Depression is a serious health concern in Australia and affects approximately 1 in 3 individuals with low vision.1For a person who has a vision impairment, depression can lead to increased levels of disability, reduced quality of life and interfere with and restrict rehabilitation outcomes (such as the use of optical devices and aids). Despite the availability of effective treatments, depression most often remains undetected and untreated in people with vision impairment.
When people lose their ability to drive, read and participate in activities they used to be able to, it is likely this will lead to a reduced quality of life and low mood. We thought it would be very useful to introduce a treatment for depression into a place where vision impaired adults regularly gain access to services.
For my PhD research, an evidence-based treatment for depression, ‘Problem-Solving Therapy for Primary Care’ (PST-PC), will be integrated into Vision Australia services. PST-PC teaches people how to solve the ‘here-and-now’ problems contributing to low mood and helps them develop the skills to cope better with challenges they face. The importance of Problem Solving Therapy for people with vision impairment is that we teach them a skill they can take away and use in their everyday lives, giving them the ability to move forward.
As part of this project, 20 Vision Australia staff across Australia have been trained to deliver PST-PC to clients who screen positive for depressive symptoms. Participants will be involved in 6 to 8 half hour sessions of Problem Solving Therapy. This involves 7 steps which focus on addressing the everyday problems and challenges that people face. Sessions are delivered over the telephone, which overcomes practical barriers, particularly important for clients with vision impairment who have had to give up driving and who live in remote areas of Australia.
With an Honours degree in Psychology, mental health has always been an area of interest for me. The segregation of physical and psychological health services within Australia poses many barriers to vision impaired individuals receiving adequate mental health care. By undertaking this important research, I hope that access to emotional support services in this population can be improved.
During the pilot phase staff received ongoing supervision from a psychologist while they became competent in delivering PST-PC. Following this, the randomised control trial commenced in January, 2012, in order to compare the effectiveness of PST-PC to usual care, which involves a referral letter to the client’s general practitioner. Short term (3 months) and sustained (6 and 12 months) outcomes including depressive symptoms, quality of life and low vision service utilisation will be measured. To date, 110 participants have enrolled into the study and data collection is expected to be completed by mid-2015.
This is the first time worldwide that low vision rehabilitation staff have been trained to manage depressive symptoms. If successful this project will not only put Australia on the map for leading the way in provision of emotional support services but it may also provide a useful model for other chronic health conditions in which depression is also occurs.
If you would like to know more about the Problem Solving Therapy and Depression project, or would be interested in taking part in the study, please contact Edith Holloway at the Centre for Eye Research Australia on (03) 9929 8427 or e-mail editheh@unimelb.edu.au.
This project is funded by the Australia Research Council (Linkage Projects), with support from Vision Australia and beyondblue: the national depression initiative. Edith Holloway was awarded an NHMRC Postgraduate Scholarship and Australian Rotary Health Ian Scott Mental Health Scholarship top-up to complete her doctoral research.
1. Horowitz A. The Prevalence and Consequences of Vision Impairment in Later Life. The Prevalence and Consequences of Vision Impairment in Later Life. 2004;20:185-195.