How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study

Ryan Man,Timothy Pickles,Claire Nollett,Jennifer H Acton,Rebecca Bartlett,Barbara Ryan

doi:10.1186/s12888-019-2387-x

Ryan Man, Timothy Pickles + Show 4 more

Open Access

https://doi.org/10.1186/s12888-019-2387-x

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Abstract

BackgroundClinically significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected. The Low Vision Service Wales (LVSW) plans to introduce depression screening and management pathways. Prior to implementation there is an unmet need to understand how eye care practitioners providing the service currently address depression with patients, and the characteristics and beliefs that influence their practice.MethodsA mixed methods convergent design was employed. Twelve low vision practitioners were purposively selected to engage in individual semi-structured interviews which were analysed using thematic analysis. A further 167 practitioners were invited to complete a questionnaire assessing professional background, current practice, confidence and perceived barriers in working with people with low vision and suspected depression. Multiple regression analyses were performed to determine the characteristics related to the Rasch-transformed questionnaire scores.ResultsOf the 122 practitioners that responded to the questionnaire, 33% aimed to identify depression in patients, and those who were more confident were more likely to do so. Those who scored higher on the perceived barriers scale and lower on confidence were less likely to report acting in response to suspected depression (all p < 0.05). Three qualitative themes were identified; depression is an understandable response to low vision, patients themselves are a barrier to addressing depression and practitioners lacked confidence in their knowledge and skills to address depression. The qualitative data largely expanded the quantitative findings.ConclusionsPractitioners viewed their own lack of knowledge and confidence as a barrier to the identification and management of depression and expressed a need for training prior to the implementation of service changes. The study findings will help to inform the development of a training programme to support low vision practitioners and those working with other chronic illness in Wales, and internationally, in the identification and management of people with depression.

Highlights

Significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected
Quantitative results A total of 167 low vision practitioners were invited to take part in the online questionnaire, of which 122 (73.1%) completed it and consented for their responses to be used for research purposes
When acting in response to suspected depression, practitioners were most likely to discuss the patient’s feelings with them and least likely to provide a referral to mental health services

Summary

Introduction

Significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected. Depression is common in the general population, but is more prevalent in people with chronic illnesses such as hypertension, diabetes and stroke: they are at least twice as likely to develop depression [1, 2]. For those with multi-morbidity, defined as two or more chronic conditions, the risk is three time as great [3]. In the UK, over 2 million people are living with sight loss [4], with 77% of people affected aged 65 or over [5], and co-morbidity with other chronic health conditions is common [6]. In 2015, an estimated 129 million people globally were living with low vision [8] and in the UK, around 1.3 million people are currently affected [4]

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