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Barry W. Rovner, MD; Robin J. Casten, PhD; Mark T. Hegel, PhD; Benjamin E. Leiby, PhD; William S. Tasman, MD

Arch Gen Psychiatry. 2007;64(8):886-892.

Context  Age-related macular degeneration is a prevalent disease of aging that may cause irreversible vision loss, disability, and depression. The latter is rarely recognized or treated in ophthalmologic settings.

Objective  To determine whether problem-solving treatment can prevent depressive disorders in patients with recent vision loss.

Design  Randomized, controlled trial.

Setting  Outpatient ophthalmology offices in Philadelphia, Pennsylvania.

Patients  Two hundred six patients aged 65 years or older with recent diagnoses of neovascular age-related macular degeneration in one eye and pre-existing age-related macular degeneration in the fellow eye.

Intervention  Patients were randomly assigned to problem-solving treatment (n = 105) or usual care (n = 101). Problem-solving treatment therapists delivered 6 sessions during 8 weeks in subjects' homes.

Main Outcome Measures  Outcomes were assessed at 2 months for short-term effects and 6 months for maintenance effects. These included DSM-IV–defined diagnoses of depressive disorders, National Eye Institute Vision Function Questionnaire–17 scores, and rates of relinquishing valued activities.

Results  The 2-month incidence rate of depressive disorders in problem-solving–treated subjects was significantly lower than controls (11.6% vs 23.2%, respectively; odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P = .03). Problem-solving treatment also reduced the odds of relinquishing a valued activity (odds ratio, 0.48; 95% confidence interval, 0.25-0.96; P = .04). This effect mediated the relationship between treatment group and depression. By 6 months, most earlier observed benefits had diminished, though problem-solving treatment subjects were less likely to suffer persistent depression (²_1,3 = 8.46; P = .04).

Conclusions  Problem-solving treatment prevented depressive disorders and loss of valued activities in patients with age-related macular degeneration as a short-term treatment, but these benefits were not maintained over time. Booster or rescue treatments may be necessary to sustain problem-solving treatment's preventative effect. This study adds important new information to the emerging field of enhanced-care models to prevent or treat depression in older persons.

Trial Registration  clinicaltrials.gov Identifier: NCT00042211

Author Affiliations: Departments of Psychiatry and Neurology (Dr Rovner), Psychiatry and Human Behavior (Dr Casten), Pharmacology and Experimental Therapeutics, Division of Biostatistics (Dr Leiby), and Department of Ophthalmology, Wills Eye Hospital (Dr Tasman), Jefferson Medical College, Philadelphia, Pennsylvania; and Departments of Psychiatry and Community & Family Medicine, Dartmouth Medical School, Hanover, New Hampshire (Dr Hegel).

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