At our health centers, we have a very strong Members’ Health Assistance Program (MHAP) dedicated to the mental and emotional health of our patients. Our organization is dedicated to the physical and emotional wellbeing of all patients, from geriatric to pediatric. MHAP’s battery of psychologists, psychiatrists, social workers, and other mental health professionals and a tight alliance with New York City agencies ensure that our patients have the care that they need for ailments beyond the physical. MHAP is engaged by our eyecare practitioners for patients who are angry or depressed about their ocular disease or loss of vision, non-acceptance of their ocular disease state, or for other concerns that have been identified as part of their patient assessment.
A recent meta-analysis that included data from 22 studies including 2.9 million patients reported that anxiety and depression are more prevalent in patients who have dry eye disease (DED) than in controls (Weatherby et al, 2019). However, there is often a great discrepancy between signs and symptoms of DED; the symptoms are often associated more with nonocular disorders such as depression and post-traumatic stress disorder (PTSD) than with tear film issues.
Therefore, DED could be considered as more of a psychiatric than an ophthalmic complaint. In fact, DED and depression feed on one another in a synergistic manner, and the severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, and conversely, effective management of depression could help alleviate symptoms of DED.
Complicating this is evidence that selective serotonin reuptake inhibitors (SSRIs) can exacerbate DED; SSRI antidepressants are a type of antidepressant that work by increasing levels of serotonin within the brain. Their “negative” effect on DED makes the management of these comorbidities more difficult.
It is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients’ lives. Collaboration between psychiatrists and eyecare providers could be beneficial in the management of patients who have DED.
Integrated Health Care
The World Health Organization (WHO) recommends the integration of mental health into general health care to close the gap between the number of patients who need mental health care and those who actually receive it. However, a recent study noted that addressing the burden of mental health problems in primary care settings has its limitations, particularly because of the time constraints in busy primary care clinics as well as the inadequate training of staff and physicians in mental health disorders (Lakkis and Mahmassani, 2015).
The WHO’s report went on to say that reliable, brief, and easy-to-administer depression screening instruments are important in helping physicians identify patients who are at risk (Lakkis and Mahmassani, 2015). One such tool is the Patient Health Questionnaire (PHQ-9), which was developed by researchers at Columbia University in the late 1990s. It is a brief, nine-item self-report screening tool that may help identify patient symptoms that could relate to depression. The PHQ-9 was developed for use in primary care settings.
It is important that practitioners have adequate management and follow up available for patients who may be suffering from depression (Weatherby et al, 2019). This will ensure that the ethical requirements for the utilization of a screening instrument for depression are met.
Should optometrists, as primary eyecare providers, incorporate depression screening into their clinical care workflows, especially for their ocular surface disease patients? Certainly, collaborative care with mental health professionals is indicated for our subset of patients who are at risk of or are suffering from depression (Weatherby et al, 2019). CLS
For references, please visit www.clspectrum.com/references and click on document #289.