Contribution of multiple pathways to the relationship between visual impairment and depression: Explaining mental health inequalities among older Chinese adults

The multiple mediating effects of vision-specific factors and depression on the association between visual impairment severity and fatigue: a path analysis study

BACKGROUND

Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.

METHODS

Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.

RESULTS

The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.

CONCLUSIONS

Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.

Association of Visual Impairment With Neuropsychiatric Symptoms of Dementia

BACKGROUND

Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined.

METHODS

We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS.

RESULTS

Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12-7.44), depression (OR 2.79; 95% CI 1.7-4.57), and agitation (OR 1.61; 95% CI 1.05-2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93-34.98), psychosis (OR 6.69, 95% CI 2.53-17.7), and mania (OR 5.92, 95% CI 1.77-19.82). However, these associations did not remain significant after covariate adjustment.

CONCLUSIONS

Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.

Self-reported visual impairment and depression of middle-aged and older adults: The chain-mediating effects of internet use and social participation

Background

Visual impairment (VI) is a strong predictor of depression in middle-aged and older adults. However, the underlying mechanisms and pathways have not been well characterized. The purpose of this study was to determine whether Internet use and social participation mediate the effects of self-reported VI on depression.

Methods

The study used the fourth wave of cross-sectional data from the China Health and Retirement Longitudinal Study, including 19,766 Chinese adults. Depression was assessed according to the CES-D 10 International Scale. Logistic regression models were used to examine the relationship between self-reported VI and depression. While adjusting for relevant covariates, the PROCESS macro (model nos. 6 and 91) was used to assess the chain-mediating effects of Internet use and social participation.

Results

A total of 17,433 respondents were included in this study. The CES-D 10 results showed that 7,327 middle-aged and older adults had depressive symptoms, of whom 39.5% were male and 10.2% were ≥75 years old. 32.1% of respondents self-reported VI. Regression analysis showed a positive association between VI and depression, while Internet use and social participation had a negative predictive effect on depression. In the mediation analysis, the social participation pathway contributed the most to the total effect, accounting for 52.69% of it. The proportion of Internet use is 37.72%. When these two mediators were considered together in the full model, they accounted for 9.58% of the total effect of VI on depression.

Conclusion

Internet use and social participation were important mediators that mitigated the effects of VI on depression. Combined with previous evidence, online activities such as e-health and m-health can effectively promote disease monitoring and diagnosis, and various offline social participation activities can also play a role in regulating emotions. Therefore, Internet use and social participation factors may serve as relevant entry points for the development of intervention programs that may further improve the mental health of the visually impaired.

Association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults

Objective

Long-term untreated vision and hearing impairments can negatively impact physical and mental wellbeing. We investigated the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.

Methods:

This was a prospective cohort study of 9,492 participants from the China Health and Retirement Longitudinal Study (CHARLS) carried out in 2011, 2013, 2015, and 2018. This study used self-reported vision and hearing status to determine the degree of impairment. Depressive symptoms were examined using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with a total score of ≥ 12 indicating depressive symptoms. A Cox proportional hazards model adjusted for age, sex, residence, marital status, educational level, smoking history, alcohol consumption, hypertension, diabetes, heart disease, digestive disease, arthritis, wearing glasses, and hearing aids was used to estimate the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.

Results:

Of the 9,492 participants [mean (SD) age at CHARLS baseline, 58.12 (9.00) years], 3,238 (34.11%) participants reported incident depressive symptoms during the 7-year follow-up period. Participants who self-reported only vision impairment [hazard ratios (HR): 1.14, 95% confidence intervals (CI): 1.05–1.24], only hearing impairment (HR: 1.24, 95% CI: 1.06–1.46), and both vision and hearing impairments (HR: 1.25, 95% CI: 1.08–1.45) were independently associated with a greater increase in the hazard risk of incident depressive symptoms compared to those without vision and hearing impairments. An increase in participants' vision and hearing scores was associated with a significant increase in the hazard risk of incident depressive symptoms (HR: 1.04, 95% CI: 1.03–1.06).

Conclusion:

Vision and hearing status was associated with increased depressive symptoms among middle-aged and older Chinese adults during the 7-year follow-up period. Participants' use of glasses and hearing aids did not improve their depressive symptoms. Our findings may facilitate the development of effective treatments to prevent and treat vision and hearing impairments, thereby enhancing the physical and mental wellbeing of middle-aged and older adults.

Visual and hearing impairment and their association with depression among middle-aged and older individuals in India: Evidence from a cross-sectional study

OBJECTIVE

The aim of the study was to determine the prevalence and associated factors of visual and hearing impairment as well as to investigate their association with depression among individuals aged 45 and above in India.

METHODS

The study utilized data from the Longitudinal Ageing Study in India (LASI) Wave 1, (2017-18). The total sample size of this study was 65,562 individuals aged 45 and above. Descriptive statistics along with bivariate and multivariable analyses were performed to fulfill the objectives.

RESULTS

The prevalence of visual impairment in the study population was 32.1 percent, whereas the prevalence of self-reported hearing impairment was 6.9 percent. In the logistic regression models, both visual impairment [Adjusted odds ratio (AOR)-1.06; 95% Confidence interval (CI):0.99-1.14] as well as hearing impairment [AOR-1.25; 95% CI:1.11-1.41] were found to be significantly associated with depression. Moreover, individuals with a single impairment were 8 percent [AOR-1.08; 95% CI: 1.01-1.16] and individuals with dual impairment were 36 percent [AOR-1.36; 95% CI:1.13-1.65] significantly more likely to have depression.

CONCLUSION

Individuals with sensory impairment were more likely to suffer from depression and the risk was significantly higher among individuals with dual impairment. Therefore, clinicians dealing with individuals with sensory impairments must be aware of the likelihood of comorbid depression in order to provide timely screening and treatment.

Visual impairment and depression in China: a 7-year follow-up study from national longitudinal surveys

OBJECTIVES

To explore the longitudinal association between visual impairment (VI) and depression among adults 45 years and older in China based on a nationally representative follow-up dataset.

SETTING

Participants in China from the China Health and Retirement Longitudinal Study were included.

PARTICIPANTS

A total of 6748 participants from two waves of the China Health and Retirement Longitudinal Study 2011-2018 were included for analysis by age group.

PRIMARY AND SECONDARY OUTCOME MEASURES

VI and depression were defined by self-diagnosis and the Center for Epidemiological Studies Depression Scale-10, respectively. Lagged dependent variable regression models with ordinary least squares estimation were used to evaluate the association between VI and depression. Age was divided into three groups, that is, 45-54, 55-64, and 65 years and older, to explore the relationship between VI and depression in different age groups.

RESULTS

In our study sample, VI remarkably predicted an increase in depressive scores. The magnitude of depressive scores increased among those with VI points greater than 3.517 (β=3.517; 95% CI=2.697 to 4.331) points than those without VI in the 7-year follow-up. Significant relationships were also found between VI and depression in the three age groups in the sensitivity analysis.

CONCLUSION

VI was associated with an increase in depression scores over a 7-year period. Female respondents, low educational attainment and high alcohol intake significantly predicted an increase in depressive status.

Feeling matters: perceived social support moderates the relationship between personal relative deprivation and depressive symptoms

BACKGROUND

Little research describes the mechanisms underlying depressive symptoms and personal relative deprivation in Chinese populations.

METHODS

In this study, the respondents were (N = 914) residents of Beijing (17-59 years old) and robust multiple linear regressions were used to assess the main relationship between relative deprivation and depressive symptoms and social support as a potential moderator for that relationship.

RESULTS

Individuals who reported higher personal relative deprivation had greater depressive symptoms than those who reported lower personal relative deprivation. Perceived social support buffered the relationship between depressive symptoms and personal relative deprivation.

CONCLUSIONS

The findings of this current study demonstrate the importance of relative deprivation for psychological strain and income in explaining how socioeconomic indices correlate with depressive symptoms. They also demonstrate the need to acknowledge the interaction of perceived social support and personal relative deprivation for influencing depression.