ORIGINAL ARTICLE Detection of Depression in Patients with Low Vision Gwyneth Rees*, Eva K. Fenwick † , Jill E. Keeffe*, David Mellor*, and Ecosse L. Lamoureux* ABSTRACT Purpose. Depression is common in people with vision impairment and further reduces levels of functioning independent of vision loss. However, depression most often remains undetected and untreated this group. Eye health professionals (EHPs) (ophthalmic nurses, ophthalmologists, optometrists, and orthoptists) and rehabilitation workers (RWs) may be able to play a role in detecting depression. This study aimed to identify current practice and investigate factors associated with depression management strategies. Methods. A self-administered cross-sectional survey of EHPs and RWs assessed current practice including confidence in working with depressed people with vision impairment; barriers to recognition, assessment, and management of depression; beliefs about the consequences, duration, and efficacy of treatment for depression in individuals with vision impariment. Results. Ninety-four participants aged 23 to 69 years took part. Thirty-seven participants (39.8%) stated that they attempted to identify depression as part of patient management, with RWs significantly more likely to do so (n = 17, 60.7%) than EHPs (n = 20, 30.8%; p = 0.007). Intention to identify depression was not associated with sociodemo- graphic factors, professional experience in eye care services, or the length and number of patient consultations, but a significant relationship was found for confidence, barriers, and beliefs about depression (p  0.05). No consistent depression management strategy emerged and a range of barriers were highlighted. Conclusions. Training programs are needed to provide EHPs and RWs with the skills and resources to address depression in people with vision loss under their care and to support the development of procedures by which concerns about depression can be identified objectively, documented, and included as part of a referral to appropriate services. (Optom Vis Sci 2009;86:1328–1336) Key Words: depression, professional development, barriers, training needs T he emotional consequences of vision loss have been well described, with rates of depression estimated to be 2 to 5 times greater in older adults with low vision than in sighted individuals of similar age. 1–5 Depression has been shown to exac- erbate disability and further reduce levels of functioning in this group independent of vision loss, by reducing motivation, initia- tive, and resiliency. 6,7 Even minimal depressive symptoms, which do not meet the diagnostic criteria, are associated with functional decline not accounted for by eye disease or other medical prob- lems. 8 The diagnostic criteria for depression are well established, and good screening tools exist. Effective medicinal and therapeutic regimes are also available to treat depression, and treatment is most effective when implemented early. Despite this, depres- sion often remains undetected and therefore untreated in peo- ple with vision loss. 6,9,10 General practitioners (GPs) play a central role in detecting and managing depression in primary care settings. However, research has identified a range of patient, doctor, and practice factors that present barriers to detection and management of depression in primary care. 11–13 The most prominent ones include practitioners’ attitudes to depression, low confidence in assessing depression, and insufficient access to mental health resources. 11–13 Communica- tion problems may make depression even more difficult to detect in older adults compared with younger adults. Specifically, GPs are less likely to ask older adults about their psychological and social wellbeing, and older adults are less likely to raise these issues. 14 Vision impairment is yet another barrier to effective doctor–patient communication. 15 Indeed, patients with vision impairment and depression have been identified as a group in which depression is least likely to be recognized by their GP. 16 Eye health professionals (EHPs), including ophthalmic nurses, ophthalmologists, optometrists, orthoptists, and rehabilitation work- ers (RWs), are key care providers for people with vision impairment who could play a role in detecting depression. In the recently pub- lished clinical guidelines for managing depression, the National Insti- *PhD † MSc Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, Uni- versity of Melbourne, Department of Opthalmology (GR, EKF, JEK, ELL), and School of Psychology, Deakin University (DM), Melbourne, Victoria, Australia. 1040-5488/09/8612-1328/0 VOL. 86, NO. 12, PP. 1328–1336 OPTOMETRY AND VISION SCIENCE Copyright © 2009 American Academy of Optometry Optometry and Vision Science, Vol. 86, No. 12, December 2009