Barriers and facilitators to implement e-mental health for depression and anxiety in patients with macular oedema: a qualitative interview study among stakeholders
Main Article Content
Abstract
Purpose: Mental health problems are common in patients with macular oedema, who receive repeated intravitreal injections with anti-vascular endothelial growth factor. A guided internet-based self-help intervention, called E-PsEYE, was developed to reduce these problems. Patients were referred by their ophthalmologist to follow E-PsEYE individually at home, guided by a social worker from low vision services. Since e-mental health is new in this setting and professionals were collaborating in a novel way, barriers and facilitators during implementation and for future scale-up were evaluated.
Methods: Semi-structured interviews were performed with patients (n=8), ophthalmologists (n=4), heads of ophthalmology departments (n=2), doctor’s assistants (n=3), social workers (n=6) and managers from low vision services (n=2), and representatives from a health insurer (n=2). Data were analyzed using a thematic approach.
Results: Both patients and professionals were satisfied with the potential efficiency and added value of the intervention. They indicated that sufficient digital skills in patients and social workers, information technology (IT) support and adding personalized face-to-face contacts, could facilitate implementation. However, a high workload within the different settings (i.e., hospital and low vision services) and the reluctance of both patients and professionals in focusing on mental health problems could hinder implementation. Moreover, evidence on cost-effectiveness and incorporation in current guidelines were expected to be important for reimbursement and scale-up.
Conclusions: Both on the individual level and in the interaction between stakeholders and their context, different important barriers and facilitators were expressed. To facilitate the use of E-PsEYE in practice, strategies that focus on these aspects could be implemented, e.g. healthcare providers could discuss and normalize mental health complaints and their digital skills could be supported.
Article Details
How to Cite
AA H.P.A, van der et al.
Barriers and facilitators to implement e-mental health for depression and anxiety in patients with macular oedema: a qualitative interview study among stakeholders.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3577>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i12.3577.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Bourne RRA, Steinmetz JD, Flaxman S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Global Health. Feb 2021;9(2):E130-E143. doi:10.1016/S2214-109x(20)30425-3
2. Harvey PT. Common eye diseases of elderly people: identifying and treating causes of vision loss. Gerontology. Jan-Feb 2003;49(1):1-11. doi:10.1159/000066507
3. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidence of retinal vein occlusion in an older population: the Blue Mountains Eye Study. Arch Ophthalmol. May 2006;124(5):726-32. doi:10.1001/archopht.124.5.726
4. Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol. Mar-Apr 2011;56(2):95-113.
doi:10.1016/j.survophthal.2010.08.006
5. Pozarowska D, Pozarowski P. The era of anti-vascular endothelial growth factor (VEGF) drugs in ophthalmology, VEGF and anti-VEGF therapy. Cent Eur J Immunol. 2016;41(3):311-316. doi:10.5114/ceji.2016.63132
6. Miller K, Fortun JA. Diabetic Macular Edema: Current Understanding, Pharmacologic Treatment Options, and Developing Therapies. Asia Pac J Ophthalmol (Phila). Jan-Feb 2018;7(1):28-35. doi:10.22608/APO.2017529
7. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. Aug 29 2014;(8):CD005139. doi:10.1002/14651858.CD005139.pub3
8. Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. Jun 22 2017;6(6):CD007419. doi:10.1002/14651858.CD007419.pub5
9. van der Aa HP, van Rens GH, Verbraak FD, Bosscha M, Comijs HC, van Nispen RM. Anxiety and depression in patients who receive anti-VEGF treatment and the usability and feasibility of e-mental health support: the E-PsEYE pilot study. Ophthalmic Physiol Opt. Jul 2021;41(4):808-819. doi:10.1111/opo.12837
10. Casten R, Rovner BW, Leiby BE, Tasman W. Depression despite anti-vascular endothelial growth factor treatment of age-related macular degeneration. Arch Ophthalmol. Apr 2010;128 (4):506-8. doi:10.1001/archophthalmol.2010.24
11. Lotery A, Xu X, Zlatava G, Loftus J. Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study. Br J Ophthalmol. Oct 2007;91(10):1303-7. doi:10.1136/bjo.2007.116939
12. Vu KV, Mitchell P, Dharamdasani Detaram H, Burlutsky G, Liew G, Gopinath B. Prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration who present for anti-VEGF therapy. Acta Ophthalmol. Sep 27 2020;doi:10.1111/aos.14635
13. Senra H, Balaskas K, Mahmoodi N, Aslam T. Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration. Am J Ophthalmol. Mar 14 2017;doi:10.1016/j.ajo.2017.03.005
14. Senra H, Ali Z, Balaskas K, Aslam T. Psychological impact of anti-VEGF treatments for wet macular degeneration-a review. Graefes Arch Clin Exp Ophthalmol. Oct 2016;254(10):1873-1880. doi:10.1007/s00417-016-3384-0
15. Casten RJ, Rovner BW. Update on depression and age-related macular degeneration. Curr Opin Ophthalmol. May 2013;24(3):239-43. doi:10.1097/ICU.0b013e32835f8e55
16. Jones GC, Rovner BW, Crews JE, Danielson ML. Effects of depressive symptoms on health behavior practices among older adults with vision loss. Rehabil Psychol. May 2009;54(2):164-72. doi:10.1037/a0015910
17. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. Br J Psychiatry. Jan 2013;202 (1):22-7. doi:10.1192/bjp.bp.112.112169
18. Konnopka A, Leichsenring F, Leibing E, Konig HH. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. J Affect Disord. Apr 2009;114(1-3):14-31. doi:10.1016/j.jad.2008.07.014
19. Luppa M, Heinrich S, Angermeyer MC, Konig HH, Riedel-Heller SG. Cost-of-illness studies of depression: a systematic review. J Affect Disord. Feb 2007;98(1-2):29-43. doi:10.1016/j.jad.2006.07.017
20. Javitt JC, Zhou Z, Willke RJ. Association between vision loss and higher medical care costs in Medicare beneficiaries costs are greater for those with progressive vision loss. Ophthalmology. Feb 2007;114(2):238-45. doi:10.1016/j.ophtha.2006.07.054
21. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. Mar 2007;37(3):319-28.
doi:10.1017/S0033291706008944
22. Karyotaki E, Riper H, Twisk J, et al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry. Apr 1 2017;74(4):351-359.
doi:10.1001/jamapsychiatry.2017.0044
23. Lokkerbol J, Adema D, Cuijpers P, et al. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study. Am J Geriatr Psychiatry. Mar 2014;22(3):253-62. doi:10.1016/j.jagp.2013.01.058
24. Reiners F, Sturm J, Bouw LJW, Wouters EJM. Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases. Int J Environ Res Public Health. Feb 21 2019;16(4)doi:10.3390/ijerph16040645
25. Buyl R, Beogo I, Fobelets M, et al. e-Health interventions for healthy aging: a systematic review. Syst Rev-London. Jun 3 2020;9(1) doi:ARTN12810.1186/s13643-020-01385-8
26. van der Aa HPA, van Rens G, Verbraak FD, et al. Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial. BMJ Open. Nov 15 2017;7(11):e018149.
doi:10.1136/bmjopen-2017-018149
27. van der Aa HP, van Rens GH, Comijs HC, et al. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ. Nov 23 2015;351:h6127. doi:10.1136/bmj.h6127
28. Lamoureux EL, Tee HW, Pesudovs K, Pallant JF, Keeffe JE, Rees G. Can clinicians use the PHQ-9 to assess depression in people with vision loss? Optom Vis Sci. Feb 2009;86(2):139-45. doi:10.1097/OPX.0b013e318194eb47
29. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. Feb 2002;52(2):69-77.
30. Fleuren M, Wiefferink K, Paulussen T. Determinants of innovation within health care organizations: literature review and Delphi study. Int J Qual Health Care. Apr 2004;16(2):107-23. doi:10.1093/intqhc/mzh030
31. van Rens GHMB, Vreeken HL, van Nispen RMA. Guideline vision disorders: rehabilitation and referral. 2011.
32. Ariens LF, Schussler-Raymakers FM, Frima C, et al. Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology. J Med Internet Res. Sep 5 2017;19(9):e300. doi:10.2196/jmir.7512
33. Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JE. Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care. JMIR Ment Health. Feb 9 2016;3(1):e9. doi:10.2196/mental.4534
34. Rees G, Fenwick EK, Keeffe JE, Mellor D, Lamoureux EL. Detection of depression in patients with low vision. Optom Vis Sci. Dec 2009;86(12):1328-36. doi:10.1097/OPX.0b013e3181c07a55
35. Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC Psychiatry. Dec 30 2019;19(1):426. doi:10.1186/s12888-019-2387-x
36. van Munster EPJ, van der Aa HPA, Verstraten P, Heymans MW, van Nispen RMA. Improved intention, self-efficacy and social influence in the workspace may help low vision service workers to discuss depression and anxiety with visually impaired and blind adults. BMC Health Serv Res. Apr 21 2022;22(1):528. doi:10.1186/s12913-022-07944-0
37. Arnaud AM, Brister TS, Duckworth K, et al. Impact of Major Depressive Disorder on Comorbidities: A Systematic Literature Review. J Clin Psychiatry. Oct 19 2022;83(6)doi:10.4088/JCP.21r14328
38. van Munster EPJ, van der Aa HPA, Verstraten P, van Nispen RMA. Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study. BMC Health Serv Res. Jul 28 2021;21(1):749. doi:10.1186/s12913-021-06682-z
39. Verhaak PF, Prins MA, Spreeuwenberg P, et al. Receiving treatment for common mental disorders. Gen Hosp Psychiatry. Jan-Feb 2009;31(1):46-55. doi:10.1016/j.genhosppsych.2008.09.011
40. Wittkampf KA, van Zwieten M, Smits FT, Schene AH, Huyser J, van Weert HC. Patients' view on screening for depression in general practice. Fam Pract. Dec 2008;25(6):438-44. doi:10.1093/fampra/cmn057
41. Clarke EL, Evans JR, Smeeth L. Community screening for visual impairment in older people. Cochrane Database Syst Rev. Feb 20 2018;2:CD001054.
doi:10.1002/14651858.CD001054.pub3
42. Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B. Motivational interviewing. BMJ. Apr 27 2010;340:c1900.
doi:10.1136/bmj.c1900
2. Harvey PT. Common eye diseases of elderly people: identifying and treating causes of vision loss. Gerontology. Jan-Feb 2003;49(1):1-11. doi:10.1159/000066507
3. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidence of retinal vein occlusion in an older population: the Blue Mountains Eye Study. Arch Ophthalmol. May 2006;124(5):726-32. doi:10.1001/archopht.124.5.726
4. Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol. Mar-Apr 2011;56(2):95-113.
doi:10.1016/j.survophthal.2010.08.006
5. Pozarowska D, Pozarowski P. The era of anti-vascular endothelial growth factor (VEGF) drugs in ophthalmology, VEGF and anti-VEGF therapy. Cent Eur J Immunol. 2016;41(3):311-316. doi:10.5114/ceji.2016.63132
6. Miller K, Fortun JA. Diabetic Macular Edema: Current Understanding, Pharmacologic Treatment Options, and Developing Therapies. Asia Pac J Ophthalmol (Phila). Jan-Feb 2018;7(1):28-35. doi:10.22608/APO.2017529
7. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. Aug 29 2014;(8):CD005139. doi:10.1002/14651858.CD005139.pub3
8. Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. Jun 22 2017;6(6):CD007419. doi:10.1002/14651858.CD007419.pub5
9. van der Aa HP, van Rens GH, Verbraak FD, Bosscha M, Comijs HC, van Nispen RM. Anxiety and depression in patients who receive anti-VEGF treatment and the usability and feasibility of e-mental health support: the E-PsEYE pilot study. Ophthalmic Physiol Opt. Jul 2021;41(4):808-819. doi:10.1111/opo.12837
10. Casten R, Rovner BW, Leiby BE, Tasman W. Depression despite anti-vascular endothelial growth factor treatment of age-related macular degeneration. Arch Ophthalmol. Apr 2010;128 (4):506-8. doi:10.1001/archophthalmol.2010.24
11. Lotery A, Xu X, Zlatava G, Loftus J. Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study. Br J Ophthalmol. Oct 2007;91(10):1303-7. doi:10.1136/bjo.2007.116939
12. Vu KV, Mitchell P, Dharamdasani Detaram H, Burlutsky G, Liew G, Gopinath B. Prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration who present for anti-VEGF therapy. Acta Ophthalmol. Sep 27 2020;doi:10.1111/aos.14635
13. Senra H, Balaskas K, Mahmoodi N, Aslam T. Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration. Am J Ophthalmol. Mar 14 2017;doi:10.1016/j.ajo.2017.03.005
14. Senra H, Ali Z, Balaskas K, Aslam T. Psychological impact of anti-VEGF treatments for wet macular degeneration-a review. Graefes Arch Clin Exp Ophthalmol. Oct 2016;254(10):1873-1880. doi:10.1007/s00417-016-3384-0
15. Casten RJ, Rovner BW. Update on depression and age-related macular degeneration. Curr Opin Ophthalmol. May 2013;24(3):239-43. doi:10.1097/ICU.0b013e32835f8e55
16. Jones GC, Rovner BW, Crews JE, Danielson ML. Effects of depressive symptoms on health behavior practices among older adults with vision loss. Rehabil Psychol. May 2009;54(2):164-72. doi:10.1037/a0015910
17. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. Br J Psychiatry. Jan 2013;202 (1):22-7. doi:10.1192/bjp.bp.112.112169
18. Konnopka A, Leichsenring F, Leibing E, Konig HH. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. J Affect Disord. Apr 2009;114(1-3):14-31. doi:10.1016/j.jad.2008.07.014
19. Luppa M, Heinrich S, Angermeyer MC, Konig HH, Riedel-Heller SG. Cost-of-illness studies of depression: a systematic review. J Affect Disord. Feb 2007;98(1-2):29-43. doi:10.1016/j.jad.2006.07.017
20. Javitt JC, Zhou Z, Willke RJ. Association between vision loss and higher medical care costs in Medicare beneficiaries costs are greater for those with progressive vision loss. Ophthalmology. Feb 2007;114(2):238-45. doi:10.1016/j.ophtha.2006.07.054
21. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. Mar 2007;37(3):319-28.
doi:10.1017/S0033291706008944
22. Karyotaki E, Riper H, Twisk J, et al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry. Apr 1 2017;74(4):351-359.
doi:10.1001/jamapsychiatry.2017.0044
23. Lokkerbol J, Adema D, Cuijpers P, et al. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study. Am J Geriatr Psychiatry. Mar 2014;22(3):253-62. doi:10.1016/j.jagp.2013.01.058
24. Reiners F, Sturm J, Bouw LJW, Wouters EJM. Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases. Int J Environ Res Public Health. Feb 21 2019;16(4)doi:10.3390/ijerph16040645
25. Buyl R, Beogo I, Fobelets M, et al. e-Health interventions for healthy aging: a systematic review. Syst Rev-London. Jun 3 2020;9(1) doi:ARTN12810.1186/s13643-020-01385-8
26. van der Aa HPA, van Rens G, Verbraak FD, et al. Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial. BMJ Open. Nov 15 2017;7(11):e018149.
doi:10.1136/bmjopen-2017-018149
27. van der Aa HP, van Rens GH, Comijs HC, et al. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ. Nov 23 2015;351:h6127. doi:10.1136/bmj.h6127
28. Lamoureux EL, Tee HW, Pesudovs K, Pallant JF, Keeffe JE, Rees G. Can clinicians use the PHQ-9 to assess depression in people with vision loss? Optom Vis Sci. Feb 2009;86(2):139-45. doi:10.1097/OPX.0b013e318194eb47
29. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. Feb 2002;52(2):69-77.
30. Fleuren M, Wiefferink K, Paulussen T. Determinants of innovation within health care organizations: literature review and Delphi study. Int J Qual Health Care. Apr 2004;16(2):107-23. doi:10.1093/intqhc/mzh030
31. van Rens GHMB, Vreeken HL, van Nispen RMA. Guideline vision disorders: rehabilitation and referral. 2011.
32. Ariens LF, Schussler-Raymakers FM, Frima C, et al. Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology. J Med Internet Res. Sep 5 2017;19(9):e300. doi:10.2196/jmir.7512
33. Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JE. Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care. JMIR Ment Health. Feb 9 2016;3(1):e9. doi:10.2196/mental.4534
34. Rees G, Fenwick EK, Keeffe JE, Mellor D, Lamoureux EL. Detection of depression in patients with low vision. Optom Vis Sci. Dec 2009;86(12):1328-36. doi:10.1097/OPX.0b013e3181c07a55
35. Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC Psychiatry. Dec 30 2019;19(1):426. doi:10.1186/s12888-019-2387-x
36. van Munster EPJ, van der Aa HPA, Verstraten P, Heymans MW, van Nispen RMA. Improved intention, self-efficacy and social influence in the workspace may help low vision service workers to discuss depression and anxiety with visually impaired and blind adults. BMC Health Serv Res. Apr 21 2022;22(1):528. doi:10.1186/s12913-022-07944-0
37. Arnaud AM, Brister TS, Duckworth K, et al. Impact of Major Depressive Disorder on Comorbidities: A Systematic Literature Review. J Clin Psychiatry. Oct 19 2022;83(6)doi:10.4088/JCP.21r14328
38. van Munster EPJ, van der Aa HPA, Verstraten P, van Nispen RMA. Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study. BMC Health Serv Res. Jul 28 2021;21(1):749. doi:10.1186/s12913-021-06682-z
39. Verhaak PF, Prins MA, Spreeuwenberg P, et al. Receiving treatment for common mental disorders. Gen Hosp Psychiatry. Jan-Feb 2009;31(1):46-55. doi:10.1016/j.genhosppsych.2008.09.011
40. Wittkampf KA, van Zwieten M, Smits FT, Schene AH, Huyser J, van Weert HC. Patients' view on screening for depression in general practice. Fam Pract. Dec 2008;25(6):438-44. doi:10.1093/fampra/cmn057
41. Clarke EL, Evans JR, Smeeth L. Community screening for visual impairment in older people. Cochrane Database Syst Rev. Feb 20 2018;2:CD001054.
doi:10.1002/14651858.CD001054.pub3
42. Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B. Motivational interviewing. BMJ. Apr 27 2010;340:c1900.
doi:10.1136/bmj.c1900