Experts' perspectives on the impact of visual impairment and comorbid mental disorders on functioning in essential life domains

BACKGROUND

Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people's daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future.

METHODS

A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder.

RESULTS

Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people's physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences.

CONCLUSION

VI and comorbid MD have a major impact on people's daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients' perspectives.

Clinical effectiveness of mindfulness-based music therapy on improving emotional regulation in blind older women: A randomized controlled trial

Background

This study aimed to investigate clinical effectiveness of a structured eight-week mindfulness-based music therapy (MBMT) program on improving mood regulation in older women with blindness. This investigation compared a MBMT group with a mindfulness intervention (MI) group and a control group.

Methods

Ninety-two older females with blindness from a residential setting in Hong Kong were recruited and randomly allocated to a MBMT (n = 31), MI (n = 30), or control (n = 31) group. Psychological measurements regarding mood regulation and general mood states (namely, Difficulties in Emotion Regulation Scale [DERS], Geriatric Depression Scale [GDS], and Depression Anxiety Stress Scales-21), were taken at pretest and posttest. Outcome assessors were blinded to group assignment.

Results

Data was analyzed based on intention-to-treat basis. At posttest, DERS scores in the MBMT group (mean differences and 95% confidence interval: 12.1, 5.5 to 18.8) and the MI group (7.2, 0.5 to 13.8) were lower than that in the control group. GDS scores in the MBMT group (2.9, 1.7 to 4.0) and the MI group (1.7, 0.6 to 2.9) were lower than those in the control group. Compared with the MI group, the MBMT group improved emotional awareness sub-scores in DERS (2.1, 0.2 to 4.1) and appeared to lower depression in GDS scores (1.1, -0.0 to 2.3; p = 0.053).

Conclusion

MBMT seems more beneficial than MI alone for improving emotional regulation in older women with blindness. The combination of mindfulness and music can generate a synergetic effect by enhancing both attention and appraisal components within the emotional-regulation process.

Trial registration

ClinicalTrials.gov, NCT05583695.

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.

Experiences of stressful situations and mindfulness training for persons with visual impairment

The aim of this study was to explore what persons with visual impairment (VI) experienced as stressful in their daily lives and their experiences with using mindfulness training (MT) to cope with stressful situations. In order to explore this we conducted semi-structured interviews with six persons with VI after finishing an 8-week MT course. Systematic text condensation was used to analyze the interviews. This qualitative study found that the participants described three main areas of stress: (1) lack of access to information, (2) social expectations, and (3) navigating the body through one’s surroundings. The participants’ experiences with using MT to cope with stressful situations resulted in emotion-based and problem-based strategies: (1) breathing anchor, (2) awareness of and reflection upon thoughts and feelings, (3) most things are doable, (4) tackling the situation in a new way, and (5) haste makes waste. Our respondents described using MT for coping with stressful situations in all the three main areas of stress. Based upon this study we propose that there is good reason to offer MT as stress management for persons with VI, but further study is required to confirm the health-promoting benefits of MT for this group.

Knowledge, skills, and attitudes of psychologists working with persons with vision impairment

PURPOSE

Psychologists working with persons with vision impairment face unique challenges in providing psychological services, including mental health care and cognitive assessments. While existing competency guidelines for general disability and rehabilitation psychology are relevant to working with persons with vision impairment in many ways, specific competencies are needed. Previous psychological research into the provision of therapy for persons with vision impairment has focused mainly on communication and intervention strategies and lacks input from the vision-impaired community.

MATERIALS AND METHODS

This qualitative study, grounded in disability, rehabilitation psychology, and competency frameworks aimed to identify the knowledge, skills, and attitudes necessary for psychologists working with persons with vision impairment.

RESULTS

Through triangulating responses from both registered psychologists (N = 10) and persons with vision impairment (N = 5), a thematic analysis identified 29 competencies under six major themes, including: Expertise, Impact, Approach, Collaboration, Assessment, and Flexibility. Competencies were discretely categorized as knowledge, skills, or attitudes.

CONCLUSIONS

This study provides data that may be used as the basis for more rigorous research into identifying areas for vision impaired-specific competency-based training in undergraduate, postgraduate, and professional psychology curricula.Implications for rehabilitationWhilst competencies for disability and rehabilitation psychology already exist, the competencies for psychologists working with persons with vision impairment require updating, informed by both practitioners and clients with vision impairment.These competencies include: knowledge of eye conditions and pathologies; knowledge of the variation in impact of vision loss; general knowledge about vision loss and normal lifespan development; and, the ability to assess the specific impact of vision loss on the individual.Other skills and attitudes, such as oral communication skills and relaying hope and optimism, whilst necessary for all therapeutic encounters, may require particular modification when working with vision-impaired persons.Educators responsible for professional postgraduate courses in psychology should ensure that training incorporates an understanding of the need to modify approaches for particular groups of clients, such as those with vision impairment.

You need the more relaxed side, but you also need the adrenaline: promoting physical health as perceived by youth with vision impairment

Purpose: Within a larger investigation of their conceptualizations of wellbeing, this article explores elements of physical health discussed by youth with vision impairment (VI) to inform physical health programs, with youths' personal motivation to be physically active previously identified as key to participation.Methods: Twenty-one youth (aged 12-25) participated. The qualitative data discussed was collected for each participant across three interviews/focus groups and audio-recording tasks in a project regarding their conceptualizations of wellbeing.Results: Thematic analysis identified an understanding of physical health characterized by four subthemes. First, participants' bodily health and fitness produced positive self-perceptions, but also held greater importance given the increased physical risks of living with VI. Second, energy-a positive, motivating feeling-held additional salience given extra demands upon participants related to their VIs. Thus, relaxation strategies (e.g., reading) were essential to meet these demands and recover from injury/pain (bodily health). Meanwhile, physical activity promoted fitness and vitality. Specific activities also entailed freedom of movement, contrasting heightened environmental risks in other settings.Conclusions: To better align with possible participation motivators, participants' discussions suggested that programs should target relaxation and energy in youth with VI-alongside physical activity-and offer free and safe movement in space.Implications for RehabilitationYouth with vision impairment consider feelings of energy important to their physical health, alongside their bodily health and fitness.Physical health programs for youth with vision impairment should target both physical activity and relaxation.Youth with vision impairment report greater physical and social threats to their bodily safety in considering their bodily health.Physical health programs for youth with vision impairment should provide an opportunity for free movement in space to balance these lived physical risks.