Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands.
Ophthalmic Physiol Opt. 2021 Jul;41(4):808-819. doi: 10.1111/opo.12837. Epub 2021 May 29.
E-PsEYE is an internet-based, guided self-help course, following the principles of cognitive behavioural therapy, to reduce anxiety and depression in patients with retinal exudative diseases who receive anti-vascular endothelial growth factor (anti-VEGF) treatment. The purpose of this study was to determine the prevalence and related factors of anxiety and depression in this population and evaluate the usability and feasibility of E-PsEYE.
Symptoms of anxiety and depression and related factors were determined in 90 patients (mean age 77 years, 58% female), based on multiple logistic regression analysis. Five patients with mild to moderate depression/anxiety tested the usability of E-PsEYE. They were asked to think aloud while completing two modules of the intervention and freely explore system features. The feasibility of the total E-PsEYE intervention was tested in 14 patients with mild to moderate depression/anxiety, based on a single arm pre-post study with a follow-up of three months: fidelity, acceptability, feasibility of study methods and potential effectiveness were explored.
Fifty-three percent of the total study population experienced at least mild anxiety and/or depression symptoms. Especially female patients (odds ratio (OR) 3.89, 95% confidence interval (CI) 1.33-11.40), those who experienced limitations in daily life activities due to vision loss (OR 9.67; 95% CI 3.18-29.45) and those who experienced loneliness (OR 3.53, 95% CI 1.14-10.95) were more likely to have anxiety/depression. The usability study raised several possibilities for improvement, based on which E-PsEYE was improved. The feasibility study showed adequate fidelity and acceptability. Most participants were satisfied with the results (79%). There was a high response rate, no loss to follow-up and mental health problems decreased in more than half of the patients. The Wilcoxon signed rank test indicated lower post-test ranks compared to pre-test ranks (depression Z -1.34, p = 0.18; anxiety Z -1.45, p = 0.15).
Mental health problems are prevalent in patients who receive anti-VEGF treatment. Healthcare providers should recognise these problems and related factors in order to refer patients to appropriate care in a timely manner. Outcomes on the usability and feasibility of E-PsEYE are promising as a prelude to performing a randomised controlled trial, which will shed more light on its (cost-)effectiveness.
E-PsEYE 是一种基于互联网的、有指导的自助课程，遵循认知行为疗法的原则，旨在减少接受抗血管内皮生长因子（anti-VEGF）治疗的视网膜渗出性疾病患者的焦虑和抑郁。本研究的目的是确定该人群中焦虑和抑郁的患病率及其相关因素，并评估 E-PsEYE 的可用性和可行性。
根据多因素逻辑回归分析，对 90 名患者（平均年龄 77 岁，58%为女性）的焦虑和抑郁症状及相关因素进行了测定。5 名轻度至中度抑郁/焦虑患者测试了 E-PsEYE 的可用性。他们在完成两个干预模块时被要求大声思考，并自由探索系统功能。在 14 名轻度至中度抑郁/焦虑患者中，基于单臂前后研究进行了 E-PsEYE 总干预的可行性测试，随访三个月：探索了研究方法的忠实度、可接受性、可行性和潜在效果。
总研究人群中有 53%至少有轻度焦虑和/或抑郁症状。特别是女性患者（比值比（OR）3.89，95%置信区间（CI）1.33-11.40）、因视力丧失而导致日常生活活动受限的患者（OR 9.67；95%CI 3.18-29.45）和感到孤独的患者（OR 3.53，95%CI 1.14-10.95）更有可能出现焦虑/抑郁。基于可用性研究中提出的一些改进建议，对 E-PsEYE 进行了改进。可行性研究表明，其忠实度和可接受性良好。大多数参与者对结果感到满意（79%）。应答率高，无失访，超过一半的患者的心理健康问题有所改善。Wilcoxon 符号秩检验表明，后测等级低于前测等级（抑郁 Z -1.34，p=0.18；焦虑 Z -1.45，p=0.15）。
接受抗 VEGF 治疗的患者中，心理健康问题较为普遍。医疗保健提供者应认识到这些问题及其相关因素，以便及时将患者转介到适当的护理中。E-PsEYE 的可用性和可行性研究结果很有希望，可以作为开展随机对照试验的前奏，从而进一步探讨其（成本）效益。
