Sight loss patients with depression “routinely overlooked”

25 January 2016

Dr Tom Margrain
Dr Tom Margrain

New research backs call for depression screening in low vision clinics

Nearly half of people attending NHS low vision clinics for help with sight loss suffer from symptoms of clinical depression but are not given the treatment they need, new Cardiff University research has uncovered.

A team of researchers from the University’s School of Optometry and Vision Sciences, led by Dr Tom Margrain, teamed up with the charity Guide Dogs to examine the full extent of the problem.

The Depression in Visual Impairment Trial (DEPVIT) found that 43% of people who lose their sight go on to battle depression, however NHS low vision services focus only on the physical need, and psychological screening or therapy is not yet an integral part of rehabilitation.

The study also found that of those who screened positive for depressive symptoms almost three-quarters (74.8%) were not receiving any treatment for their depression.

Currently just two low vision services in Britain regularly screen patients for depression.

The three-year research trial, commissioned by the charity Guide Dogs, found that diagnosis and treatment for depression for people attending low vision clinics is “routinely overlooked”.

This lack of support prevents those living with sight loss from accessing vital treatments and services that could help build confidence to live full and independent lives. In the UK today, almost two million people are living with sight loss and of these around 180,000 rarely leave home alone.

The DEPVIT research showed that when measuring using the Geriatric Depression Scale (GDS-15), one of the most widely used tools for the screening of depression, 43% of patients attending low vision clinics scored over six (any score above five indicates a level of depression) – one of the highest rates for any health condition or disability.

Dr Tom Margrain said: “The results of the DEPVIT trial are extremely alarming.

“The prevalence of depression for people with sight loss is among the highest for any health condition or disability and yet there is virtually no provision for depression screening.

“Further research is urgently needed so we can evaluate the best way to deliver the right support for this high risk group. 

“But right now, the best thing we can do is introduce depression screening in low vision rehabilitation clinics across the UK, and offer people a referral to their GP when needed.

“We hope our recommendations will be taken seriously and integrated into NHS care.”

Jenny Cook, Head of Strategy and Research from the charity Guide Dogs said: “It’s heart-breaking that people with sight loss are being left to suffer emotionally.

“It’s clear from the results of this trial that early screening and effective treatment needs to be integrated into rehabilitation services as soon as possible so people with sight loss can be supported and encouraged to regain their confidence and independence in the world.

“For the first time we have data confirming that people with a visual impairment suffer some of the highest rates of depression. Adjusting to life with sight loss can be extremely challenging. Many people struggle with feelings of isolation, find activities they used to enjoy more difficult and can feel reliant on their family and friends. Depression is a debilitating illness that provides an extra barrier to seeking the right help and support, but it can be treated.”

Chris Glover, who suffered a breakdown after losing his sight and was diagnosed with depression by his GP, said: “When I was diagnosed with sight loss it hit me really hard and the negative feelings were suffocating. When you are in that situation you are even less likely to ask for help.

“I had to reach rock bottom before my depression was identified. My GP was fantastic but I also wish someone could have helped me cope with the emotional impact of losing my sight much sooner.”

Now Guide Dogs is supporting Cardiff University in their bid to launch a second phase of research named BEWELL to develop a model of treatment.

This second phase will see Guide Dogs mobility instructors trained, who work with people living with sight loss to help them get out and about independently, deliver ‘stepped care intervention’, which has been successfully trialled in Holland.

Stepped care involves assessing a person’s needs in order to provide the right treatment at the right time, and ‘stepping up’ this treatment should it need to increase in intensity. The funding application for this second phase is currently being considered by National Institute for Health Research (NIHR).

With an ageing population and the prevalence of long-term conditions related to sight loss, such as diabetes, the number of people who are blind or partially sighted in the UK is set to double by 2050.