteria used are highly heterogeneous, which also leads to very heterogenous epidemiological data.Conclusions: Clear conclusions are not possible scrutinising the reported results. Most definitions seem to be arbitrary, with considerable overlap (e.g., between SD and minor depression). The review also revealed that the impact of SD on quality of life and related parameters appear to be in the range of the respective impact of major depression (MD) and therapeutic approaches might be helpful for SD and also for the prevention of conversion from SD to MD. Keeping the presented difficulties in mind, a proposal for the definition of SD is made in the present paper in order to facilitate the discussion leading to more homogeneous criteria.
Collapse
Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Johanna Stirnweiß
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics. Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
8
|
van Munster EPJ, van der Aa HPA, Verstraten P, Heymans MW, van Nispen RMA. Improved intention, self-efficacy and social influence in the workspace may help low vision service workers to discuss depression and anxiety with visually impaired and blind adults. BMC Health Serv Res 2022; 22:528. [PMID: 35449055 PMCID: PMC9027071 DOI: 10.1186/s12913-022-07944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Depression and anxiety are common in visually impaired and blind adults, but often remain untreated in those who receive support from low vision service (LVS) organizations. This study aims to determine factors associated with discussing mental health by LVS workers. Methods A self-administered cross-sectional survey in one hundred LVS workers was performed. Data on current practice, symptom attribution, and determinants of the Integrated Change Model (i.e. predisposing and environmental factors, awareness, attitude, self-efficacy, social influence, confidence and barriers) were investigated. Multivariable logistic regression analysis was performed to determine predictors of discussing mental health problems in this population. Subsequently, internal validation was conducted using a bootstrapping method. Results Around 80% of the participants often discussed mental health with clients. Five factors were found to predict discussion of mental health: female gender (OR = 4.51; 95% confidence interval (CI) 0.98 to 21.61), higher education (OR = 3.39; CI 1.19 to 9.66), intention to discuss mental health problems (OR = 3.49; CI 1.20 to 10.15), higher self-efficacy (OR = 1.11; CI 1.02 to 1.20), and higher perceived social influence (OR = 1.15; CI 1.05 to 1.27). Good discrimination after internal validation was reflected by the area under the curve (0.850). Conclusions Previous studies indicate clients want healthcare providers to initiate discussions about mental health. However, still 20% of LVS workers do not discuss suspected depression or anxiety. In order to improve this, LVS organizations could address mental health as part of their care and provide training to ensure intention to discuss mental health problems, improve self-efficacy and create a supportive environment between colleagues. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07944-0.
Collapse
Affiliation(s)
- Edine P J van Munster
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, the Netherlands. .,Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands. .,Robert Coppes Foundation, Expertise, Innovation and Knowledge, Vlasmeersestraat 38-A, Vught, the Netherlands.
| | - Hilde P A van der Aa
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, the Netherlands.,Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands.,Robert Coppes Foundation, Expertise, Innovation and Knowledge, Vlasmeersestraat 38-A, Vught, the Netherlands.,The Lighthouse Guild NYC, 250 W 64th St, New York, USA
| | - Peter Verstraten
- Robert Coppes Foundation, Expertise, Innovation and Knowledge, Vlasmeersestraat 38-A, Vught, the Netherlands
| | - Martijn W Heymans
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, the Netherlands.,Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Stolwijk ML, Nispen RMA, Verburg IWM, Gerwen L, Brug T, Rens GHMB. Trends in low vision service utilisation: A retrospective study based on general population healthcare claims. Ophthalmic Physiol Opt 2022; 42:828-838. [PMID: 35661209 PMCID: PMC9325458 DOI: 10.1111/opo.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Purpose To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands. Methods A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio‐demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time. Results A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio‐economic status and lived in urban areas (68%). Between 2015–2018, significant downward trends were found for treatment with intravitreal injections and lens‐related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time. Conclusion The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens‐related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non‐users further.
Collapse
Affiliation(s)
- Miriam L Stolwijk
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Ruth M A Nispen
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Lieke Gerwen
- Healthcare Information Center Vektis CV Zeist the Netherlands
| | - Tim Brug
- Epidemiology and Data Science Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Ger H M B Rens
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| |
Collapse
|
10
|
Elsman EBM, van Munster EPJ, van Nassau F, Verstraten P, van Nispen RMA, van der Aa HPA. Perspectives on Implementing the Patient Health Questionnaire-4 in Low-Vision Service Organizations to Screen for Depression and Anxiety. Transl Vis Sci Technol 2022; 11:16. [PMID: 35024786 PMCID: PMC8762693 DOI: 10.1167/tvst.11.1.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the process of implementing a screening questionnaire for depression and anxiety, the Patient Health Questionnaire-4 (PHQ-4), in low-vision service (LVS) organizations. Methods This study consisted of three parts: (1) a usability study combined with semistructured interviews, in which clients (n = 10) of LVS organizations expressed their preference for using the PHQ-4; (2) a feasibility study, in which the PHQ-4 was implemented on a small scale and its use was evaluated, involving health care providers (n = 6) and clients (n = 9); and (3) semistructured interviews to identify barriers and facilitators for implementing the PHQ-4 according to health care providers (n = 6) and managers (n = 4) of LVS organizations. Results were integrated into themes and linked to constructs of the Consolidated Framework for Implementation Research (CFIR). Results Six themes were derived from the substudies: (1) quality of the intervention, (2) applicability for clients of LVS organizations, (3) attitude and needs of clients, (4) attitude of health care providers, (5) support within LVS organizations, and (6) embedment in current practice. Results could be linked to 12 CFIR constructs. The constructs "relative advantage," "patient needs and resources," and "available resources" emerged most prominently in our themes as either barrier or facilitator. Conclusions The PHQ-4 seems an appropriate screening instrument for use in LVS organizations because of its quality and adaptable use. It might provide opportunities to timely detect depression and anxiety, but challenges in implementing the PHQ-4 should be considered. Translational Relevance Barriers and facilitators for implementing the PHQ-4 may also apply to implementing other questionnaires in LVS organizations.
Collapse
Affiliation(s)
- Ellen B M Elsman
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Edine P J van Munster
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter Verstraten
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| |
Collapse
|
11
|
van Munster EPJ, van der Aa HPA, Verstraten P, van Nispen RMA. Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study. BMC Health Serv Res 2021; 21:749. [PMID: 34320953 PMCID: PMC8317369 DOI: 10.1186/s12913-021-06682-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI) or blindness. The purpose of this study was to explore visually impaired and blind adults' views on facilitators and barriers in recognizing and discussing mental health problems. METHODS Semi-structured interviews, based on the Integrated Model for Change, were conducted with 16 visually impaired or blind adults receiving support from three Dutch low vision service organizations. Interview data was analyzed using the framework approach. RESULTS Participants perceived their focus on practical support with regard to their VI, lack of mental health literacy, and misattribution of symptoms of depression or anxiety as barriers for recognizing mental health problems. With regard to discussing mental health problems, they perceived difficulties in acknowledging their VI and mental health problems due to feelings of vulnerability and inequality. Participants mentioned that their social support system and healthcare providers (could) facilitate them in recognizing and discussing mental health problems. However, participants thought that healthcare providers currently often lacked the knowledge, skills and attitude to recognize and discuss this topic with their clients. CONCLUSION Our findings suggest that visually impaired and blind adults may experience several barriers to recognize, acknowledge and discuss mental health. Healthcare providers and social support systems seem essential for them in reducing these barriers. However, there might be a mismatch between the needs of visually impaired and blind adults and healthcare providers' knowledge, skills and attitude. Training healthcare providers may improve detection of depression and anxiety in adults with VI or blindness, and enhance clinician-patient communication on mental health.
Collapse
Affiliation(s)
- Edine P. J. van Munster
- Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Hilde P. A. van der Aa
- Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Peter Verstraten
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Ruth M. A. van Nispen
- Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Parravano M, Petri D, Maurutto E, Lucenteforte E, Menchini F, Lanzetta P, Varano M, van Nispen RMA, Virgili G. Association Between Visual Impairment and Depression in Patients Attending Eye Clinics: A Meta-analysis. JAMA Ophthalmol 2021; 139:753-761. [PMID: 34042966 PMCID: PMC8160932 DOI: 10.1001/jamaophthalmol.2021.1557] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients. OBJECTIVE To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services. DATA SOURCES MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched. STUDY SELECTION Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy. DATA EXTRACTION AND SYNTHESIS Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Proportion of depression. RESULTS A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51). CONCLUSIONS AND RELEVANCE The results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.
Collapse
Affiliation(s)
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Erica Maurutto
- Department of Medicine–Ophthalmology, University of Udine, Udine, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Paolo Lanzetta
- Department of Medicine–Ophthalmology, University of Udine, Udine, Italy
| | | | - Ruth M. A. van Nispen
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Firenze and Careggi University Hospital, Florence, Italy
- Centre for Public Health, Queen’s University of Belfast, Belfast, United Kingdom
| |
Collapse
|
13
|
Simning A, Caprio TV, Li Y, Conwell Y. Near Vision but not Hearing Loss is Associated with Lacking a Usual Source of Health Care. J Aging Health 2021; 33:786-797. [PMID: 33914652 DOI: 10.1177/08982643211014323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Sensory loss may be a barrier to accessing healthcare services, and this study seeks to examine the association of sensory loss with whether older adults report having a usual source of health care. Methods: Our study included 7548 older adults who participated in the National Health and Aging Trends Study in 2015. Having a self-reported usual source of health care was our outcome, and hearing and vision loss were our primary independent variables. Results: In multivariate analysis accounting for demographics, socioeconomic, health status, and environmental covariates, near vision loss but not distance vision or hearing loss was associated with decreased odds of having a usual source of health care. Discussion: That older adults with near vision loss were less likely to report having a usual source of health care is concerning. Examining barriers to care is needed to identify sensory loss-relevant processes to optimize and intervene upon.
Collapse
Affiliation(s)
- Adam Simning
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Thomas V Caprio
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Department of Public Health Sciences, 6927University of Rochester, NY, USA.,Division of Geriatrics, Department of Medicine, 6927University of Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, 6927University of Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, 6927University of Rochester, NY, USA.,Office for Aging Research and Health Services, 6927University of Rochester, NY, USA
| |
Collapse
|
14
|
Dillon L, Gandhi S, Tang D, Liew G, Hackett M, Craig A, Mitchell P, Keay L, Gopinath B. Perspectives of people with late age‐related macular degeneration on mental health and mental wellbeing programmes: a qualitative study. Ophthalmic Physiol Opt 2021; 41:255-265. [DOI: 10.1111/opo.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa Dillon
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Sarthak Gandhi
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
- Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Diana Tang
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Gerald Liew
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Maree Hackett
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
- Faculty of Health and Wellbeing University of Central Lancashire Preston United Kingdom
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research Northern Clinical School Faculty of Medicine and Health The University of Sydney St. Leonards Australia
| | - Paul Mitchell
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Lisa Keay
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Bamini Gopinath
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| |
Collapse
|
15
|
Choi S, Seo J. Trends in Healthcare Research on Visual Impairment and Blindness: Use of Bibliometrics and Hierarchical Cluster Analysis. Ophthalmic Epidemiol 2020; 28:277-284. [PMID: 33380253 DOI: 10.1080/09286586.2020.1863993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Individuals with visual impairments and blindness who are marginalized in healthcare systems are located at the intersection of low accessibility for healthcare services and health-related information. To uncover recent trends in vision healthcare research, this study employed a text mining approach to literature analysis.Methods: A total of 506 journal articles published between January 2000 and April 2020 were collected from the Web of Science database. To investigate the main research themes and evolving trends, bibliometric and hierarchical cluster analyses were performed using R software.Results: Although the number of articles per year fluctuated in the past two decades, the findings of this study indicate a growing interest in visual impairment healthcare research. The United States contributed 32.3% to the overall output followed by the United Kingdom (16.7%). The prolific journals were Ophthalmic Epidemiology (4.7%), British Journal of Ophthalmology (4.4%), and JAMA Ophthalmology (3.4%). By using a hierarchical clustering algorithm, the 10 main research topics were estimated.Conclusions: Given the increasing prevalence of visual impairment in an aging society, an understanding of the current knowledge structure in scientific literature is essential for innovating on the existing healthcare system. The results of this study can guide researchers to discover the unexplored research areas and provide new directions for future work.
Collapse
Affiliation(s)
- Soyoung Choi
- College of Nursing,The Pennsylvania State University, University Park, Pennsylvania, USA
| | - JooYoung Seo
- Learning, Design, and Technology,The Pennsylvania State University, University Park, Pennsylvania, USA
| |
Collapse
|
16
|
Demmin DL, Silverstein SM. Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clin Ophthalmol 2020; 14:4229-4251. [PMID: 33299297 PMCID: PMC7721280 DOI: 10.2147/opth.s258783] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. Patients and methods A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. Results Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. Conclusion In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.
Collapse
Affiliation(s)
- Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester, Rochester, NY, USA
| |
Collapse
|
17
|
Thier A, Holmberg C. The patients' view: age-related macular degeneration and its effects - a meta-synthesis. Disabil Rehabil 2020; 44:661-671. [PMID: 32574120 DOI: 10.1080/09638288.2020.1775901] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: The aim of this meta-synthesis is to find out what it means for patients with age-related macular degeneration to live with visual impairment, how they cope with the illness and how they experience their medical care, including vascular endothelial growth factor inhibitor therapy.Method: Inclusion criteria: qualitative studies exploring patients' experiences with age-related macular degeneration in their daily lives and with medical care, published in journals in English or German. The included studies were analysed following the rules and principles of grounded theory.Results: For the analysis, twenty-four articles matching the inclusion criteria were identified. Three main analytic themes emerged from the included studies: (i) a life shaped by losses; (ii) the burden of medical treatment; and (iii) coping with vision loss. For patients, visual impairment/vision loss means living with multiple losses in various domains of life. With the introduction of vascular endothelial growth factor inhibitor therapy, patients with neovascular age-related macular degeneration have a good chance of slowing down the disease progression; therapy does, however, also represent a major burden.Conclusion: New strategies need to be conceived to reduce the burden of medical treatment and to improve the dissemination of information about age-related macular degeneration.IMPLICATIONS FOR REHABILITATIONMost of the people with age- related macular degeneration seem to adapt to visual impairment.Medical treatment implies a great physical and psychological burden for patients with neovascular (wet) age- related macular degeneration.The physical and psychological burden needs to be recognized and addressed in the management of patients with neovascular (wet) AMD in medical facilities.More research is needed on how rehabilitation services may support the adaptation process of patients in the different stages of AMD.
Collapse
Affiliation(s)
- Anne Thier
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam
| |
Collapse
|
18
|
Roche YSB, Chur-Hansen A. Knowledge, skills, and attitudes of psychologists working with persons with vision impairment. Disabil Rehabil 2019; 43:621-631. [PMID: 31293173 DOI: 10.1080/09638288.2019.1634155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Psychologists working with persons with vision impairment face unique challenges in providing psychological services, including mental health care and cognitive assessments. While existing competency guidelines for general disability and rehabilitation psychology are relevant to working with persons with vision impairment in many ways, specific competencies are needed. Previous psychological research into the provision of therapy for persons with vision impairment has focused mainly on communication and intervention strategies and lacks input from the vision-impaired community. MATERIALS AND METHODS This qualitative study, grounded in disability, rehabilitation psychology, and competency frameworks aimed to identify the knowledge, skills, and attitudes necessary for psychologists working with persons with vision impairment. RESULTS Through triangulating responses from both registered psychologists (N = 10) and persons with vision impairment (N = 5), a thematic analysis identified 29 competencies under six major themes, including: Expertise, Impact, Approach, Collaboration, Assessment, and Flexibility. Competencies were discretely categorized as knowledge, skills, or attitudes. CONCLUSIONS This study provides data that may be used as the basis for more rigorous research into identifying areas for vision impaired-specific competency-based training in undergraduate, postgraduate, and professional psychology curricula.Implications for rehabilitationWhilst competencies for disability and rehabilitation psychology already exist, the competencies for psychologists working with persons with vision impairment require updating, informed by both practitioners and clients with vision impairment.These competencies include: knowledge of eye conditions and pathologies; knowledge of the variation in impact of vision loss; general knowledge about vision loss and normal lifespan development; and, the ability to assess the specific impact of vision loss on the individual.Other skills and attitudes, such as oral communication skills and relaying hope and optimism, whilst necessary for all therapeutic encounters, may require particular modification when working with vision-impaired persons.Educators responsible for professional postgraduate courses in psychology should ensure that training incorporates an understanding of the need to modify approaches for particular groups of clients, such as those with vision impairment.
Collapse
Affiliation(s)
| | - Anna Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, Australia
| |
Collapse
|
19
|
Abstract
UNLABELLED ABSTRACTObjectives:To examine the longitudinal risk of vision loss (VL) or hearing loss (HL) for experiencing suicidal ideation in older adults. DESIGN The Three-City study, examining data from three waves of follow-up (2006-2008, 2008-2010, and 2010-2012). SETTING Community-dwelling older French adults. PARTICIPANTS N = 5,438 adults aged 73 years and over. MEASUREMENTS Suicidality was assessed by the Mini-International Neuropsychiatric Interview, Major Depressive Disorder module. Mild VL was defined as Parinaud of 3 or 4 and severe VL as Parinaud >4. Mild HL was self-reported as difficulty understanding a conversation and severe HL as inability to understand a conversation. RESULTS Severe VL was associated with an increased risk of suicidal ideation at baseline (OR = 1.59, 95% CIs = 1.06-2.38) and over five years (OR = 1.65, 95% CIs = 1.05-2.59). Mild and severe HL were associated with an increased risk of suicidal ideation, both at baseline (OR = 1.29, 95% CIs = 1.03-1.63; OR = 1.78, 95% CIs = 1.32-2.40) and over five years (OR = 1.47, 95% CIs = 1.17-1.85; OR = 1.97, 95% CIs = 1.44-2.70). CONCLUSION Sensory losses in late life pose a risk for suicidal ideation. Suicidality requires better assessment and intervention in this population.
Collapse
|
20
|
Cosh S, von Hanno T, Helmer C, Bertelsen G, Delcourt C, Schirmer H. The association amongst visual, hearing, and dual sensory loss with depression and anxiety over 6 years: The Tromsø Study. Int J Geriatr Psychiatry 2018; 33:598-605. [PMID: 29193338 DOI: 10.1002/gps.4827] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the longitudinal association of dual and single (vision and hearing) sensory loss on symptoms of depression and anxiety in older adults. METHODS Two thousand eight hundred ninety adults aged 60 years or over who participated in the longitudinal population-based Tromsø Study, Norway, were included. The impact of objective vision loss, self-report hearing loss, or dual sensory loss on symptoms of depression and anxiety, as assessed by the Hopkins Symptom Checklist 10, was examined at baseline and 6-year follow-up using linear mixed models. RESULTS Hearing loss had a cross-sectional relationship with increased depression (b = 0.1750, SE = 0.07, P = .02) and anxiety symptoms (b = 0.1765, SE = 0.08, P = .03); however, these relationships were not significant at the 6-year follow-up. Both vision loss only and dual sensory loss predicted increased depression scores at follow-up (b = 0.0220, SE = 0.01, P = .03; and b = 0.0413, SE = 0.02, P = .01, respectively). Adjustment for social isolation did not attenuate the main depression results. CONCLUSION Dual sensory loss resulted in increased depression symptomatology over time and posed an additional long-term risk to depression severity beyond having a single sensory loss only. Only hearing loss is associated with anxiety symptoms. Older adults with vision, hearing, and dual sensory loss have different mental health profiles. Therefore, management and intervention should be tailored to the type of sensory loss.
Collapse
Affiliation(s)
- S Cosh
- Bordeaux Population Health Research Center, team LEHA, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - T von Hanno
- Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway (UiT), Tromsø, Norway.,Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - C Helmer
- Bordeaux Population Health Research Center, team LEHA, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - G Bertelsen
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway (UiT), Tromsø, Norway.,Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - C Delcourt
- Bordeaux Population Health Research Center, team LEHA, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - H Schirmer
- Department of Clinical Medicine, Cardiovascular Research Group (UNN), The Arctic University of Norway (UiT), Tromsø, Norway
| | | |
Collapse
|
21
|
Guo C, Wang Z, Li N, Chen G, Zheng X. Comorbid Visual and Psychiatric Disabilities Among the Chinese Elderly: A National Population-Based Survey. Curr Eye Res 2017; 42:1733-1737. [PMID: 29083235 DOI: 10.1080/02713683.2017.1315143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence of, and association between, co-morbid visual and psychiatric disabilities among elderly (>65 years-of-age) persons in China. METHODS Random representative samples were obtained using multistage, stratified, cluster sampling, with probabilities proportional to size. Standard weighting procedures were used to construct sample weights that reflected this multistage, stratified cluster sampling survey scheme. Logistic regression models were used to elucidate associations between visual and psychiatric disabilities. RESULTS Among the Chinese elderly, >160,000 persons have co-morbid visual and psychiatric disabilities. The weighted prevalence among this cohort is 123.7 per 100,000 persons. A higher prevalence of co-morbid visual and psychiatric disabilities was found in the oldest-old (p<0.001); women (65-79 years-of-age, p=0.001; ≥80 years-of-age, p=0.004); illiterate (65-79 years-of-age, p<0.001; ≥80 years-of-age, p=0.02); and single elders (65-79 years-of-age, p=0.01; ≥80 years-of-age, p=0.001). Presence of a visual disability was significantly associated with a higher risk of having a psychiatric disability among persons aged ≥80 years-of-age [adjusted odds ratio, 1.24; 95% confidence interval (CI), 1.03-1.54]. CONCLUSION A significant number of Chinese elderly persons were living with co-morbid visual and psychiatric disabilities. To address the challenge of these co-morbid disorders among Chinese elders, it is incumbent upon the government to implement additional and more comprehensive prevention and rehabilitation strategies for health-care systems, reinforce health promotion among the elderly, and improve accessibility to health-care services.
Collapse
Affiliation(s)
- Chao Guo
- a Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science , Peking University , Beijing , China.,b APEC Health Science Academy , Peking University (HeSAY) , Beijing , China.,c Freeman Spogli Institute for International Studies , Stanford University , CA , USA
| | - Zhenjie Wang
- a Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science , Peking University , Beijing , China
| | - Ning Li
- a Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science , Peking University , Beijing , China
| | - Gong Chen
- a Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science , Peking University , Beijing , China.,b APEC Health Science Academy , Peking University (HeSAY) , Beijing , China
| | - Xiaoying Zheng
- a Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science , Peking University , Beijing , China.,b APEC Health Science Academy , Peking University (HeSAY) , Beijing , China
| |
Collapse
|
22
|
Heesterbeek TJ, van der Aa HPA, van Rens GHMB, Twisk JWR, van Nispen RMA. The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: a longitudinal prospective cohort study. Ophthalmic Physiol Opt 2017; 37:385-398. [PMID: 28516509 DOI: 10.1111/opo.12388] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/01/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE Depression and anxiety are highly prevalent in older adults with vision impairment. Because symptoms of depression and anxiety appear to fluctuate, it is important to identify patients who are at risk of developing these symptoms for early diagnosis and treatment. Therefore, the aim of this study was to determine the incidence of subthreshold depression and anxiety, and to investigate predictors of developing symptoms of depression and anxiety in older adults with vision impairment who had no subthreshold depression or anxiety at baseline. METHODS A longitudinal prospective cohort study with a follow-up of 24 months in 540 older adults with vision impairment (mean age 75 years, 56% female, 48% macular degeneration, 15% glaucoma) from outpatient low-vision rehabilitation organisations was performed. The cumulative incidences of subthreshold depression and anxiety were calculated and linear mixed models with maximum likelihood estimation were used to determine two prediction models. Main outcome measures were: fluctuations in (i) depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D) and (ii) anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety subscale, HADS-A). RESULTS The annual cumulative incidences of subthreshold depression and anxiety were 21.3% (95% Confidence Interval (CI) 18.7-23.9%) and 9.5% (95% CI 7.4-11.6%), respectively. Risk factors for developing depressive symptoms were: living alone, having just enough money to cover expenses, having macular degeneration, having problems with adaptation to vision loss, reduced health related quality of life, and experiencing symptoms of anxiety. For developing anxiety symptoms, a relatively younger age, experiencing symptoms of depression, not living alone and experiencing hindrance at work proved to be risk factors. CONCLUSIONS This study shows that the incidence of subthreshold depression and anxiety in older adults with vision impairment is twice as high compared with older adults in general and confirms that depression and anxiety symptoms fluctuate over time. It is of great importance that low vision rehabilitation staff monitor older adults with vision impairment who are most vulnerable for developing these symptoms, based on the risk factors that were found in this study, to be able to offer early interventions to prevent and treat mental health problems in this population.
Collapse
Affiliation(s)
- Thomas J Heesterbeek
- Department of Ophthalmology and EMGO & Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology and EMGO & Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, the Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology and EMGO & Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, the Netherlands.,Department of Ophthalmology, Elkerliek Hospital, Helmond, the Netherlands
| | - Johannes W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO & Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
23
|
Holloway E, Sturrock B, Lamoureux E, Keeffe J, Hegel M, Casten R, Mellor D, Rees G. Can we address depression in vision rehabilitation settings? Professionals' perspectives on the barriers to integrating problem-solving treatment. Disabil Rehabil 2016; 40:287-295. [PMID: 27868437 DOI: 10.1080/09638288.2016.1250172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR. METHODS Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC. Barriers and facilitators at the practitioner, client, intervention, and organizational level were identified with thematic analysis using a "theoretical" approach. RESULTS Prominent barriers were a lack of role recognition for PST-PC practitioners (n = 32), unmet client expectation with PST-PC (n = 28), dissatisfaction with telephone delivery (n = 27), and limited organizational awareness of PST-PC (n = 39). Facilitating factors included a recognized need for evidence-based psychological services (n = 28), clients experiencing benefits in early sessions (n = 38), PST-PC promoting practical skills (n = 26), and comprehensive PST-PC training (n = 36). CONCLUSIONS PST-PC may provide an accessible early intervention for LVR clients with depressive symptoms. Ongoing practitioner training, clinical support, and screening potential LVR clients for treatment suitability are likely to enhance delivery in this setting. Implications for rehabilitation Depression is highly prevalent in adults engaged in low vision rehabilitation (LVR) programs, yet few receive support. Clinical guidelines recommend integrated models of care be offered within rehabilitation settings as early intervention for mild to moderate levels of depressive symptoms. Integrated telephone-based problem-solving treatment for primary care (PST-PC) delivered by trained LVR practitioners is a practical, skills-based model that has potential to increase access to an early psychological intervention in LVR clients with depressive symptoms. LVR clients are often older in age, have multiple comorbid health conditions and a significant level of functional disability, requiring flexibility in the delivery of PST-PC and specialized staff training, and support in working with older and more complex clients.
Collapse
Affiliation(s)
- Edith Holloway
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
| | - Bonnie Sturrock
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
| | - Ecosse Lamoureux
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia.,c Singapore Eye Research Institute , National University of Singapore , Singapore.,d Duke-National University of Singapore Medical School , Singapore
| | - Jill Keeffe
- e LV Prasad Eye Institute , Hyderabad , India
| | - Mark Hegel
- f Department of Psychiatry , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
| | - Robin Casten
- g Department of Psychiatry and Human Behavior , Thomas Jefferson University , Philadelphia , PA , USA
| | - David Mellor
- h School of Psychology , Deakin University , Melbourne , Australia
| | - Gwyneth Rees
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
| |
Collapse
|
24
|
[Internet search for counseling offers for older adults suffering from visual impairment]. Ophthalmologe 2016; 113:933-942. [PMID: 27311708 DOI: 10.1007/s00347-016-0276-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Visual impairment is a relevant problem of aging. In many cases promising therapeutic options exist but patients are often left with visual deficits, which require a high degree of individualized counseling. This article analyzed which counseling offers can be found by patients and relatives using simple and routine searching via the internet. METHOD Analyses were performed using colloquial search terms in the search engine Google in order to find counseling options for elderly people with visual impairments available via the internet. RESULTS With this strategy 189 offers for counseling were found, which showed very heterogeneous regional differences in distribution. The counseling options found in the internet commonly address topics such as therapeutic interventions or topics on visual aids corresponding to the professions offering rehabilitation most present in the internet, such as ophthalmologists and opticians. Regarding contents addressing psychosocial and help in daily tasks, self-help and support groups offer the most differentiated and broadest spectrum. Support offers for daily living tasks and psychosocial counseling from social providers were more difficult to find with these search terms despite a high presence in the internet. DISCUSSION There are a large number of providers of counseling and consulting for older persons with visual impairment. In order to be found more easily by patients and to be recommended more often by ophthalmologists and general practitioners, the presence of providers in the internet must be improved, especially providers of daily living and psychosocial support offers.
Collapse
|
25
|
Cimarolli VR, Casten RJ, Rovner BW, Heyl V, Sörensen S, Horowitz A. Anxiety and depression in patients with advanced macular degeneration: current perspectives. Clin Ophthalmol 2015; 10:55-63. [PMID: 26766899 PMCID: PMC4699633 DOI: 10.2147/opth.s80489] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.
Collapse
Affiliation(s)
| | - Robin J Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Psychiatry, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vera Heyl
- Institute of Special Education, University of Education, Heidelberg, Germany
| | - Silvia Sörensen
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, USA; Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, NY, USA
| |
Collapse
|
26
|
van der Aa HPA, van Rens GHMB, Comijs HC, Margrain TH, Gallindo-Garre F, Twisk JWR, van Nispen RMA. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ 2015; 351:h6127. [PMID: 26597263 PMCID: PMC4655616 DOI: 10.1136/bmj.h6127] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY QUESTION Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? METHODS 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months' follow-up. STUDY ANSWER AND LIMITATIONS 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes. WHAT THIS STUDY ADDS Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety. FUNDING, COMPETING INTERESTS, DATA SHARING Funded by ZonMw InZicht, the Dutch Organisation for Health Research and Development-InSight Society. There are no competing interests. Full dataset and statistical code are available from the corresponding author.Study registration www.trialregister.nl NTR3296.
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Hannie C Comijs
- Department of Psychiatry VUmc/GGZinGeest, 1081HL Amsterdam, Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Francisca Gallindo-Garre
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| |
Collapse
|