title: Self-care tools to treat depressive symptoms in patients with age-related eye disease: a randomized controlled clinical trial.
abstract: BACKGROUND
  Depression is very common in people with age-related eye disease. Our goal was to determine if self-care tools plus limited telephone support could reduce depressive symptoms in patients with age-related macular degeneration or diabetic retinopathy.
  
  
  METHODS
  A single-blind randomized controlled clinical trial was conducted at Maisonneuve-Rosemont Hospital in Montreal, Canada.
  
  
  METHODS
  Eighty participants were recruited.
  
  
  METHODS
  To be eligible, participants must have had either late stage age-related macular degeneration or diabetic retinopathy, at least mild depressive symptoms, and visual acuity better than 20/200. Half were randomized to the intervention arm and half to delayed intervention/usual care. The intervention consisted of large print written and audio tools incorporating cognitive-behavioral principles plus three 10-minute telephone calls from a lay coach. Eight-week follow-up data were collected by telephone.
  
  
  METHODS
  The primary outcome was the 8-week change in depressive symptoms as measured by the Patient Health Questionnaire-9. Secondary outcomes included anxiety, life space and self-efficacy.
  
  
  RESULTS
  The baseline mean logMAR visual acuity was 0.37 (SD = 0.20), and the baseline mean Patient Health Questionnaire-9 score was 9.5 (SD = 3.9) indicating moderate depressive symptoms. After adjusting for baseline imbalances in visual acuity, the intervention reduced depressive symptoms by 2.1 points more than usual care (P = 0.040). The intervention was not associated with the secondary outcomes (P > 0.05).
  
  
  CONCLUSIONS
  Self-care tools plus telephone coaching led to a modest improvement in depressive symptoms in patients with age-related eye disease. Additional research on how to maximize their effect is necessary.
authors.affiliation: Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Hortence
authors.initials: H
authors.lastname: Kamga
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Yaffe
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Maida
authors.initials: M
authors.lastname: Sewitch
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Sussman
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Strumpf
authors.affiliation: Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.|Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Olivier
authors.affiliation: School of Optometry, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Wittich
authors.affiliation: Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Solmaz
authors.initials: S
authors.lastname: Moghadaszadeh
authors.affiliation: Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.|Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.|School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Freeman
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: depressive symptom; eye disease; self-care