Watchful waiting for subthreshold depression and anxiety in visually impaired older adults

Abstract

PurposeImmediate 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.MethodsA 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.ResultsAfter 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.ConclusionsWatchful 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.

The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: a longitudinal prospective cohort study

“…Gender and having a history of depressive, dysthymic or panic disorder was not a predictor for developing depressive or anxiety symptoms. However, a previous study in visually impaired older adults with subthreshold depression found that the female gender and psychiatric history was associated with the development of major depressive and anxiety disorders . Our results are probably biased because females and elderly with a psychiatric history, who are more vulnerable to develop depressive or anxiety symptoms, had already subthreshold depression or anxiety at baseline and were, therefore, excluded from this study in which we wanted to determine the incidence of these symptoms.…”

“…Depression and anxiety are well known transient conditions . A recent study in older adults with vision impairment and subthreshold depression and/or anxiety showed that after a three‐month watchful waiting period, in which no psychological treatment was offered, one‐third of the participants recovered from these symptoms and one‐fifth developed a depressive and/or anxiety disorder indicating that depression and anxiety symptoms fluctuate, which is similar to findings in the general population . Since interventions are usually only offered when symptoms manifest themselves, it is likely that no treatment is offered even though a person might be at high risk of developing clinically significant symptoms in the near future.…”

Improving mental healthcare for the elderly in Belgium

“…The implementation strategies mentioned above were used alone or in combination for managing specific MHP in the elderly population such as major depression, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] minor or sub-threshold depression, [39][40][41][42] depression and anxiety in residential care homes, [43][44][45][46][47] suicidal ideation, 48 alcohol abuse, 49,50 behavioural symptoms in Alzheimer, 51 and mental problems in specific patient groups. 15,[52][53][54][55][56] Evidence showed that the collaborative care strategy is best adapted for the organisation of MHCE, often combined with one of the other operational strategies (see Table 1). Studies on severe psychiatric disorders in the elderly were, however, sparse.…”

Psychological and Psychosocial Interventions for Depression and Anxiety in Patients With Age-Related Macular Degeneration: A Systematic Review

“…Five out of seven RCT studies suggested effective interventions to prevent and treat depression in AMD patients (53,55,57,59,61), and one of these studies also showed positive outcomes for anxiety (61). However, only 4 studies in our review had included an outcome measure for anxiety (60)(61)(62)(63), which suggests the need for additional research investigating the effect of psychological and psychosocial interventions on anxiety related to AMD.…”

“…The studies included in this review examined the effectiveness of psychosocial and psychological interventions which were mainly composed of cognitive-behavioural techniques such as self-management, self-help, problem solving, behavioural activation, and emotion-focused intervention. Although all studies have tested the effectiveness of the intervention programme to reduce symptoms of depression, only four studies included anxiety as an outcome measure (59)(60)(61)(62). Five out of seven RCT studies suggested effective interventions to prevent and treat depression in AMD patients (53,55,57,59,61), and one of these studies also showed positive outcomes for anxiety (61).…”