Preventing depression in age-related macular degeneration

Arch Gen Psychiatry. 2007 Aug;64(8):886-92. doi: 10.1001/archpsyc.64.8.886.


Context: Age-related macular degeneration is a prevalent disease of aging that may cause irreversible vision loss, disability, and depression. The latter is rarely recognized or treated in ophthalmologic settings.

Objective: To determine whether problem-solving treatment can prevent depressive disorders in patients with recent vision loss.

Design: Randomized, controlled trial.

Setting: Outpatient ophthalmology offices in Philadelphia, Pennsylvania.

Patients: Two hundred six patients aged 65 years or older with recent diagnoses of neovascular age-related macular degeneration in one eye and pre-existing age-related macular degeneration in the fellow eye.

Intervention: Patients were randomly assigned to problem-solving treatment (n = 105) or usual care (n = 101). Problem-solving treatment therapists delivered 6 sessions during 8 weeks in subjects' homes.

Main outcome measures: Outcomes were assessed at 2 months for short-term effects and 6 months for maintenance effects. These included DSM-IV-defined diagnoses of depressive disorders, National Eye Institute Vision Function Questionnaire-17 scores, and rates of relinquishing valued activities.

Results: The 2-month incidence rate of depressive disorders in problem-solving-treated subjects was significantly lower than controls (11.6% vs 23.2%, respectively; odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P = .03). Problem-solving treatment also reduced the odds of relinquishing a valued activity (odds ratio, 0.48; 95% confidence interval, 0.25-0.96; P = .04). This effect mediated the relationship between treatment group and depression. By 6 months, most earlier observed benefits had diminished, though problem-solving treatment subjects were less likely to suffer persistent depression (chi2(1,3) = 8.46; P = .04).

Conclusions: Problem-solving treatment prevented depressive disorders and loss of valued activities in patients with age-related macular degeneration as a short-term treatment, but these benefits were not maintained over time. Booster or rescue treatments may be necessary to sustain problem-solving treatment's preventative effect. This study adds important new information to the emerging field of enhanced-care models to prevent or treat depression in older persons.

Trial registration: Identifier: NCT00042211.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Ambulatory Care
  • Behavior Therapy / methods*
  • Comorbidity
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / prevention & control*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Home Care Services
  • Humans
  • Incidence
  • Macular Degeneration / epidemiology
  • Macular Degeneration / psychology*
  • Problem Solving*
  • Psychiatric Status Rating Scales
  • Surveys and Questionnaires
  • Treatment Outcome
  • Vision Disorders / epidemiology
  • Vision Disorders / psychology

Associated data