title: Age-related macular degeneration: self-management and reduction of depressive symptoms in a randomized, controlled study.
abstract: OBJECTIVE
  To assess the effectiveness of a self-management program for age-related macular degeneration (AMD) in reducing depressive symptoms.
  
  
  METHODS
  Analysis of 6-month follow-up for a subset of participants in a randomized, controlled trial who were clinically depressed at baseline.
  
  
  METHODS
  University ophthalmology clinic.
  
  
  METHODS
  Thirty-two depressed older adult volunteers (mean age 81.5) with advanced AMD who had been randomized to a self-management program (n=12) or one of two control conditions (n=20). Subjects were included if at baseline they met criteria from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Axis, I, Fourth Edition, Research Version, for major or minor depressive disorder with significant depressive symptoms (>or=5 points) on the 15-item Geriatric Depression Scale (GDS-15).
  
  
  METHODS
  AMD self-management program consisting of cognitive and behavioral elements including health education and enhancement of problem-solving skills.
  
  
  METHODS
  Primary outcome measure was GDS-15. Secondary outcome measures included National Eye Institute Visual Function Questionnaire (NEI-VFQ) and AMD Self-Efficacy Questionnaire.
  
  
  RESULTS
  At 6-month follow-up, the self-management group had a significantly greater reduction in depressive symptoms on the GDS-15 than the controls (P=.03). The mean reduction of 2.92 points in the self-management group was more than the 2-point change threshold considered to be clinically meaningful. Change on the NEI-VFQ was nonsignificant. Reduction in depressive symptoms was associated with greater self-efficacy in the self-management group.
  
  
  CONCLUSIONS
  These findings may support the effectiveness of an AMD self-management program for depressed older adults with advanced vision loss from AMD.
authors.affiliation: Department of Ophthalmology, Shiley Eye Center, University of California at San Diego, La Jolla, CA 92093, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Brody
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Roch-Levecq
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Moutier
authors.forename: Stuart I
authors.initials: SI
authors.lastname: Brown
mesh_terms: D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000523:psychology* / Q000628:therapy*; D008297:Male; D012648:Self Care; D020377:Self Efficacy; D012944:Social Support; D016896:Treatment Outcome