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Paul C. Knox, Suzanne Hodge, Wally Barr; The Effect Of Counselling And Emotional Support On The Mental Health Of Low Vision Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5569.
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The impact of visual impairment on mental health is well known. There is less evidence supporting the use of interventions designed to ameliorate the mental health impacts of visual impairment. We report here the results of an evaluation of the effectiveness of an Emotional Support and Counselling (ESaC) Service integrated within a low vision service.
Users attending two low vision centres in the UK (one in London, one in Gateshead) were provided with information about the ESaC service. They were able to self refer to the ESaC service, although most were referred by a rehabilitation worker in the Low Vision service. Therapy consisted of an agreed number of 50 minute sessions with an experienced and accredited counsellor. To measure the impact of therapy we used the 34 item CORE-OM questionnaire which in addition to providing an overall score, provides four sub-scores related to wellbeing, problems/symptoms, life functioning and risk. Higher scores reflect greater psychological distress. This was administered twice, once at baseline (T1) and at the end of therapy (T2).
Data were provided by 35 participants (mean age:59y; 23 females). Acuity data was available for 26 allowing us to place them into one of five vision levels related to UK visual impairment registration status (1: <1 logMAR better eye to 5: >0.6 both eyes). Median vision level was 2 (0.6-1 better eye). For the majority of particpants the cause of impairment was macular disease. Mean duration of therapy was 11±8.58 weeks (mean ±SD) with a range of 1 to 46 weeks; mean number of agreed therapy sessions was 8.54±3.70. The mean CORE total score at T1 was 53±21, consistent with the group belonging to a "clinical population". Highest domain scores were observed in the "wellbeing" and "problem" domains. Total score reduced to 31±19 at T2; the T1-T2 difference was statistically significant (paired t test=7.323; p<0.001). Each of the underlying domain score T1-T2 differences were also statistically significant (all p<0.01).
These data are consistent with the psychological wellbeing of this group of participants at the outset being well below what would be expected of a healthy population. However, by the end of therapy the CORE-OM scores had both been statistically significantly reduced, and reduced below those expected of a clinical population. The magnitude of the difference is suggestive of a real therapeutic effect. The results suggest that the ESaC service is both needed by low vision patients, and effective.
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