Struggling With Hidden Depression? We Care! An Evidence-Based Innovative Guideline To Support Patients With Diabetic Retinopathy And Major Depressive Disorders

Nga Sze Wong

Background: Growing epidemiological studies suggested the association between depression and DR. Depression could cause earlier retinal microvascular changes, poorer glycemic control and increased health care burdens. However, 60% of diabetes with Major Depressive Disorders (MDD) remained under-diagnosed. A lack of depression management guideline was reported as the major barrier among ophthalmic nurses to provide holistic care.

Purposes: To develop an evidence-based guideline for ophthalmic nurses for caring patients with DR and MDD.

Methods: An integrative literature review was conducted using Ovid MEDLINE(R), Allied and Complementary Medicine, British Nursing Index, British Nursing Index & Archive, PubMed and Cochrane Library. A guideline was developed using translational nursing research approach, under expert supervision. A non-experimental pretest-posttest evaluation study was proposed. Primary outcomes were CB-PHQ-9 depression scores, remission rate of MDD, recognition rate of MDD and patient's satisfaction of care.

Results: Seven randomized controlled trials and one meta-analysis (2000 to August 2009) were extracted. A nurse-coordinated program comprising depression screening, referral and 12-month continuous monitoring followed by the initiation of antidepressant treatment, significantly improved mental health outcomes for MDD patients. In our hospital, 128 subjects (calculated by Java Applets for Power and Sample Size) would be recruited for data analysis. Expected outcomes were a decrease of 16.75% of depression scores during post-intervention, 25% MDD remission, 28% case-recognition, and 80% of patient satisfied with care.

Conclusion: In viewing the serious and costly impacts of untreated MDD in patients with DR, this guideline could promote mental health for depressed outpatient with DR.