Hierarchical Linear Modeling of Psychological Factors That Influence Coping With Low Vision

Abstract

Purpose: : To investigate whether patient characteristics can explain successful coping with low vision in individuals that qualify for and/or have accessed rehabilitation services.

Methods: : Over a 9-month period, 289 patients from 4 urban ophthalmology departments, ranging in age from 26 to 100, completed psychological and demographic questionnaires (in English or French). A two-level hierarchical linear model was used to analyze the data. At level 1, within-person variability on coping scores (Brief COPE) was predicted by variables such as depression (CES-D) and visual functioning (VF-14). At level 2, participant characteristics (age, living distance, awareness and/or use of rehab services, visual acuity, etc.) were entered to predict variability at level 1.

Results: : At level 1, a significant interaction emerged, whereby high levels of visual functioning predicted better coping quality; however, this relationship was only present for individuals with low depression scores. At level 2, an interaction effect of living distance from rehabilitation services and visual impairment level indicated that individuals that had to travel further showed improved coping only when their impairment was more severe. In addition, increased age indicated poorer coping quality, while a statistical trend indicated that having accessed vision rehabilitation services may improve coping quality.

Conclusions: : It is not surprising that increased depression levels are detrimental to visual functioning as well as coping with low vision, especially for an elderly population. However, lowering depression will have beneficial effects on multiple aspects of the lives of these individuals. It can be speculated that accessing rehabilitation services, which should include psychological support for depressed individuals, can benefit both visual functioning and perceived coping quality, especially for seniors with severe impairment in rural areas.

Keywords: low vision • quality of life