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Watchful waiting for subthreshold depression and anxiety in visually impaired older adults
Hilde P A van der Aa1,2, Esther Krijnen-de Bruin3, Ger H M B van Rens4,5,6
1Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. h.vanderaa@vumc.nl.
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.
