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  • Claire L. Nollett
    Cardiff University
  • Nathan John Bray
  • Catey Bunce
    National Institute for Health Research Biomedical Research Center (NIHR BRC) for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust LondonUCL Institute of Ophthalmology, London
  • Robin J. Casten
    Thomas Jefferson University, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
  • Rhiannon Edwards
  • Mark T. Hegel
    Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
  • Sarah Janikoun
    Ophthalmology (Eye) Department South Wing, St. Thomas' Hospital, London
  • Sarah E. Jumbe
    National Institute for Social Care and Health Research Clinical Research Centre (NISCHR CRC) South East Wales Research Network/Rhwydwaith Ymchwil De Ddwyrain Cymru, Cardiff
  • Barbara Ryan
    School of Optometry and Vision Sciences, Cardiff University
  • Julia Shearn
    University of South Wales, Pontipridd, Wales
  • Daniel J. Smith
    Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
  • Miles Stanford
    Ophthalmology (Eye) Department South Wing, St. Thomas' Hospital, London
  • Wen Xing
    National Institute for Health Research Biomedical Research Center (NIHR BRC) for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust London
  • Tom H. Margrain
    School of Optometry and Vision Sciences, Cardiff University
Purpose: The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms.
Methods: This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory.
Results: At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London.
Conclusions: Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.
Original languageEnglish
Pages (from-to)4247-4254
JournalInvestigative Ophthalmology & Visual Science
Volume57
DOIs
Publication statusPublished - 31 Aug 2016

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