Preventing late-life depression in age-related macular degeneration.
OBJECTIVE
To determine whether problem-solving treatment (PST) can prevent depressive disorders in patients with age-related macular degeneration (AMD).


METHODS
Two hundred six patients with AMD were randomly assigned to PST (n = 105) or usual care (n = 101). PST therapists delivered six PST sessions over 8 weeks in subjects' homes.


METHODS
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Diagnoses of Depressive Disorders, Hamilton Depression Rating Scale scores, and rates of relinquishing valued activities were assessed at 2 months for short-term effects and 6 months for maintenance effects.


RESULTS
The 2-month incidence rate of depressive disorders in PST-treated subjects was significantly lower than controls (11.6% versus 23.2%, respectively; OR = 0.43; 95% CI [0.20, 0.95]). PST also reduced the odds of relinquishing a valued activity (OR = 0.48; 95% CI [0.25, 0.96]); this effect mediated the relationship between treatment group and depression. By 6 months most earlier observed benefits had diminished. Secondary analyses showed that a minimal level of depressive symptoms were disabling and predicted incident depressive disorders.


CONCLUSIONS
PST prevented depressive disorders and loss of valued activities as a short-term treatment but these benefits were not maintained over time. To sustain PST's effect, an intervention that uses a problem-solving framework to enhance rehabilitative skills may be necessary.
Rovner
Barry W
BW
Department of Psychiatry and Neurology, Jefferson Medical College, Jefferson Medical College, Philadelphia, PA 19107, USA. barry.rovner@jefferson.edu
Casten
Robin J
RJ
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D008268:Macular Degeneration / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D011614:Psychotherapy, Brief / Q000379:methods*; D012307:Risk Factors; D012803:Sick Role