Improving detection of depression in adults with vision impairment

Purpose : One in three adults with vision impairment (VI) experience symptoms of depression. However, healthcare providers often experience difficulties in recognizing and discussing depression in this population. Detection of depression, and subsequently providing mental health support, can be improved by determining predictors to detect depression in adults with VI from the perspective of healthcare providers. Methods : Cross-sectional data on demographics, work, confidence, experienced barriers, intention to identify depression and taking initiative to discuss depression was analyzed in Welsh (n=122), Australian (n=94) and Dutch (n=100) healthcare providers. Multivariable logistic regression analysis was performed in the Welsh sample. The derived model was internally validated by using a bootstrap method, followed by external validation of the recalibrated model in the Australian and Dutch samples. Results : Work experience (β -0.05; 95% confidence interval (CI) 0.92 to 0.99) and experienced barriers (β -0.05; 95% CI 0.92 to 0.98), such as lack of time, knowledge and standard procedures, were found to predict healthcare providers’ initiative to discuss depression. Internal validation of the model provided an area under the curve (AUC) of 0.73, reflecting good discrimination. The recalibrated model showed a good fit in the Australian sample (AUC = 0.77) and a poor fit in the Dutch sample (AUC = 0.63). Conclusions : Predictors for discussing depression by healthcare providers lacked generalizability. Dutch healthcare providers experienced less barriers in depression management than their Welsh and Australian colleagues, which could be a result of the increased attention for mental health in their education and work, and the difference in healthcare systems. Furthermore, a previous study showed intention to discuss depression, self-efficacy and social support predict healthcare providers’ initiative to discuss depression. To improve the detection of depression in adults with VI, the found predictors for each country should be addressed, for instance by means of tailored training programs and effective referral pathways