Dr Gwyn Reesa,
Associate Professor Jill Keeffe,
Dr Ecosse Lamoureuxa,
Associate Professor David Mellorb
a Centre for Eye Research Australia, The University of Melbourne
b School of Psychology, Deakin University
beyondblue Victorian Centre of Excellence
Project completion year
This project aimed to improve the identification of depression in people with vision impairment and to develop care pathways. The project had three phases.
- In Phase 1, focus groups with eye health professionals at the Royal Victorian Eye and Ear Hospital determined current practice, barriers to care and training needs.
- Phase 2 was a survey of eye health professionals and rehabilitation staff across Victoria to determine current practice, knowledge about depression, barriers to care and training needs.
- In Phase 3, a training program was developed specifically for eye health professionals and rehabilitation staff. The program involves three 90-minute sessions held in a group format over three consecutive weeks. The three modules were: understanding depression, detecting depressive symptoms, and developing and implementing referral pathways. Participants were encouraged to trial activities between sessions and discuss their experiences and any difficulties encountered. They were provided with information, tools and resources, and encouraged to develop local procedures and processes in their specific work contexts. Five training groups were conducted, with a total of 49 participants.
Participants in both the focus groups and survey believed that many patients may be experiencing depression, but detection and referral was not standard practice. Participants demonstrated awareness of both the symptoms of and treatment options for depression. Nevertheless, they found it difficult to distinguish symptoms of depression from a normal response to vision loss and lacked confidence in communicating with patients and their families about depression and its treatment.
Barriers to adequate management of depression included confusion over roles and responsibilities, low knowledge about depression, lack of guidelines and unclear communication pathways between staff. Despite these, participants were enthusiastic about resolving obstacles and establishing clear pathways to care.
The training program was successful at significantly improving knowledge about depression and confidence in managing depression, as well as reducing perceived barriers, according to baseline and post-training questionnaires from 36 participants (73 per cent response rate). The likelihood of discussing feelings, providing information and education about depression, providing written resources about depression and support options, using a depression screening questionnaire, and referring people to their GP increased.
Implications for policy, practice and further research
There is a clear need for training to help eye care staff recognise depression, communicate their concerns with patients and families, and implement referral processes. Implementation of this requires managerial support and commitment so that staff can attend training programs to increase their skills. This could be achieved by building training into undergraduate or continuing professional development programs.
Rees G., Mellor D., Heenan M. 2010. Depression Training Program for Eye Health and Rehabilitation Professionals. Optometry and Vision Science. 87(7), 494-500.
Fenwick E.K., Lamoureux E.L., Keeffe J.E., Mellor D., Rees G. 2009. Detection and Management of Depression in Patients with Vision Impairment. Optometry and Vision Science. 86, 948-954.
Rees G., Fenwick E., Keeffe J.E., Mellor D., Lamoureux E.L. 2009. Detection of depression in patients with low vision. Optometry and Vision Science. 86(6).