Age-Related Macular Degeneration: Self-Management and Reduction of Depressive Symptoms in a Randomized, Controlled Study: AMD SELF-MANAGEMENT and REDUCED DEPRESSIVE SYMPTOMS

OBJECTIVES: To assess the effectiveness of a self-management program for age-related macular degeneration (AMD) in reducing depressive symptoms. DESIGN: Analysis of 6-month follow-up for a subset of participants in a randomized, controlled trial who were clinically depressed at baseline. SETTING: University ophthalmology clinic. PARTICIPANTS: 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, 1, Fourth Edition, Research Version, for major or minor depressive disorder with significant depressive symptoms (>= 5 points) on the 15-item Geriatric Depression Scale (GDS-15). INTERVENTION: AMD self-management program consisting of cognitive and behavioral elements including health education and enhancement of problem-solving skills. MEASUREMENTS: 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. CONCLUSION: These findings may support the effectiveness of an AMD self-management program for depressed older adults with advanced vision loss from AMD.