Rees Gwyneth, Mellor David, Holloway Edith E, Sturrock Bonnie A, Hegel Mark T, Casten Robin, Xie Jing, Finkelstein Eric, Lamoureux Ecosse, Keeffe Jill E
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Australia .
Ophthalmic Epidemiol. 2013 Oct;20(5):321-9. doi: 10.3109/09286586.2013.787102.
Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment.
A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up.
We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.
抑郁症是视力障碍者中的常见问题，会导致功能衰退。本文介绍了一项研究方案，以评估一种针对有抑郁症状患者的新型护理模式，该模式将心理治疗融入低视力康复服务中。低视力工作人员将接受培训，以提供“初级保健问题解决疗法”（PST-PC），这是一种专门为非心理健康护理人员开发的有效心理治疗方法。PST-PC通过8次每周一次、每次时长30 - 45分钟的电话咨询以及4次每月一次的维持咨询来实施。我们预测这种新型综合护理模式将显著减轻视力障碍者的抑郁症状并提高其生活质量。
将在澳大利亚视觉协会提供的全国低视力康复服务中开展PST-PC的随机对照试验。对抑郁症状筛查呈阳性且符合研究标准的客户将被随机分配接受PST-PC或常规护理，常规护理包括转介给他们的全科医生进行更详细的评估和治疗。结果指标包括抑郁症状与行为、生活质量、应对方式以及对视力障碍的心理调适。在干预前、干预后以及6个月和12个月随访时进行盲法评估。
我们预计这种创新的服务提供模式将以具有成本效益的方式持续改善客户的生活质量，并提供一种适用于抑郁症合并存在的其他医疗保健领域的创新服务提供模式。
