Robin J. Casten

Psychometric Characteristics of the Minimum Data Set II: Validity

OBJECTIVE: To determine the validity of the Minimum Data Set (MDS).

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample

&NA; This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research‐based diagnoses based on Diagnostic and Statistical Manual‐revised 3rd edition (DSM‐IIIR) criteria, and (2) evaluations of ones recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research‐based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research‐based anxiety.

Age-related macular degeneration and depression: a review of recent research.

Purpose of review The purpose of this review is to summarize current research findings regarding relationships between depression and age-related macular degeneration (AMD). Recent findings The current literature indicates that the prevalence of depression among patients with AMD is fairly high (approximately 30%) and that depression is a major cause of disability among patients with AMD, even when severity of vision loss is considered. Interventions to alleviate the emotional distress associated with vision loss are also discussed. Summary Several studies indicate that AMD is a risk factor for depression, and this has serious consequences for the quality of life among patients with AMD.

Psychometric Characteristics of the Minimum Data Set I: Confirmatory Factor Analysis

OBJECTIVE: To determine the structure and statistical reliability of the federally mandated Minimum Data Set (MDS).

Low Vision Depression Prevention Trial in Age-Related Macular Degeneration: A Randomized Clinical Trial

PURPOSE To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD). DESIGN Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months. PARTICIPANTS Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188). INTERVENTIONS Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. MAIN OUTCOME MEASURES The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Questionnaire-9 (primary outcome), Activities Inventory, National Eye Institute Vision Function Questionnaire-25 plus Supplement (NEI-VFQ), and NEI-VFQ quality of life (secondary outcomes). RESULTS At 4 months, 11 BA+LVR subjects (12.6%) and 18 ST+LVR subjects (23.4%) developed a depressive disorder (relative risk [RR], 0.54; 95% CI, 0.27-1.06; P = 0.067). In planned adjusted analyses the RR was 0.51 (95% CI, 0.27-0.98; P = 0.04). A mediational analysis suggested that BA+LVR prevented depression to the extent that it enabled subjects to remain socially engaged. In addition, BA+LVR was associated with greater improvements in functional vision than ST+LVR, although there was no significant between-group difference. There was no significant change or between-group difference in quality of life. CONCLUSIONS An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to standard outpatient LVR in patients with AMD. As the population ages, the number of persons with AMD and the adverse effects of comorbid depression will increase. Promoting interactions between ophthalmology, optometry, rehabilitation, psychiatry, and behavioral psychology may prevent depression in this population.

Update on depression and age-related macular degeneration.

Purpose of review This review updates the literature on depression in age-related macular degeneration (AMD). Treatment for AMD has been revolutionized since the 2004 review of depression and AMD. New data describing the prevalence of depression in AMD, as well as novel interventions for managing depression in AMD, are discussed. Recent findings Depression continues to be prevalent in AMD and new information is available on the pathways by which impaired vision leads to depression. Strategies for the treatment of depression in patients with impaired vision have evolved. Summary AMD is still a major risk factor for depression and people with activity restriction due to vision loss are at greatest risk. An integrated approach to depression management in older adults with impaired vision may be the best course of action.

Development of a Shorter Version of the Geriatric Depression Scale for Visually Impaired Older Patients

OBJECTIVE To validate a shorter version of the Geriatric Depression Scale (GDS) for older, visually impaired patients. PARTICIPANTS Subjects were 70 visually impaired adults over age 65 who were presenting for services at a low vision clinic. METHOD Subjects were interviewed by a geriatric nurse practitioner. A structured clinical interview was used to ascertain major depression, and the 15-item GDS was used to assess depressive symptoms. A multiple logistic regression was performed in which the dependent variable was clinical diagnosis of major depression and the independent variables were the 15 GDS items. Four items were significant, and were used to form the GDS-Abbreviated (GDS-A) scale. Sensitivity and specificity analyses were performed on various combinations of these four items to generate an effective cutoff score. RESULTS Endorsing any two or more of the following four items--a) dissatisfied with life, (b) feeling helpless, (c) reporting problems with memory, and (d) lost activities and interests-yielded the best results with a sensitivity of .71 and a specificity of .88. This GDS-A cutoff score better differentiates depressed from nondepressed individuals than the cutoff score of 5 that is recommended for the GDS-15. CONCLUSION The GDS-As short format and strong discriminating ability make it an effective, convenient tool for screening visually impaired, older patients for depression.

The Depression in Visual Impairment Trial (DEPVIT): trial design and protocol

BackgroundThe prevalence of depression in people with a visual disability is high but screening for depression and referral for treatment is not yet an integral part of visual rehabilitation service provision. One reason for this may be that there is no good evidence about the effectiveness of treatments in this patient group. This study is the first to evaluate the effect of depression treatments on people with a visual impairment and co morbid depression.Methods /designThe study is an exploratory, multicentre, individually randomised waiting list controlled trial. Participants will be randomised to receive Problem Solving Therapy (PST), a ‘referral to the GP’ requesting treatment according to the NICE’s ‘stepped care’ recommendations or the waiting list arm of the trial. The primary outcome measure is change (from randomisation) in depressive symptoms as measured by the Beck’s Depression Inventory (BDI-II) at 6 months. Secondary outcomes include change in depressive symptoms at 3 months, change in visual function as measured with the near vision subscale of the VFQ-48 and 7 item NEI-VFQ at 3 and 6 months, change in generic health related quality of life (EQ5D), the costs associated with PST, estimates of incremental cost effectiveness, and recruitment rate estimation.DiscussionDepression is prevalent in people with disabling visual impairment. This exploratory study will establish depression screening and referral for treatment in visual rehabilitation clinics in the UK. It will be the first to explore the efficacy of PST and the effectiveness of NICE’s ‘stepped care’ approach to the treatment of depression in people with a visual impairment.Trial registrationISRCTN46824140

The relationship between external events and affect states in older people

Long-term and moderately short-term effects of bereavement and marriage on psychological well-being (PWB) among older people were investigated. The aspect of PWB that was examined was the prevalence of six affects, rated in terms of their frequency during the past year. Affect frequency of four groups was tested: Recently widowed, recently married, and widowed and married elders unselected for length of time in those marital statuses. As predicted, both length of time in the marital status and congruence between the positive event (marriage) and positive affect and between congruence of the negative event (bereavement and negative affect) were associated with group differences. Depressive affect was greatest among the recently bereaved but the recently-married, long-married, and longer-bereaved groups did not differ in depression. Positive affect was greatest among the recently married and other groups did not differ in this respect. Hostility, anxiety, shyness, and contentment were not predicted to differ among groups; in fact, contentment was least in the bereaved; shyness was least among the recently-married, and hostility was lowest among the long-widowed. Results are discussed in terms of the joint influences of time since a life event and the differential relevance of positive and negative affect states to positive and negative events. Continued research attention to the covariation of these factors in relation to the affective aspects of PWB is needed to understand the conditions of stability and change.

Activity loss is associated with cognitive decline in age-related macular degeneration.

The objective of this study was to determine whether relinquishing cognitive, physical, and social activities is associated with an increased risk of cognitive decline in patients with age‐related macular degeneration (AMD). We conducted a 3‐year longitudinal study of 206 nondemented patients with AMD.