Fenwick Eva K, Lamoureux Ecosse L, Keeffe Jill E, Mellor David, Rees Gwyn
Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia.
Optom Vis Sci. 2009 Aug;86(8):948-54. doi: 10.1097/OPX.0b013e3181b2f599.
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.
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.
Participants reported relying mainly on observational cues of patients' behavior or using other indirect methods to identify depression. On the basis of these observations, they acknowledged that the prevalence of depression 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.
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.
抑郁症在视力障碍患者中很常见，且有诸多使人衰弱的影响。然而，它常常未被识别，因此未得到治疗。本研究旨在探讨眼科医护人员对视力障碍患者抑郁症的看法，确定当前的管理做法以及有效护理的障碍。
对一家大型三级眼科医院的26名工作人员进行了6次焦点小组讨论和2次半结构式访谈。参与者包括视光师、眼科护士和辅助人员。采用基于持续比较法的归纳分析方法对数据进行分析。
参与者报告主要依靠观察患者行为的线索或使用其他间接方法来识别抑郁症。基于这些观察结果，他们承认该医院视力障碍患者中抑郁症的患病率很高，并认为这对患者的实际功能和情绪功能有负面影响。很少有人报告与患者公开讨论抑郁症。对疑似抑郁症的应对措施因工作人员对资源或转诊选择的个人了解情况而异。确定了抑郁症充分管理的各种障碍，包括角色和职责的混淆以及工作人员之间沟通途径不明确。参与者热衷于解决这些障碍，并在医院内部和更广泛的社区建立明确的护理途径。他们也愿意接受关于抑郁症的培训和教育，特别是针对视力障碍人群的培训和教育。
在这家三级眼科护理机构中，改善抑郁症管理有很大的空间和热情。然而，结果可能不适用于所有眼科环境。需要量身定制新的举措，以适合在这类眼科服务中实施。
