Heesterbeek Thomas J, van der Aa Hilde P A, van Rens Ger H M B, Twisk Johannes W R, van Nispen Ruth M A
Department of Ophthalmology and EMGO & Institute for Health and Care Research (EMGO+), VU University Medical Centre, Amsterdam, the Netherlands.
Department of Ophthalmology, Elkerliek Hospital, Helmond, the Netherlands.
Ophthalmic Physiol Opt. 2017 Jul;37(4):385-398. doi: 10.1111/opo.12388. Epub 2017 May 18.
Depression and anxiety are highly prevalent in older adults with vision impairment. Because symptoms of depression and anxiety appear to fluctuate, it is important to identify patients who are at risk of developing these symptoms for early diagnosis and treatment. Therefore, the aim of this study was to determine the incidence of subthreshold depression and anxiety, and to investigate predictors of developing symptoms of depression and anxiety in older adults with vision impairment who had no subthreshold depression or anxiety at baseline.
A longitudinal prospective cohort study with a follow-up of 24 months in 540 older adults with vision impairment (mean age 75 years, 56% female, 48% macular degeneration, 15% glaucoma) from outpatient low-vision rehabilitation organisations was performed. The cumulative incidences of subthreshold depression and anxiety were calculated and linear mixed models with maximum likelihood estimation were used to determine two prediction models. Main outcome measures were: fluctuations in (i) depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D) and (ii) anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety subscale, HADS-A).
The annual cumulative incidences of subthreshold depression and anxiety were 21.3% (95% Confidence Interval (CI) 18.7-23.9%) and 9.5% (95% CI 7.4-11.6%), respectively. Risk factors for developing depressive symptoms were: living alone, having just enough money to cover expenses, having macular degeneration, having problems with adaptation to vision loss, reduced health related quality of life, and experiencing symptoms of anxiety. For developing anxiety symptoms, a relatively younger age, experiencing symptoms of depression, not living alone and experiencing hindrance at work proved to be risk factors.
This study shows that the incidence of subthreshold depression and anxiety in older adults with vision impairment is twice as high compared with older adults in general and confirms that depression and anxiety symptoms fluctuate over time. It is of great importance that low vision rehabilitation staff monitor older adults with vision impairment who are most vulnerable for developing these symptoms, based on the risk factors that were found in this study, to be able to offer early interventions to prevent and treat mental health problems in this population.
抑郁症和焦虑症在视力受损的老年人中非常普遍。由于抑郁和焦虑症状似乎会波动，识别有出现这些症状风险的患者以便早期诊断和治疗很重要。因此，本研究的目的是确定阈下抑郁和焦虑的发病率，并调查在基线时没有阈下抑郁或焦虑的视力受损老年人出现抑郁和焦虑症状的预测因素。
对来自门诊低视力康复机构的540名视力受损老年人（平均年龄75岁，56%为女性，48%患有黄斑变性，15%患有青光眼）进行了一项为期24个月的纵向前瞻性队列研究。计算阈下抑郁和焦虑的累积发病率，并使用最大似然估计的线性混合模型来确定两个预测模型。主要结局指标为：（i）抑郁症状（流行病学研究中心抑郁量表，CES-D）和（ii）焦虑症状（医院焦虑抑郁量表-焦虑分量表，HADS-A）的波动情况。
阈下抑郁和焦虑的年累积发病率分别为21.3%（95%置信区间（CI）18.7-23.9%）和9.5%（95%CI 7.4-11.6%）。出现抑郁症状的危险因素包括：独居、钱仅够维持开支、患有黄斑变性、难以适应视力丧失、健康相关生活质量下降以及出现焦虑症状。对于出现焦虑症状而言，相对年轻的年龄、出现抑郁症状、非独居以及工作中遇到阻碍被证明是危险因素。
本研究表明，视力受损老年人中阈下抑郁和焦虑的发病率是一般老年人的两倍，并证实抑郁和焦虑症状会随时间波动。低视力康复工作人员根据本研究中发现的危险因素，对最易出现这些症状的视力受损老年人进行监测，以便能够提供早期干预措施来预防和治疗该人群的心理健康问题，这一点非常重要。
