Self-care tools to treat depressive symptoms in patients with age-related eye disease: a randomized controlled clinical trial

BackgroundDepression is very common in people with age-related eye disease. Our goal was to determine if self-care tools plus limited telephone support could reduce depressive symptoms in patients with age-related macular degeneration or diabetic retinopathy. DesignA single-blind randomized controlled clinical trial was conducted at Maisonneuve-Rosemont Hospital in Montreal, Canada. ParticipantsEighty participants were recruited. MethodsTo be eligible, participants must have had either late stage age-related macular degeneration or diabetic retinopathy, at least mild depressive symptoms, and visual acuity better than 20/200. Half were randomized to the intervention arm and half to delayed intervention/usual care. The intervention consisted of large print written and audio tools incorporating cognitive-behavioral principles plus three 10-minute telephone calls from a lay coach. Eight-week follow-up data were collected by telephone. Main Outcome MeasuresThe primary outcome was the 8-week change in depressive symptoms as measured by the Patient Health Questionnaire-9. Secondary outcomes included anxiety, life space and self-efficacy. ResultsThe baseline mean logMAR visual acuity was 0.37 (SD=0.20), and the baseline mean Patient Health Questionnaire-9 score was 9.5 (SD=3.9) indicating moderate depressive symptoms. After adjusting for baseline imbalances in visual acuity, the intervention reduced depressive symptoms by 2.1 points more than usual care (P=0.040). The intervention was not associated with the secondary outcomes (P>0.05). ConclusionsSelf-care tools plus telephone coaching led to a modest improvement in depressive symptoms in patients with age-related eye disease. Additional research on how to maximize their effect is necessary.