VISION LOSS AND DEPRESSION - LITERATURE REVIEW

Vision loss is not only associated with functional problems but also with affective disorders including lower morale, depression, social isolation, reduced feelings of self-esteem, diminished emotional security and low levels of social interaction. (Branch et al. 1989).

The clinical literature on the issue of depression and visual impairment indicates that depression is a common emotional reaction to vision loss. However, these studies are based on relatively small sample sizes. Based on the study of the empirical literature Horowitz (Horowitz et al., 2000) asserts that it is wrong to see depression as an essential part of the grieving process before adjustments could be made to cope with vision loss. The majority of adults with vision loss and adults who experience other chronic illnesses do not suffer from depression and it is important to recognize that depression is a serious disease that can be treated. However, a significant sub-group of older adults who are visually impaired are affected by depression which can have significant impact on functional ability, rehabilitation experiences and general quality of life.

Vision impairment is associated with higher than normal risk of depression. This was shown in the studies by Branch et al. (1989), Campbell et al. (1999), Carabalese et al. (1993), Wahl, Oswald et al. (1999) as well as Wahl,Schilling et al. (1999). The Carabalese study found that persons with vision impairments had a 2.3 times greater risk of depression than those without a vision problem.

Another study (Bazargan et al., 1995) investigated the effect of eleven common chronic conditions on depressive symptomatology among a sample of African Americans. It showed that vision impairment was one of only three conditions (in addition to kidney and circulation problems) that independently predicted depression when demographical factors, social support, and all other health conditions were held constant.

All studies seem to confirm the increased risk of depressive symptomatology whether vision impairment is assessed medically or through self-reporting.

Vision impairment is associated with higher than normal risk of depression.

Verbrugge (Verbrugge et al. 1995) identified vision impairment as one of only three independent predictors for depression based on an analysis of the relationship between depression and functional disability on the one hand and vision impairment and functional disability on the other. He points out that the primary link between chronic illness and depression is the association of chronic illness with functional disability. Since a growing body of evidence shows the link between vision impairment and functional disability Verbrugge states that it is not surprising to see the strong links between vision impairment and depression.

The prevalence of depression in adults with vision impairment

About 5% of adults in the general population suffer from depressive disorders.

The figures are 3% of the general population of elderly in the community, 5% of those in primary care settings and 15-20% of those in nursing homes. These are the figures for severe depression. Below that level there are an estimated 5%-20% of older Americans who suffer from serious and persistent symptoms of depression. The figures for visually impaired people are much higher with at least one third of participants in most studies classed as depressed. Figures vary as to the severity of depression. However, it is significant to note that most people who were classed as depressed at baseline remained so in follow-up studies.

The likelihood of developing depression does not seem to depend on the severity of the visual impairment, the age of the person, number of eye conditions, age of onset, time since onset or whether the onset of the vision impairment was sudden or gradual. The link between functional ability and depression mentioned above seems to be much more significant.

RNIB research into the situation of older visually impaired people (Baker et al., 1998) shows that functional limitations caused by visual impairment, and in particular mobility problems, lead to isolation with 40% of survey respondents feeling lonely and 48% feeling "left out of society" (p. 34). Isolation may therefore be a contributing factor to the increased tendency for depression.

Finally, Horowitz et al. (2000) points to an interesting link between attitudes towards blindness and the ability of people to cope with vision loss. A number of surveys have found that vision loss is one of the disabilities most feared by the general population. An individual's own fears relating to visual impairment can have a negative impact on his or her ability to cope when sight loss occurs thus increasing the tendency to experience depression.

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References

Baker, M., Winyard, S. (1998): „Lost Vision - Older visually impaired people in the UK". Royal National Institute of the Blind, Campaign Report No. 6.

Bazargan, M. and Hamm-Baugh, V.P. (1995): The relationship between chronic illness and depression in a community of urban black elderly persons" Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 50, Issue 2 S119-S127

Branch, L.G., Horowitz, A., and Carr, C. (1989): "The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. Gerontologist, 29 359-365.

Campbell, V.A., Crews, J.E., Moriarty, D.G., Zack, M.M., Blackman, D.K. (1999): "Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults - United States, 1993-1997". MMWR 48(SS-8) 131-157.

Caraballese, C., Appollonio, I., Rozzini, R., Bianchetti, A., Frisoni, G.B. Frattola, L., and Trabucchi, M. (1993): "Sensory impairment and quality of life in a community elderly population. Journal of the American Geriatrics Society, 41(4), 401-407.

Hamlin, D., Lightstone, A., and Wood, J. (2002): "Associated psychological and emotional aspects of sight loss". Optometry February 2002(43-45). [On-line] Available: www.optometry.co.uk

Horowitz, A. (1995): Aging, vision loss and depression: A review of the research. Aging & Vision News, (7) 1, 6,7.

Horowitz, A., and Reinhardt, J.P. (2000): "Mental health issues in visual impairment: Research in depression, disability, and rehabilitation. Silverstone, B., Lang, M.,

Rosenthal, B., and Faye, E. (eds). The Lighthouse handbook on vision impairment and vision rehabilitation: Vol. II Vision rehabilitation (1089-1109)

Mangione, C.M., Guitierrez, P.R., Lowe, G., Orav, E.J., and Seddon, J.M. (1999): "Influence of age-related maculopathy on visual functioning and health-related quality of life. American Journal of Ophthalmology, 128 (1), 45-53.

Verbrugge, L.M., Patrick, D.L. (1995): "Seven Chronic Conditions: Their Impact on US Adults' Activity Levels and Use of Medical Services". American Journal of Public Health 1995 (85) 173-182.

Wahl, H-W., Oswald, F., Zimprich, D. (1999): „Everyday competence in visually impaired older adults: a case for person-environment perspectives". The Gerontologist 39(2). 140-149.

Wahl, H-W., Schilling, O., Oswald, F., and Heyl, V. (1999): "Psychosocial consequences of Age-Related Visual Impairment: Comparison with Mobility-Impaired Older Adults and Long-Term Outcome". Journal of Gerontology: Psychosocial Sciences 1999(54B No. 5) 304-316.