Abstract
Purpose :
Visual Impairment (VI) is strongly associated with psychiatric disorders. However, recent research indicates that depression may be less related to quantitated vision loss than it is to the secondary impact of decreased functional status. It remains unclear what functional aspects of vision influence the development of anxiety and depression associated with vision loss. We analyzed the relation between instrumental and non-instrumental activities of daily living (IADL and ADL) and self-reported VI and how the inability to perform tasks may mediate depression and anxiety.
Methods :
Cross-sectional responses from the 2016 National Health Interview Survey (n=15,690) were analyzed using a structural equation modeling (SEM) approach to calculate the direct effect of subjective VI on the frequency of anxiety and depression symptoms and the indirect effect mediated by impairment in ADLs and IADLs. Unstandardized regression coefficients were estimated after controlling for baseline demographics, socioeconomic status, and comorbid disease using the Charlson Comorbidity Index. A separate SEM assessed the impact of near and distance vision dysfunction on the severity of anxiety and depression.
Results :
IADLS: Both cleaning and communicating difficulty showed a significant mediating effect for anxiety and depression, while shopping difficulty only had a significant relation to depression but not anxiety. Interestingly, transportation difficulty did not mediate either relationship. ADLS: Bathing, dressing, mobility and toileting limitations all demonstrated a significant mediating effect between VI and anxiety frequency (collective p < 0.0005), while feeding did not. Only dressing limitations were a significant mediator for depression frequency. Lastly, distance VI was found to be a significant predictor of anxiety and depression frequency (p = 0.001, 0.002), but near VI was not (p = 0.755, 0.171).
Conclusions :
ADL and IADL dysfunction may contribute to depression and anxiety symptoms induced by VI. The indirect effects were minor compared to the direct effects indicating that other factors that could not be studied may play a larger role in the severity of psychiatric illness. These results may help inform which activities should be targeted by low vision and visual rehabilitation providers.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.