caa a22 4500 606178996 CHVBK 20210128100759.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s11136-015-1032-5 doi (NATIONALLICENCE)springer-10.1007/s11136-015-1032-5 Watchful waiting for subthreshold depression and anxiety in visually impaired older adults [Elektronische Daten] [Hilde van der Aa, Esther Krijnen-de Bruin, Ger van Rens, Jos Twisk, Ruth van Nispen] Purpose: Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting' period. Methods: A pretest-posttest study in 265 visually impaired older adults (mean age 74years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results: After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p<0.001). Of all participants, 34% recovered from subthreshold depression and/or anxiety and 18% developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95% confidence interval (CI) 0.28-0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95% CI 1.00-1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95% CI 1.02-1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95% CI 1.28-4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions: Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting. The Author(s), 2015 Watchful waiting nationallicence Low vision nationallicence Depression nationallicence Anxiety nationallicence RCT : Randomised controlled trial nationallicence CES-D : Centre for Epidemiologic Studies Depression Scale nationallicence HADS-A : Hospital Anxiety and Depression Scale—Anxiety subscale nationallicence MINI : Mini International Neuropsychiatric Interview nationallicence LVQOL : Low Vision Quality of Life Questionnaire nationallicence AVL : Adaptation to Vision Loss Scale nationallicence PNCQ : Perceived Need for Care Questionnaire nationallicence OR : Odds ratio nationallicence van der Aa Hilde Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut Krijnen-de Bruin Esther Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut van Rens Ger Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut Twisk Jos Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut van Nispen Ruth Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut Quality of Life Research Springer International Publishing 24/12(2015-12-01), 2885-2893 0962-9343 24:12<2885 2015 24 11136 https://doi.org/10.1007/s11136-015-1032-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s11136-015-1032-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van der Aa Hilde Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Krijnen-de Bruin Esther Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- van Rens Ger Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Twisk Jos Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- van Nispen Ruth Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 773 0- Quality of Life Research Springer International Publishing 24/12(2015-12-01), 2885-2893 0962-9343 24:12<2885 2015 24 11136