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Activity Loss and Depression in Age-Related Macular Degeneration

Received September 25, 2000; revised December 15, 2000; accepted January 22, 2001. From the Department of Psychiatry and Human Behavior, Jefferson Medical College at Wills Eye Hospital, Philadelphia, PA (BWR), and the Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, Philadelphia, PA (RJC). Address correspondence to Barry W. Rovner, M.D., Geriatric Psychiatry, Wills Eye Hospital, 900 Walnut Street, 8th Floor, Philadelphia, PA 19107. e-mail: rovner1{at}aol.com

Age-related macular degeneration (AMD) is the most frequent cause of severe vision loss in older persons and is associated with high rates of disability and depression. The authors evaluated 51 patients with bilateral AMD to investigate the interrelationships of disease severity, disability, and depression and focused on loss of valued activities as an emblematic disabling consequence of AMD. They characterized depression by the Center for Epidemiologic Studies–Depression (CES–D) score, a syndromal state based on the CES–D, and as a level of distress (Index of Affective Suffering; IAS). Thirty subjects (58.8%) had loss of a valued, discretionary activity. They had worse visual acuity and more depressive symptoms and were represented in higher IAS levels than other subjects. Visual acuity was significantly correlated with IAS levels, but not with CES–D scores or syndromal depression. A regression model demonstrated that activity loss mediated the relationship between visual acuity and IAS level. Affective distress occurs in AMD, largely to the extent that valued activities are relinquished because of vision loss. IAS levels best illuminated this relationship, suggesting the value of this dimension of affective functioning in studies of the consequences of chronic disease.

Key Words: Depression • Activity Level • Sensory Loss

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