van Munster Edine P J, van Nispen Ruth M A, Nollett Claire L, Holloway Edith E, Maarsingh Otto R, Heymans Martijn W, van der Aa Hilde P A
Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands.
Acta Ophthalmol. 2023 Nov;101(7):766-774. doi: 10.1111/aos.15663. Epub 2023 Mar 23.
Healthcare providers often experience difficulties in discussing depression with adults with visual impairment (VI), obstructing timely referral. The purpose of this study was to examine predictors of routine discussions of depression with adults with VI from the perspective of different healthcare providers from different countries.
Cross-sectional survey data from Welsh (N = 122), Australian (N = 94) and Dutch (N = 100) healthcare providers, that is eye care practitioners (ECPs) and low-vision care providers (LVCPs), were analysed. Multivariable logistic regression analysis was performed in the Welsh sample to determine predictors for discussing depression. Internal validation was conducted by using a bootstrap method, and the recalibrated model was externally validated in the Australian and Dutch sample.
Work experience in eye care services (OR 0.95; 95% confidence interval (CI) 0.92 to 0.99) and perceived barriers (OR 0.95; 95% CI 0.92 to 0.98) was found to predict discussing depression with patients. The area under the curve (AUC) of 0.73 reflected good discrimination of the model. The model showed a slightly better fit in the Australian sample (AUC = 0.77), but a poor fit in the Dutch sample.
The final prediction model was not generalizable to Dutch healthcare providers. They perceived less barriers in depression management than Welsh and Australian healthcare providers. This could be explained by differences in ECPs and LVCPs roles and responsibilities, increased attention on mental health and differences in organizing health care. Differences between healthcare providers' responsibilities and support needs should be taken into account while creating a facilitating environment to discuss depression.
医疗保健提供者在与视力受损的成年人讨论抑郁症时常常遇到困难，这阻碍了及时转诊。本研究的目的是从不同国家的不同医疗保健提供者的角度，探讨与视力受损的成年人进行抑郁症常规讨论的预测因素。
分析了来自威尔士（N = 122）、澳大利亚（N = 94）和荷兰（N = 100）的医疗保健提供者（即眼科护理从业者（ECP）和低视力护理提供者（LVCP））的横断面调查数据。在威尔士样本中进行多变量逻辑回归分析，以确定讨论抑郁症的预测因素。使用自助法进行内部验证，并在澳大利亚和荷兰样本中对重新校准的模型进行外部验证。
发现眼科护理服务的工作经验（比值比[OR] 0.95；95%置信区间[CI] 0.92至0.99）和感知到的障碍（OR 0.95；95% CI 0.92至0.98）可预测与患者讨论抑郁症。曲线下面积（AUC）为0.73，反映了模型的良好区分度。该模型在澳大利亚样本中的拟合度稍好（AUC = 0.77），但在荷兰样本中的拟合度较差。
最终的预测模型不适用于荷兰的医疗保健提供者。他们在抑郁症管理中感知到的障碍比威尔士和澳大利亚的医疗保健提供者少。这可以通过ECP和LVCP的角色和职责差异、对心理健康的关注度增加以及医疗保健组织方式的差异来解释。在营造便于讨论抑郁症的环境时，应考虑医疗保健提供者的责任和支持需求之间的差异。
