Detection and Management of Depression in Patients with Vision Impairment

Purpose. Depression is common in people with vision impairment and has a number of debilitating effects. However, it is often not identified and therefore is left untreated. This study aimed to explore eye healthcare professionals' views of depression in patients with vision impairment and identify current management practices and barriers to effective care. Methods. Six focus groups and two semistructured interviews were conducted with 26 staff members from a large tertiary eye care hospital. Participants included orthoptists, ophthalmic nurses, and Support staff. The data were analyzed using an inductive analytical approach based on the constant comparative method. Results. Participants reported relying mainly on observational cues of patients' behavior or using other indirect methods to identify depression. On the basis oft these observations, they acknowledged that the prevalence of depress ion in visually impaired patients at the hospital was high and believed it impacts negatively on patients' practical and emotional functioning. Few reported overtly discussing depression with patients. Responses to suspected depression varied according to individual staff knowledge of resources or referral options. Various barriers to adequate management of depression were identified, including confusion over roles and responsibilities, and unclear communication pathways between staff. Participants were enthusiastic about resolving these obstacles and establishing clear pathways to care both within the hospital and in the wider community. They were also receptive to receiving training and education about depression, with specific reference to the visually impaired population. Conclusions. There is considerable scope and enthusiasm for improving depression management in this tertiary eye care facility. The results may not, however, be generalizable to all ophthalmic settings. New initiatives need to be tailored to suit implementation within such ophthalmic services. (Optom Vis Sci 2009;86:948-954)