The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision

Purpose

Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined.

Patients and Methods

A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem.

Results

Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI.

Conclusion

To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.

Social functioning in adults with visual impairment from minority ethnic communities in the United Kingdom

Background

Visual impairment (V.I.) has been associated with a negative impact on social functioning, while social support can impact on well-being in those with V.I. Adults from minority ethnic communities (MEC) are projected to make up an increasing proportion of adults living with V.I. in the UK, but limited research has explored their social functioning. This article provides a preliminary insight into social functioning among MEC adults living with V.I. in the UK.

Methods

The article reports findings from a secondary analysis of V.I. Lives survey data. V.I. Lives was a UK telephone survey, which explored the life experiences of people with V.I. across a wide range of topics including social functioning. This secondary analysis explored social participation, support, isolation, and relationships among a matched control sample of 77 MEC and 77 adults aged 18 and over from White communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest subgroups within the MEC group, Asian (n = 46) and Black participants (n = 22).

Results

Contact with like-minded people (U = 2174.50, p = 0.003, r = -0.24) and opportunities to take part in more social activities (U = 2253.50, p = 0.007, r = -0.22) was significantly more important to MEC than WC participants. Moreover, MEC participants were significantly less likely to feel supported by friends/family (U = 3522.50, p = 0.017, r = 0.19) and had fewer people they could ask for help (U = 3775.50, p = 0.001, r = 0.26), but there were no significant differences in the perceived impact of V.I. on their friendships/social life and marriage/relationship, their ability to take part in a range of activities, nor their marital status. Asian participants were significantly more likely than Black participants to feel cut off from the people and places around them (U = 655.50, p = 0.042, r = 0.25). Effect sizes were overall small. Although there were no further statistically significant differences between the two groups, Asian participants were also less likely to be able to take part in activities, and more likely to report a negative impact on their social life/friendships and on their marriage/relationship, as well as a smaller social network.

Conclusion

The findings suggest that V.I. may have had a greater impact on social functioning among Asian participants in this sample, including on experiences of social isolation and participation in social activities. Future research will need to confirm these findings and explore the possible reasons.

Impact of COVID-19 on Depressive Symptoms Among Patients with Low Vision and Blindness

Background

Disability is globally recognized as a key cause of depression. Likewise, the COVID-19 pandemic has significantly increased the vulnerability of patients with low vision to health and health-related issues, especially mental health. This study aimed to examine the association between the impact of COVID-19 and depressive symptoms in patients with low vision and blindness.

Methods

This cross-sectional study was conducted between February and July 2022 and involved face-to-face interviews. Patients with low vision and blindness diagnosed with depression were excluded. The following items were included in the questionnaire: sociodemographic information, Multi-Dimensional Scale of Perceived Social Support (MSPSS), the impact of COVID-19, and The Center for Epidemiological Studies-Depression (CES-D). Hierarchical linear regression analysis was used to examine the association between the impact of COVID-19 and depression.

Results

The prevalence of depression among patients with low vision and blindness was 43.0%. Three factors were associated with depressive symptoms: compliance with COVID-19 prevention strategies (β = 0.16, p<0.01), anxiety during COVID-19 (β = 0.24, p<0.001), and social support (β = -0.16, p<0.01).

Conclusion

The findings indicated that COVID-19 significantly increased depressive symptoms among patients with low vision and blindness. The psychological effects of the COVID-19 pandemic have been considered critical and emergent public health issues. Stakeholders, particularly public health organizations, need to urgently implement preventive and protective measures to help patients with physical and mental disabilities.

Conceptualizations of well-being in adults with visual impairment: A scoping review

Background

Despite its ubiquity, it is often not clear what organizations and services mean by well-being. Visual impairment (VI) has been associated with poorer well-being and well-being has become a key outcome for support and services for adults living with VI. A shared understanding of what well-being means is therefore essential to enable assessment of well-being and cross-service provision of well-being support.

Objectives

To provide an overview of the ways in which well-being has been conceptualized in research relating to adults living with VI.

Eligibility criteria

Articles were included in the review if the article discussed well-being in the context of adults living with VI, was available in English and as a full text.

Data sources

A systematic search using search terms relating to VI and well-being was conducted in EBSCOHost (Medline, CINHL) and Ovid (Embase Classic, Embase, Emcare 1995, Health + Psychosocial, HMIC Health Management Info, APA, PsycArticles, PsycInfo, PsycTests).

Charting

A team of three reviewers screened titles, abstracts and full-texts articles and extracted data. Ambiguous articles were referred to the research group and discussed.

Results

Of 10,662 articles identified in the search, 249 were included in the review. These referred to 38 types of well-being. The most common types were general well-being (n = 101; 40.6%) emotional well-being (n = 86, 34.5%) and psychological well-being (n = 66, 26.5%). Most articles (n = 150; 60.2%) referred to one type only, with a maximum of 9 listed in one article. A large number of articles did not clearly define well-being. A wide range of indicators of well-being related to the domains of hedonia, mood, positive and negative affect, quality of life, mental health, eudaimonia, self/identity, health, psychological reactions to disability and health problems, functioning, social functioning and environment, were extracted, many of which were used just once.

Conclusions

There remains a lack of consensus on how well-being is conceptualized and assessed in the context of adult VI. A standardized multi-domain approach derived with input from adults with VI and practitioners working with them is required to enable comparison of findings and cross-organizational provision of support.

African Americans, Caribbean Blacks and Depression: Which Biopsychosocial Factors Should Social Workers Focus On? Results from the National Survey of American Life (NSAL)

Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.

Character Strengths Predict Subjective Well-Being, Psychological Well-Being, and Psychopathological Symptoms, Over and Above Functional Social Support

The increasing value of character strengths in the prediction of well-being and psychopathology, after the effects of functional social support and sociodemographic variables are accounted for, is examined. Participants were 1494 Spanish-speaking students between the ages of 18 and 68 (43.3% men and 56.7% women) who completed measures of character strengths, functional social support, subjective well-being, psychological well-being, and symptoms of psychopathology. Functional social support had predictive value in explaining the variability of each component of well-being and psychopathology. Regarding character strengths, theological strengths had the greatest predictive power for life satisfaction (β = 0.41), positive affect (β = 0.49), affect balance (β = 0.45), purpose in life (β = 0.60), self-acceptance (β = 0.50), environmental mastery (β = 0.47), and positive relations with others (β = 0.25). Emotional strengths made the strongest contribution to the variance explained (β = 0.41) of autonomy, and intellectual strengths were the strongest predictive variable for personal growth (β = 0.39). Strengths of restraint had the greatest predictive power for the global severity index of psychopathology (β = –0.27). Functional social support and character strengths have strong links to mental health. Positive interventions to develop these variables could contribute to enhance well-being and prevent psychological distress.

Effect of Psychological Capital of Volunteers on Volunteering Behavior: The Chained Mediation Role of Perceived Social Support and Volunteer Motivation

This study explored the role of perceived social support and voluntary motivation in the effect of psychological capital of volunteers on volunteering behavior. A sample of 1,165 volunteers who were registered in the China Voluntary Service Information System was investigated using a self-reported questionnaire, showing that the psychological capital, perceived social support, voluntary motivation, and volunteering behavior of the volunteers were significantly and positively related to each other. The psychological capital of the volunteers affected volunteering behavior not only directly, but also indirectly through the mediating role of voluntary motivation. Moreover, perceived social support and voluntary motivation also played a chain role in the relationship between the psychological capital and volunteering behavior of the volunteers. Therefore, increasing the psychological capital of the volunteers should promote their perceived social support and inspire voluntary motivation, in turn affecting their volunteering behavior.

Association of vision loss and depressive symptomatology in older adults assessed for ocular health in senior living facilities

PURPOSE

People with vision loss are at increased risk for major depressive disorder (MDD) and subclinical depression. However, screening for depression is rarely done in eye care settings or among groups in the general population known to have vision disorders.

METHODS

We examined the prevalence of depression, using the Patient Health Questionnaire - 2 (PHQ-2), among a group of older adults (N = 204; mean age = 82.15) at two senior living facilities (SLFs) and determined the relationships between severity of depression and objective visual findings, visual function, beliefs about taking an active role in one's own eye care (i.e., patient activation) and level of social support.

RESULTS

Approximately 50% of the sample had impaired vision in at least one eye, and close to 30% of the sample obtained a score on the PHQ-2 indicating the likely presence of major depressive disorder. Visual testing findings were related to visual function (e.g., ability to read), but not to depression. Patient activation was also not significantly related to the level of depression. However, impaired visual functioning and less social support were both strong predictors of depression. These two variables and their interaction accounted for 17% of the total PHQ-2 score variance.

CONCLUSIONS

These data indicate the potential utility of screening for depression as part of vision care in populations likely to have significant vision loss. The findings also suggest that a comprehensive approach to depression prevention and/or reduction in SLF and similar populations may require interventions to address reduced visual functioning and methods to strengthen social networks.

Arts activity and well-being for visually impaired military veterans: a narrative discussion of current knowledge

OBJECTIVES

The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans.

STUDY DESIGN

A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge.

RESULTS

While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans.

CONCLUSIONS

Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.

Perspectives on social support among adults with acquired vision impairment

This study investigates the implications of acquiring vision impairment later in life on the effect of social support among adults with acquired vision impairment in Nigeria. It further explores the importance of maintaining social contact after vision loss which serves as the structural aspect of social support needed for adaptation to vision loss. A qualitative study using a phenomenological approach was undertaken. Eight adults (18- 59years) were recruited from disability service organizations in Nigeria. Telephone interviews were recorded and transcribed, and thematic analysis was used to analyse the data gathered in this study. Three broad themes were developed from participants’ accounts of their experiences: (1) diminishment in social contact and social support from friends, romantic partners, and others; (2) negative changes in social support at workplace; and (3) increased social support from family members. The findings indicate that participants experienced diminished social contact and negative social support from friends, colleagues, and employers at the workplace. However, participants experienced increased social contact and positive social support from family members in the form of tangible and effective support. As social connectedness are highly valued in Nigeria’s diverse society, we suggest that adults with acquired vision impairment would significantly benefit from support services that would assist these individuals to build and maintain their social contact or networks providing a platform for positive social support.

Loneliness in young adults with a visual impairment: Links with perceived social support in a twenty-year longitudinal study

BACKGROUND

Young people with disabilities are more at risk of experiencing loneliness in later life than their typically developing peers.

AIM

To identify those who become lonely in later life, trajectories of perceived parent and peer support from adolescence to adulthood of young people with a visual impairment were studied.

METHODS

A total of 316 adolescents (M = 18 years; SD = 6.5) enrolled in a cohort study in 1996; 205 of them participated in 2005, 178 in 2010, and 161 in 2016. Latent growth curve models were fitted to the data.

RESULTS

Perceived parent support followed a linear decreasing course. No association was found between perceived parent support and loneliness in later life. For perceived peer support a quadratic growth pattern was found, with an increase in peer support up to age 27, and thereafter a decrease. Both the initial level and the rate of change in perceived peer support significantly predicted loneliness in adulthood.

CONCLUSIONS

The course of peer support is a better indicator for the risk of loneliness in later life than support from parents. Normative life transitions may affect the already vulnerable social support for young people with a visual impairment. This study highlights the importance of establishing and maintaining peer relationships throughout life.

The mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults

Vision impairment is prevalent and it is strongly associated with depressive symptoms in older adults. This study aimed to investigate the mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults. This study used data from a probability-based sample of 1,093 adults aged 60 and older in Shanghai, China. Structural equation models were used to examine the structural relationships among sets of variables simultaneously, including vision impairment, activities of daily living ADLs, instrumental ADLs (IADLs), friends support, family support, relatives support and depressive symptoms. The bootstrapping method and the program PRODCLIN were used to test the indirect effects of these variables. This study found that vision impairment was directly associated with a higher level of depressive symptoms, and the association was partially mediated by functional limitations (IADLs) and social support (friends support). The study demonstrates that improving social support from friends and enhancing social participation for visually impaired older adults can reduce depressive symptoms. More importantly, this study contributes to the knowledge of mediating mechanisms between vision impairment and depressive symptoms.

The relationship between vision impairment and well-being among centenarians: findings from the Georgia Centenarian Study

OBJECTIVE

The current study evaluated the visual function among centenarians and assessed the relationship between vision, social support, and well-being.

METHODS

This study used the data set of the Georgia Centenarian Study including 106 centenarians (18 men and 88 women). We used scores of the Snellen chart for objective vision and self-reports for subjective vision. Social support, depression, and loneliness were also assessed.

RESULTS

Approximately 75% of the centenarians showed some level of objective visual impairment, and 56% of them reported that they had visual impairment. Objective vision impairment was significantly related to depression. Multiple regression analysis revealed that both variables of visual function were significantly associated with depression, but not loneliness. In the model including depression, a significant interaction was obtained for social support and objective vision. Centenarians reported lower level of depression when they had social support. However, centenarians who had low level of visual function tended to report higher depression even if they had social support.

IMPLICATIONS

These results indicated that vision function was related to centenarians' well-being, especially depression. Copyright © 2017 John Wiley & Sons, Ltd.

Social support and depression of adults with visual impairments

Relatively little research exists with regard to the relationship between social support and depression among adults with visual impairments. Such a gap is noteworthy when one considers that individuals become more dependent on others as they enter middle and late adulthood. The present research will examine the association between social networks, social support and depression among adults with visual impairments. Seventy-seven adults with visual impairments participated in the study. Depression, social network and emotional/practical social support were measured with self-report measures. Additionally, the degree to which emotional/practical social support received were positive or negative and the ability of respondents to self-manage their daily living were assessed. Less than a third of respondents scored above the threshold for depressive symptoms. Depressive symptoms were not related to gender or vision status. Depression was correlated with age, educational level, less positive practical support, more negative practical support and more negative emotional support, with lower perceptions of self-management representing the most robust predictor of depression. Age moderated the relationship between depression and self-management, and between depression and negative emotional support. Lower perceptions of self-management and negative emotional support were significantly associated with depressive symptoms.

Social Support, Social Networks, and Happiness of Individuals With Visual Impairments

The purpose of this study was to examine the structure of active social networks of individuals with visual impairments, the social support they receive from their social networks, and their satisfaction from received support. In addition, we examined these factors as predictors of happiness in people with visual impairments. A total of 96 individuals with visual impairments, who ranged in age from 16 to 50, participated in this study. Three self-constructed questionnaires, which included questions related to demographic data, social networks, social support, and happiness, were used in the study. Participants reported being satisfied with received support, and they also appeared to receive more positive than negative support. Findings also demonstrated the merit of social support for the happiness of individuals with visual impairments.

Problem-solving orientation and attributional style as predictors of depressive symptoms in Egyptian adolescents with visual impairment

The association between attributional style (AS), problem-solving orientation (PSO), and gender on depressive symptoms was investigated in Egyptian adolescents with visual impairment (VI). After being written in Braille, measures of AS, PSO, and depression were administered to 110 adolescents with VI, ages 12–17 years, from a residential school for pupils with VI. Regression analyses showed that gender, negative general (NG) attributions, and negative problem-solving orientation (NPSO) were the strongest predictors of depressive symptoms in adolescents with VI, whereas negative internal (NI) attributions and avoidant problem-solving orientation (APSO) were weak predictors. The findings are discussed in relation to different perspectives and models of depression, particularly the stress-diathesis model. The theory that these cognitive variables are core constituents of a cognitive diathesis model of depression in individuals with VI is not supported by this study.