Consulting may prevent depression after vision loss

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Patients with age-related macular degeneration, a frequent cause of vision loss in the elderly, are less likely to develop depressive disorders in the short-term if they’re taught problem-solving skills, new study findings suggest. However, the benefits don’t seem to be maintained over time.

Age-related macular degeneration often leads to “irreversible vision loss, disability, and depression,” write Dr. Barry W. Rovner, of Jefferson Medical College, Philadelphia, Pennsylvania, and colleagues. However, depression in these patients is rarely diagnosed or treated in during visits to the eye doctor. 

The researchers examined whether problem-solving treatment could prevent depressive disorders in patients with recent vision loss. Problem-solving treatment is “a manual-driven psychological treatment” that teaches problem-solving skills: defining problems, setting realistic goals, implementing solutions, and evaluating outcomes.

Included in the study were 206 patients at least 65 years of age who were recently diagnosed with age-related macular degeneration in one eye and had pre-existing macular degeneration in the other eye. The patients were randomly assigned to problem-solving treatment or to the usual care. Therapists conducted 6 problem-solving sessions over 8 weeks in the patients’ homes.

After 2 months, the team assessed the short-term treatment effects, and after 6 months, evaluated the maintenance effects. The main outcome measures included diagnoses of major or minor depression, as defined by the Diagnostic and Statistical Manuel-IV; scores on the National Eye Institute Vision Function Questionnaire-17; and the number of patients who had to relinquish activities that were important to them.

At 2 months, the incidence of depressive disorders was significantly lower in problem-solving group compared with the control group—11.6 percent versus 23.2 percent, respectively. The researcher estimated that patients in the problem-solving group were 61 percent less likely to develop a depressive order compared with the control group. The number of patients needed to treat to prevent one case of depression was nine.

The odds of having to give up a valued activity were also significantly reduced with problem-solving treatment. The investigators found that this probably mediated the relationship between problem-solving treatment and depression.

The changes in scores on the National Eye Institute Vision Function Questionnaire-17, a subjective measure of vision-related task difficulty, showed that the problem-solving group improved according to patients’ subjective reports, despite the fact that there were no changes in visual acuity. There were also no changes in acuity among the control patients, but these subjects did report declines in their ability to perform vision-related tasks, Rovner’s team reports.

Most short-term benefits had diminished by 6 months, although subjects in the problem-solving group were less likely to suffer persistent depression. “Booster or rescue treatments may be necessary to sustain problem-solving treatment’s preventative effect,” the investigators conclude.

SOURCE: Archives of General Psychiatry, August 2007.

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