Stepped-care to reduce depression and anxiety in visually impaired older adults - a randomised controlled trial (WC2011-069)


Starting date: 01/01/2012

Impaired vision is one of the leading causes of age-related disability; 285 million people globally are visually impaired, of whom 65% are aged ≥50 years. Depression and anxiety are common health problems in visually impaired older adults. About one-third experience subthreshold depression and/or anxiety (indicating clinically significant symptoms, but no actual disorder). Health care utilisation is elevated in populations with subclinical levels of depression and anxiety and quality of life is seriously affected.  Depressive and anxiety symptoms may influence factors that are necessary for a successful rehabilitation, such as the ability to learn new tasks, processing information and being oriented towards achieving certain goals. Furthermore, these symptoms are the most important predictors of developing an actual depressive or anxiety disorder according to DSM-IV criteria. It is therefore crucial to treat these symptoms. However, care providers underestimate the negative effects of vision loss, standard procedures are missing, and patients often do not perceive a need for professional mental health services. Hence, detection of depression and anxiety is poor and treatment is often lacking.

Previous research on psychosocial interventions in visually impaired older adults is scarce and results have only been investigated up to six months. Several studies outside the field of low vision found that stepped-care service delivery models, designed to delay or prevent the onset of depression and anxiety in persons who show early symptoms, can be effective. Stepped-care aims to meet the long-term disease management needs of patients and maximise the effectiveness and efficiency of resource allocation. Subsequent treatment components are offered by order of intensity, i.e. patients start with low-intensity interventions and only move on to higher-intensity interventions when a sufficient response is lacking. Progress is monitored throughout the entire process.