Self-care tools to treat depressive symptoms in patients with age-related eye disease

Abstract

Purpose : Depression is a common problem in people with age-related macular degeneration (AMD) and diabetic retinopathy (DR). Antidepressants and psychotherapy are often underutilized. Self-care tools have shown efficacy in some trials although many have been done in young, volunteer populations and none in those with limited vision. Our goal was to determine if self-care tools plus limited telephone support could reduce depressive symptoms.

Methods : A single-blind randomized controlled clinical trial is being conducted at Maisonneuve-Rosemont Hospital in Montreal, Canada. All eligible patients are invited to participate in the trial. To be eligible, participants must have either AMD or DR, at least mild depression, and must have visual acuity better than 20/200. Half are randomized to the intervention arm and half to delayed intervention/usual care. The intervention consists of large print written and audio tools incorporating cognitive-behavioral principles plus 3x10-minute telephone calls from a coach. Eight-week follow-up data collection is collected by telephone. The primary outcome is the 8-week change in depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Secondary outcomes include anxiety, life space, self-efficacy, and medication adherence.

Results : Seventy-four participants have been recruited achieving our target sample size. Eight-week follow-up data collection has been completed on 59 people (80%) with follow-up expected to finish shortly. The mean age is 74 years old (standard deviation (SD)=11), 61% are women, the mean logMAR acuity in the better eye is 0.4 (SD=0.2), while the mean PHQ-9 score is 10 (SD=4) indicating moderate depressive symptoms. In preliminary results, there are minimal differences between the two arms for all outcomes (P>0.05). Only 44% of people in the intervention group reported using the tools. Some reasons for disuse included disinterest, difficulty with vision, being too busy, and poor health.

Conclusions : Self-care tools plus telephone coaching did not reduce depressive symptoms in patients with age-related eye disease. Alternative self-care strategies need to be developed for this population.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.