RecognEYEze: detecting and discussing depression and anxiety in adults with vision impairment

Depression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI). The first aim of this thesis was to determine barriers and facilitators in discussing (subthreshold) depression and anxiety in patients. A semi-structured interview study was conducted to explore these barriers and facilitators from the patients’ perspective. Thereafter, the current practice of low vision service workers and factors associated with discussing depression and anxiety with patients were determined. This was followed by an international study in which a prediction model for discussing depression by healthcare providers was developed and internally validated in a Welsh sample of eye care practitioners, and subsequently externally validated in a Dutch sample of low vision service workers and an Australian sample of eye care practitioners and rehabilitation workers. The second aim of this thesis was to investigate ways to support healthcare providers to address depression and anxiety in patients with VI. Therefore, the usability and feasibility of introducing a screening instrument for depression and anxiety, i.e. the Patient Health Questionnaire (PHQ)-4, in low vision service organizations was investigated. Moreover, a pragmatic mixed-methods study was performed to determine the potential effectiveness and feasibility of two tailored training programs about the detection of depression and anxiety for eye care practitioners and low vision workers. Barriers and facilitators for implementation in clinical practice were explored in both studies. The results of this thesis showed that recognition and discussion of depression and anxiety is not self-evident due to barriers in patients with VI and healthcare providers. There is still work to be done to integrate mental health in ophthalmic care and low vision services, and to support healthcare providers to feel competent in performing routines regarding mental health in patients. Implications for clinical practices focus on the organization of care, accessible information for patients with VI, screening for depression and anxiety as a standard procedure, low intensity mental health support, and providing training to healthcare providers.