Barry W. Rovner, M.D., Professor of Psychiatry and Human Behavior, Jefferson Medical College and Medical Director of Jefferson's
Geriatric Psychiatry Program at Wills Eye Hospital, was recently awarded $2.4 million by the National Institute of Mental
Health to evaluate the efficacy of Problem Solving Treatment (PST), a type of cognitive behavioral therapy, to prevent depression
among older people who have Age-Related Macular Degeneration (AMD).
Why AMD?
Impaired vision in one of the most common causes of disability among older people, and most cases of irreversible vision loss
are due to AMD. Many patients with AMD will develop depression in response to the disability associated with impaired vision.
This resulting depression often exacerbates the vision-related disability, leading to increasing functional decline.
Why Prevention?
The incidence rate of depression in AMD is about 29%. It is important to prevent depression from ever happening as once it
sets in, the affective and cognitive experiences are difficult to dispel. Also, depression can precipitate new or exacerbate
pre-existing medical conditions.
Why PST?
Most older people prefer psychosocial over pharmaceutical treatments for depression. PST was chosen because it is an effective
treatment for depression, is brief, and can be administered by non-mental health professionals.
What is PST?
The basic premise of PST is that inaccurate appraisals of problems and/or difficulty generating or effectively implementing
adaptive solutions can lead to poor coping and depression. PST emphasizes finding practical ways to find solutions to every
day life problems. During the course of therapy, patients are taught to: define their problems, generate possible solutions,
choose the best course of action, and implement and evaluate their solutions. Lessons are reinforced through weekly homework.
Method:
In this 5-year clinical trial, 230 AMD patients will be randomized into either a usual care control group or a treatment group.
Those in the treatment group will be visited in their homes weekly for 6 weeks by a nurse who will perform PST. In-home
assessment of depression, physical function, visual acuity, vision function, quality of life, and physical health will be
performed at 2, 6, and 12 months post-baseline by a geriatric psychiatric nurse.
Aims:
- To test the efficacy of PST to reduce the incidence of depressive disorder by 6 months.
- To determine whether PST has beneficial effects on function and vision-related quality of life at 6 months compared to the
control group.
