Preventing late-life depression in age-related macular degeneration.

Full Abstract

OBJECTIVE:
To determine whether problem-solving treatment (PST) can prevent depressive disorders in patients with age-related macular degeneration (AMD).

DESIGN:
Two hundred six patients with AMD were randomly assigned to PST (n = 105) or usual care (n = 101). PST therapists delivered six PST sessions over 8 weeks in subjects' homes.

MEASUREMENTS:
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Diagnoses of Depressive Disorders, Hamilton Depression Rating Scale scores, and rates of relinquishing valued activities were assessed at 2 months for short-term effects and 6 months for maintenance effects.

RESULTS:
The 2-month incidence rate of depressive disorders in PST-treated subjects was significantly lower than controls (11.6% versus 23.2%, respectively; OR = 0.43; 95% CI [0.20, 0.95]). PST also reduced the odds of relinquishing a valued activity (OR = 0.48; 95% CI [0.25, 0.96]); this effect mediated the relationship between treatment group and depression. By 6 months most earlier observed benefits had diminished. Secondary analyses showed that a minimal level of depressive symptoms were disabling and predicted incident depressive disorders.

CONCLUSION:
PST prevented depressive disorders and loss of valued activities as a short-term treatment but these benefits were not maintained over time. To sustain PST's effect, an intervention that uses a problem-solving framework to enhance rehabilitative skills may be necessary.

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Author information

Author/s: Rovner, Barry W (BW); Casten, Robin J (RJ);

Affiliation: Department of Psychiatry and Neurology, Jefferson Medical College, Jefferson Medical College, Philadelphia, PA 19107, USA. barry.rovner(-atsign-)jefferson.edu

Grants: R0 1 MH61331 (Agency:United States NIMH) ; U01 EY 015839 (Agency:United States NEI)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry (Am J Geriatr Psychiatry), published in United States. (Language: eng)

Reference: 2008-Jun; vol 16 (issue 6) : pp 454-9

Dates: Created 2008/06/02; Completed 2008/08/07;

PMID: 18515689, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Activities of Daily Living - psychology
Aged
Behavior Therapy - methods
Depressive Disorder - diagnosis; prevention & control; psychology
Depressive Disorder, Major - diagnosis; prevention & control; psychology
Female
Follow-Up Studies
Goals

Humans
Macular Degeneration - psychology; rehabilitation
Male
Middle Aged
Problem Solving
Psychotherapy, Brief - methods
Risk Factors
Sick Role

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