1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
2
|
Billiet L, van Nispen RMA, De Baets S, de Vries R, Van de Velde D, van der Aa HPA. The first step in developing an International Classification of Functioning, Disability and Health Core Set for Vision Loss: A systematic review. Ophthalmic Physiol Opt 2024; 44:413-425. [PMID: 38251457 DOI: 10.1111/opo.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
AIM As a first step in developing an International Classification of Functioning, Disability and Health (ICF) Core Set for adults with vision loss, this systematic review sought to identify the researchers' perspective by identifying the most often used outcome measures and research topics obtained from studies on adults with vision loss. METHODS PubMed, Embase, CINAHL, APA PsycINFO and Web of Science were searched for studies on vision loss. Meaningful outcome measures and research topics were linked to the ICF components: environmental factors, body functions, body structures and the Activities and Participation life domains. RESULTS After deduplication, 7219 records remained, of which 2328 articles were eligible for further review. For feasibility reasons, approximately 20% were randomly chosen from every publication year, resulting in 446 included articles. After full-text reading, 349 articles remained, describing 753 outcome measures based on questionnaires and 2771 additional research topics that could be linked to the ICF. Most were linked to the component Activities and Participation, with a focus on recreation and leisure activities (ICF code d920, 70%), reading (d166, 34%) and driving (d475, 27%). For the component body function, seeing functions (b210, 83%) were most often reported. Outcome measures and research topics were least often linked to the body structure component and environmental factors. CONCLUSION The broad range of ICF categories identified in this systematic review represents the variety of functioning typical for adults with vision loss. These results reflect the focus of researchers over the past 21 years by using various vision-related outcomes. In our next steps to develop the ICF Core Set for Vision Loss, we will include perspectives of experts and lived experience.
Collapse
Affiliation(s)
- Lorenzo Billiet
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences - Occupational Therapy Research Group, Ghent University, Ghent, Belgium
- Blindenzorg Licht en Liefde, Varsenare, Belgium
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Stijn De Baets
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences - Occupational Therapy Research Group, Ghent University, Ghent, Belgium
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences - Occupational Therapy Research Group, Ghent University, Ghent, Belgium
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
- The Lighthouse Guild, New York, New York, USA
| |
Collapse
|
3
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
4
|
Elsman EBM, Lee SQ, van der Aa HPA, van Nassau F, Wisse RPL, Maarsingh OR, Keunen JEE, van Rens GHMB, van Nispen RMA. The evaluation of an online nurse-assisted eye-screening tool in older adults receiving home healthcare. Ophthalmic Physiol Opt 2023. [PMID: 36807604 DOI: 10.1111/opo.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To investigate the agreement between an online nurse-assisted eye-screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. METHODS Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye-screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye-screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. RESULTS A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye-screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye-screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye-screening tool, although remarks for further improvements were made. CONCLUSIONS The eye-screening tool is promising for nurse-assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye-screening tool in practice, cost-effectiveness needs to be investigated.
Collapse
Affiliation(s)
- Ellen B M Elsman
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Shan Qi Lee
- Ophthalmology, 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.,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Femke van Nassau
- Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Otto R Maarsingh
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Aging & Later Life, Amsterdam Public Health, Amsterdam, the Netherlands
| | | | - Ger H M B van Rens
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
6
|
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: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
7
|
Veldman MHJ, van der Aa HPA, Bode C, Knoop H, Hulshof CTJ, Koopmanschap M, Stavleu E, van Rens GHMB, van Nispen RMA. E-nergEYEze, a vision-specific eHealth intervention based on cognitive behavioral therapy and self-management to reduce fatigue in adults with visual impairment: study protocol for a randomized controlled trial. Trials 2021; 22:966. [PMID: 34963472 PMCID: PMC8715593 DOI: 10.1186/s13063-021-05935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background More than half of the adults with visual impairment experience severe symptoms of fatigue, with a negative impact on daily life. Since there is no evidence-based treatment to reduce fatigue in adults with visual impairment, we developed E-nergEYEze, an eHealth intervention based on cognitive behavioral therapy and self-management tailored to the needs of visually impaired adults. The aim is to describe the study protocol of a randomized controlled trial testing E-nergEYEze. Methods A randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of E-nergEYEze to reduce fatigue severity compared to care as usual from a healthcare and societal perspective. A total of 172 severely fatigued adults with visual impairment will be recruited and randomized to either the E-nergEYEze intervention plus care as usual or to care as usual only (ratio 1:1). Inclusion criteria are having a visual impairment, experiencing severe fatigue (Checklist Individual Strength – subscale Fatigue Severity: CIS-FS > 35), being 18 years or older, understanding the Dutch language, and having access to the internet. The intervention consists of one face-to-face session and a computer training followed by internet-based modules with information and assignments on coping with fatigue. During this 5-month intervention, participants will be digitally supported by a social worker. All measurements will be administered at baseline, after 6 and 12 months, and additionally, those related to cost-effectiveness at 3 and 9 months. The primary outcome is fatigue severity (CIS-FS). Discussion Severe fatigue on top of visual impairment compromises quality of life and is associated with incremental societal costs that largely determine the economic burden of low vision or blindness. E-nergEYEze contributes to the evidence base of potentially feasible interventions to reduce the important health-related consequences of vision loss and could fulfill the gap in knowledge, skills and treatment options for low vision services. Trial registration Dutch Trial Register NTR7764. Registered on 28 May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05935-w.
Collapse
Affiliation(s)
- Manon H J Veldman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands.
| | - Hilde P A van der Aa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Hans Knoop
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Koopmanschap
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Edwin Stavleu
- Royal Dutch Visio, Centre of Expertise for Visually Impaired and Blind People, Huizen, The Netherlands
| | - Ger H M B van Rens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands.,Elkerliek Hospital, Ophthalmology, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
9
|
van der Ham AJ, van der Aa HPA, Verstraten P, van Rens GHMB, van Nispen RMA. Experiences with traumatic events, consequences and care among people with visual impairment and post-traumatic stress disorder: a qualitative study from The Netherlands. BMJ Open 2021; 11:e041469. [PMID: 33542039 PMCID: PMC7925917 DOI: 10.1136/bmjopen-2020-041469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Having a visual impairment is known to be associated with an increased vulnerability to (potentially) traumatic events. Little is known about how people with visual impairment experience and process such events. This qualitative study aimed to provide more insight into experiences with traumatic events, consequences of traumatic events and post-traumatic stress disorder (PTSD)-related care among people with visual impairment and PTSD. METHODS Eighteen persons with visual impairment and (a history of) PTSD were interviewed. Among them were 14 women and 4 men aged between 23 and 66 years. Recruitment of participants was done through health professionals from two low-vision service centres and a patient association for people with eye diseases and visual impairment in The Netherlands. Interviews focused on experiences with (1) traumatic events, (2) consequences of traumatic events and (3) PTSD-related care. Thematic content analysis of interview data was performed using ATLAS.ti. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to check for completeness and transparency of the study. Data were collected between 2018 and 2020. RESULTS The most commonly reported traumatic events were sexual and physical abuse. Many participants experienced that their impairment had negatively affected their acceptance by others, independence and self-esteem, increasing their vulnerability for traumatic events. Additionally, having a visual impairment negatively impacted participants' ability to respond to situations and aggravated post-traumatic stress reactions. Existing treatments seem suitable for people with visual impairment when accommodated to the impairment. CONCLUSIONS Having a visual impairment may affect traumatic events and post-traumatic stress reactions, particularly by contributing to low self-esteem, problems in social interactions and a lack of visual information. Insights from this study provide starting points for adapting pretraumatic and post-traumatic care to the needs of people with visual impairment.
Collapse
Affiliation(s)
- Alida J van der Ham
- Ophthalmology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Peter Verstraten
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Ger H M B van Rens
- Ophthalmology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | | |
Collapse
|
10
|
Schakel W, Bode C, Elsman EBM, van der Aa HPA, de Vries R, van Rens GHMB, van Nispen RMA. The association between visual impairment and fatigue: a systematic review and meta-analysis of observational studies. Ophthalmic Physiol Opt 2020; 39:399-413. [PMID: 31696537 PMCID: PMC6899802 DOI: 10.1111/opo.12647] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/21/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity. METHODS A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale. RESULTS After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness. CONCLUSIONS Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.
Collapse
Affiliation(s)
- Wouter Schakel
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Ellen B M Elsman
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gerardus H M B van Rens
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Pronk M, Lissenberg-Witte BI, van der Aa HPA, Comijs HC, Smits C, Lemke U, Zekveld AA, Kramer SE. Longitudinal Relationships Between Decline in Speech-in-Noise Recognition Ability and Cognitive Functioning: The Longitudinal Aging Study Amsterdam. J Speech Lang Hear Res 2019; 62:1167-1187. [PMID: 31026198 DOI: 10.1044/2018_jslhr-h-ascc7-18-0120] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Purpose Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.
Collapse
Affiliation(s)
- Marieke Pronk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hilde P A van der Aa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hannie C Comijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Research and Innovation, Oldenaller 1, Amsterdam, The Netherlands
| | - Cas Smits
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | | | - Adriana A Zekveld
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Elsman EBM, Al Baaj M, van Rens GHMB, Sijbrandi W, van den Broek EGC, van der Aa HPA, Schakel W, Heymans MW, de Vries R, Vervloed MPJ, Steenbergen B, van Nispen RMA. Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review. Surv Ophthalmol 2019; 64:512-557. [PMID: 30703405 DOI: 10.1016/j.survophthal.2019.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/19/2022]
Abstract
Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children's well-being, children should be entitled to the most effective rehabilitation programs. We review evidence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology.
Collapse
Affiliation(s)
- Ellen B M Elsman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Mo Al Baaj
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gerardus H M B van Rens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | | | | | - Hilde P A van der Aa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Wouter Schakel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Amerdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ruth M A van Nispen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Schakel W, van der Aa HPA, Bode C, Hulshof CTJ, van Rens GHMB, van Nispen RMA. The Economic Burden of Visual Impairment and Comorbid Fatigue: A Cost-of-Illness Study (From a Societal Perspective). Invest Ophthalmol Vis Sci 2019; 59:1916-1923. [PMID: 29677352 DOI: 10.1167/iovs.17-23224] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the burden of visual impairment and comorbid fatigue in terms of impact on daily life, by estimating societal costs (direct medical costs and indirect non-health care costs) accrued by these conditions. Methods This cost-of-illness study was performed from a societal perspective. Cross-sectional data of visually impaired adults and normally sighted adults were collected through structured telephone interviews and online surveys, respectively. Primary outcomes were fatigue severity (FAS), impact of fatigue on daily life (MFIS), and total societal costs. Cost differences between participants with and without vision loss, and between participants with and without fatigue, were examined by (adjusted) multivariate regression analyses, including bootstrapped confidence intervals. Results Severe fatigue (FAS ≥ 22) and high fatigue impact (MFIS ≥ 38) was present in 57% and 40% of participants with vision loss (n = 247), respectively, compared to 22% (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] [2.7, 7.6]) and 11% (adjusted OR 4.8; 95% CI [2.7, 8.7]) in those with normal sight (n = 233). A significant interaction was found between visual impairment and high fatigue impact for total societal costs (€449; 95% CI [33, 1017]). High fatigue impact was associated with significantly increased societal costs for participants with visual impairment (mean difference €461; 95% CI [126, 797]), but this effect was not observed for participants with normal sight (€12; 95% CI [-527, 550]). Conclusions Visual impairment is associated with an increased prevalence of high fatigue impact that largely determines the economic burden of visual impairment. The substantial costs of visual impairment and comorbid fatigue emphasize the need for patient-centered interventions aimed at decreasing its impact.
Collapse
Affiliation(s)
- Wouter Schakel
- Department of Ophthalmology, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Carel T J Hulshof
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
14
|
van der Aa HPA, van Rens GHMB, Verbraak FD, Bosscha M, Koopmanschap MA, Comijs HC, Cuijpers P, van Nispen RMA. Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial. BMJ Open 2017; 7:e018149. [PMID: 29146648 PMCID: PMC5695477 DOI: 10.1136/bmjopen-2017-018149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Because of the great potential of vascular endothelial growth factor inhibitors (anti-VEGF) for retinal exudative diseases, an increased number of patients receives this treatment. However, during this treatment, patients are subjected to frequent invasive intravitreal injections, and the effects on reversing the process of vision loss are uncertain, which may have negative consequences for patients' mental health. One in three patients experience at least mild symptoms of depression/anxiety. To support patients in dealing with these symptoms, an e-mental health intervention (called E-PsEYE) has been developed. E-PsEYE is based on cognitive-behavioural therapy (CBT) and contains nine modules. A stepped-care model with three steps will be used to deliver the intervention: (1) providing information and psychoeducation, (2) when symptoms of depression/anxiety persist, guided CBT is offered and supported by social workers from low vision rehabilitation services and (3) when symptoms still persist, patients are referred to their general practitioner. METHODS AND ANALYSIS An economic evaluation from a healthcare and societal perspective will be conducted alongside a multicentre randomised controlled trial in two parallel groups to evaluate whether E-PsEYE is cost-effective in comparison with usual care. Participants (n=174) will be 50 years or older, have retinal exudative diseases, receive anti-VEGF treatment and have mild symptoms of depression/anxiety (assessed prior to randomisation). Main outcome measures are: depression (Patient Health Questionnaire-9), anxiety (Hospital Anxiety and Depression Scale-Anxiety) and quality-adjusted life-years (determined with the Health Utility Index-3 and the EuroQol-5 dimensions). Five measurements take place: at baseline and after 3, 6, 9 and 12 months. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of the VU University Medical Centre Amsterdam. It will provide new and essential information on the cost-effectiveness of an innovative intervention for a vulnerable population. Outcomes will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION http://www.trialregister.nl, identifier: NTR6337.
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Frank D Verbraak
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Machteld Bosscha
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marc A Koopmanschap
- Department of Health Policy and Management/iMTA, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, VUmc/GGZinGeest and the Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Schakel W, Bode C, van der Aa HPA, Hulshof CTJ, Bosmans JE, van Rens GHMB, van Nispen RMA. Exploring the patient perspective of fatigue in adults with visual impairment: a qualitative study. BMJ Open 2017; 7:e015023. [PMID: 28775181 PMCID: PMC5724118 DOI: 10.1136/bmjopen-2016-015023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Fatigue is an often mentioned symptom by patients with irreversible visual impairment. This study explored the patient perspective of fatigue in visually impaired adults with a focus on symptoms of fatigue, causes, consequences and coping strategies. SETTING Two large Dutch low vision multidisciplinary rehabilitation organisations. PARTICIPANTS 16 visually impaired adults with severe symptoms of fatigue selected by purposive sampling. METHODS A qualitative study involving semistructured interviews. A total of four first-level codes were top-down predetermined in correspondence with the topics of the research question. Verbatim transcribed interviews were analysed with a combination of a deductive and inductive approach using open and axial coding. RESULTS Participants often described the symptoms of fatigue as a mental, daily and physical experience. The most often mentioned causes of fatigue were a high cognitive load, the intensity and amount of activities, the high effort necessary to establish visual perception, difficulty with light intensity and negative cognitions. Fatigue had the greatest impact on the ability to carry out social roles and participation, emotional functioning and cognitive functioning. The most common coping strategies were relaxation, external support, socialising and physical exercise and the acceptance of fatigue. CONCLUSIONS Our results indicate that low vision-related fatigue is mainly caused by population specific determinants that seem different from the fatigue experience described in studies with other patient populations. Fatigue may be central to the way patients react, adapt and compensate to the consequences of vision loss. These findings indicate a need for future research aimed at interventions specifically tailored to the unique aspects of fatigue related to vision loss.
Collapse
Affiliation(s)
- Wouter Schakel
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences and Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerardus H M B van Rens
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
16
|
van der Aa HPA, van Rens GHMB, Bosmans JE, Comijs HC, van Nispen RMA. Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment: randomized controlled trial. BMC Psychiatry 2017; 17:280. [PMID: 28764679 PMCID: PMC5539614 DOI: 10.1186/s12888-017-1437-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the cost-effectiveness of stepped-care versus usual care within low vision rehabilitation. METHODS An economic evaluation from a societal perspective was performed alongside a multicenter randomized controlled trial. Data were collected by masked assessors during 24 months. Included were 265 older adults with vision impairment and subthreshold depression and/or anxiety. They were randomly assigned to stepped-care plus usual care (n = 131) or usual care alone (n = 134). Stepped-care comprised 1) watchful waiting, 2) guided self-help based on cognitive behavioral therapy, 3) problem solving treatment, and 4) referral to a general practitioner. Costs were based on direct healthcare costs and indirect non-healthcare costs. Main outcome measures were quality-adjusted life years (QALYs) and the cumulative incidence of major depressive, dysthymic and/or anxiety disorders. Secondary outcomes were symptoms of depression and anxiety. RESULTS Based on intention-to-treat, significant differences were found in the incidence of depressive/anxiety disorders (mean difference 0.17; 95% CI 0.06 to 0.29) and symptoms of anxiety (mean difference 1.43, 95% CI 0.10 to 2.77) in favor of stepped-care versus usual care; no significant difference was found for QALYs and symptoms of depression. Societal costs were non-significantly lower in the stepped-care group compared with the usual care group (mean difference: -€877; 95% confidence interval (CI): -8039 to 5489). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 95% or more at a willingness-to-pay of €33,000 per disorder prevented. The probability that stepped-care was cost-effective compared to usual care was 59% or more for a ceiling ratio of 0 €/QALY and increased to 65% at 20000 €/QALY. CONCLUSIONS This economic evaluation shows that stepped-care is dominant to usual care, with a probability of around 60%, due to its clinical superiority and its modest cost savings. However, it depends on the willingness-to-pay of decision makers whether or not stepped-care is considered cost-effective compared with usual care. TRIAL REGISTRATION identifier: NTR3296 , date: 13-02-2012.
Collapse
Affiliation(s)
- Hilde P. A. van der Aa
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands
| | - Ger H. M. B. van Rens
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands ,0000 0004 0409 6003grid.414480.dDepartment of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 Helmond, HA The Netherlands
| | - Judith E. Bosmans
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1105, 1081 Amsterdam, HV The Netherlands
| | - Hannie C. Comijs
- Department of Psychiatry VUmc/GGZinGeest, A.J.Ernststraat 1187, 1081 Amsterdam, HL The Netherlands
| | - Ruth M. A. van Nispen
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands
| |
Collapse
|
17
|
van der Aa HPA, Margrain TH, van Rens GHMB, Heymans MW, van Nispen RMA. Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis. Ophthalmic Physiol Opt 2017; 36:584-606. [PMID: 27580757 DOI: 10.1111/opo.12313] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years). METHODS The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials (RCTs), non-RCTs and before and after comparisons (BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences (SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non-RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data. RESULTS The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non-RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms (SMD -0.30, 95% confidence interval (CI) -0.60 to -0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms (b = 0.03, 95% CI 0.01 to 0.05), psychological stress (b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being (b = -0.03, 95% CI -0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained. CONCLUSIONS There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients.
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Ger H M B van Rens
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.,Department of Ophthalmology, Elkerliek Hospital, Helmond, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
18
|
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: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
19
|
van der Aa HPA, Xie J, Rees G, Fenwick E, Holloway EE, van Rens GHMB, van Nispen RMA. Validated Prediction Model of Depression in Visually Impaired Older Adults. Ophthalmology 2016; 123:1164-6. [PMID: 26778330 DOI: 10.1016/j.ophtha.2015.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, The Netherlands.
| | - Jing Xie
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | - Gwyneth Rees
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | - Eva Fenwick
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | - Edith E Holloway
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, The Netherlands; Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
20
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
21
|
van der Aa HPA, Krijnen-de Bruin E, van Rens GHMB, Twisk JWR, van Nispen RMA. Watchful waiting for subthreshold depression and anxiety in visually impaired older adults. Qual Life Res 2015; 24:2885-93. [PMID: 26085328 PMCID: PMC4615663 DOI: 10.1007/s11136-015-1032-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Purpose Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting’ period. Methods A pretest–posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28–0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00–1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02–1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28–4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Esther Krijnen-de Bruin
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
22
|
van der Aa HPA, Comijs HC, Penninx BWJH, van Rens GHMB, van Nispen RMA. Major depressive and anxiety disorders in visually impaired older adults. Invest Ophthalmol Vis Sci 2015; 56:849-54. [PMID: 25604690 DOI: 10.1167/iovs.14-15848] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE We assessed the prevalence of subthreshold depression and anxiety, and major depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and general anxiety disorder) in visually impaired older adults and compared these estimates with those of normally sighted peers. METHODS Cross-sectional data were analyzed based on telephone interviews with visually impaired older adults aged ≥ 60 years (n = 615) with a visual acuity of ≥ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face interviews with community-dwelling normally sighted peers (n = 1232). To determine prevalence rates, the normally sighted population was weighted on sex and age to fit the visually impaired population. Logistic regression analyses were used to compare the populations and to correct for confounders. RESULTS The prevalence of major depressive disorder (5.4%) and anxiety disorders (7.5%), as well as the prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%), were significantly higher in visually impaired older adults compared to their normally sighted peers (P < 0.05). Agoraphobia and social phobia were the most prevalent anxiety disorders in visually impaired older adults. CONCLUSIONS This study shows that depression and anxiety are major public health problems in visually impaired older adults. Research on psychotherapeutic and psychopharmacologic interventions to improve depression and anxiety in this population is warranted. (http://www.trialregister.nl number, NTR3296.).
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands
| | - Hannie C Comijs
- EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands Department Psychiatry VUmc/GGZinGeest, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands Department Psychiatry VUmc/GGZinGeest, Amsterdam, The Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
23
|
van der Aa HPA, Hoeben M, Rainey L, van Rens GHMB, Vreeken HL, van Nispen RMA. Why visually impaired older adults often do not receive mental health services: the patient's perspective. Qual Life Res 2014; 24:969-78. [PMID: 25398494 DOI: 10.1007/s11136-014-0835-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen's behavioural model. METHODS A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ). RESULTS About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance. CONCLUSIONS Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.
Collapse
Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,
| | | | | | | | | | | |
Collapse
|