Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners’ clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. Before training, only one third of practitioners (n = 15) identified depression in low vision patients, increasing to over 90% (n = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% (n = 4) to 80% (n = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p < 0.001) and perceived less barriers to addressing depression (difference in means = − 0.95, 95% CI − 1.32 to − 0.59, p < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients’ perspective, to determine the desire for and acceptability of screening.

中文翻译：

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将常规抑郁症筛查纳入社区低视力康复服务的障碍：混合方法研究。

视力低下者常见抑郁症，因此建议进行抑郁症筛查。但是，抑郁症筛查是一个复杂的过程，低视力从业者需要对其进行培训。这项研究使用两个问题检查了常规抑郁筛查的整合，并在从业人员接受培训后的6个月内将转介途径引入了威尔士国家低视力服务，并确定了实施的主要障碍。这项前后单组研究采用了融合的混合方法设计，以收集有关低视力从业者临床实践以及实施抑郁症筛查的已知障碍的定量问卷和定性访谈数据。四十名从业人员在培训前，培训后和培训后六个月完成了问卷调查，其中九名在培训后六个月完成了访谈。在进行线性回归分析之前，将有序的问卷调查分数Rasch转换为间隔水平数据，以确定分数随时间的变化以及感知障碍与临床实践之间的关联。专题分析应用于访谈，叙述性结果与问卷调查结果合并。在训练之前，只有三分之一的从业者（n = 15）在低视力患者中发现了抑郁症，在训练后的6个月时，抑郁症的患病率上升到90％以上（n = 37），而使用已验证的抑郁症筛查问题的从业者从10起增加了％（n = 4）至80％（n = 32）。训练六个月后，从业者报告对疑似抑郁症采取了更多的行动（均数= 2.77,95％CI 1.93至3.61，p <0。001）并减少解决抑郁症的障碍（均数差异=-0.95，95％CI-1.32至-0.59，p <0.001）。但是，筛选问题并未得到一致使用。实施过程中仍然存在一些障碍，包括认为患者不愿讨论抑郁症，时间限制以及对解决抑郁症缺乏信心。抑郁症筛查服务指南和培训的引入成功增加了识别和解决抑郁症的低视力从业者的人数。但是，尚未实现对所有弱视参与者的标准化筛查，仍然存在一些障碍。医疗服务在考虑进行心理健康筛查时需要解决这些障碍，并且进一步的研究应从患者的角度着眼于这一过程，