How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study

Nollett, Claire; Bartlett, Rebecca; Pickles, Timothy; Ryan, Barbara; Acton, Jennifer H.

doi:10.1186/s12888-019-2387-x

Cited by 23 publications

(90 citation statements)

References 44 publications

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“…Analysis was undertaken using the Andrich Rating Scale model 43 via the Winsteps software version 3.92.1 (http://www.winsteps.com), to assess the questionnaire scales. A detailed description of this process applied to the data is published elsewhere 29 …”

Section: Methodsmentioning

confidence: 99%

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

Bartlett

Acton

Ryan

et al. 2021

Ophthalmic Physiologic Optic

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Purpose The prevalence of depression in people with low vision is high and often goes undiagnosed. There is the potential for those who provide low vision services to perform concurrent depression screening. However, prior training in depression identification and suitable referral pathways is required. The aims of this study were: (1) to assess the impact of a training programme on practitioners’ confidence and behaviour in addressing depression in patients with low vision, and (2) to review the training programme and identify areas for further development. Methods A convergent mixed methods approach was used. Questionnaires were completed by practitioners pre‐, immediately post‐ and 6 months post‐ training (n = 40) to assess practitioner confidence in approaching depression in patients with low vision. Qualitative interviews were performed with a subset of practitioners 6 months post‐training (n = 9). Additionally, routine data from the Low Vision Service Wales (LVSW) database was used to determine the change in the number of practitioners identifying depression in patients, and the change in the number of patients identified at risk of depression 6 months post‐training. Results Of the 148 practitioners who completed low vision assessments pre‐ and post‐training, 28 (18.9%) documented risk of depression in their patients pre‐training, which increased substantially to 65 (43.9%) post‐training (p < 0.0001). Mixed methods analysis confirmed increased documentation of depressive symptoms by practitioners. Practitioner confidence increased following training, with 92.3% feeling more confident to approach emotional issues with patients and 92.2% intending to use the recommended screening tool to identify depression. Interviews provided insight into areas where confidence was still lacking. Quantitative questionnaires revealed that training content was considered appropriate by 91% of participants. Interviews confirmed these findings while expanding upon possibilities for programme improvement. Conclusions Training for depression screening was found to be time‐efficient and acceptable for LVSW practitioners and shown to increase practitioner confidence in the identification of depression. Additionally, the programme changed behaviour, resulting in an increase in the identification of depression in patients with low vision. However, this is a complex topic and ongoing development is required to embed depression screening as an integral part of low vision services.

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Section: Methodsmentioning

confidence: 99%

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

Bartlett

Acton

Ryan

et al. 2021

Ophthalmic Physiologic Optic

Self Cite

View full text Add to dashboard Cite

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“…Participants who had completed a pre-training qualitative interview as part of the wider study [25] (N = 12) were invited by email to take part in a follow-up interview, 6 months after the training. Participants were selected for the interviews using a maximum variation strategy with the purpose of eliciting the views of practitioners with a range of characteristics and experience [43].…”

Section: Methodsmentioning

confidence: 99%

“…The study utilised data from a broader pre-post single group study conducted by the same research team [ 25 ]. A convergent mixed methods design was employed to provide a comprehensive understanding of practice [ 35 ] (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…In Wales, individuals can access the Low Vision Service Wales (LVSW), delivered by eye care professionals accredited as low vision practitioners. Despite a 37% prevalence of depressive symptoms in those attending the LVSW [9], our previous work indicated that in 2018, only a third of low vision practitioners aimed to identify depression and only 18% used a validated screening tool to do so [25]. The majority relied on their intuition to gain a sense as to whether a patient might be depressed.…”

Section: Introductionmentioning

confidence: 98%

“…Prior to the training, we sought to understand eye care practitioners' views on addressing depression in people with low vision [25]. Common barriers cited were lack of knowledge about and confidence in depression identification and referral pathways, fears of 'doing more harm than good' and patient reluctance to discuss depression.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study

et al. 2020

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Background: Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. Methods: This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners' clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post-and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. Results: Before training, only one third of practitioners (n = 15) identified depression in low vision patients, increasing to over 90% (n = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% (n = 4) to 80% (n = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p < 0.001) and perceived less barriers to addressing depression (difference in means = − 0.95, 95% CI − 1.32 to − 0.59, p < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. Conclusions: The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients' perspective, to determine the desire for and acceptability of screening.

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Association Between Visual Impairment and Depression in Patients Attending Eye Clinics

et al. 2021

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IMPORTANCE Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients.OBJECTIVE To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services.DATA SOURCES MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched.STUDY SELECTION Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy.DATA EXTRACTION AND SYNTHESIS Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Proportion of depression.RESULTS A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51). CONCLUSIONS AND RELEVANCEThe results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.

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How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study

Cited by 23 publications

References 44 publications

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study

Association Between Visual Impairment and Depression in Patients Attending Eye Clinics

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