Studies have shown that those with disabilities suffer with depression and anxiety. Vision loss is one of the most feared of disabilities and one that has the greatest impact on everyday functioning and the greatest impact for the development of depression and anxiety. This fear, by someone who develops vision loss, may result in negative attitude and reactions to attempts for adjusting and adapting to life with a disability.
How can vision loss affect your life?
Underlying the physical aspect and the obvious limitations of vision loss, there are often mental health issues of depression and anxiety. These concerns are often unrecognized and untreated in both adults and children.
Depression is normal. It is more than just sadness. Depression can be mild, occasional episodes, or a severe daily occurrence. Persistent, functionally debilitating, long-term depression needs to be identified and addressed.
The American Psychiatric Association in
identifies major depression as having five of the following nine criteria:
1. Depressed mood such as feeling sad, empty, tearful, or irritable most of the day, nearly every day;
2. Decreased interest or pleasure in most activities, most of each day;
3. Significant weight change (5%) or change in appetite;
4. Change in sleep: Insomnia or increased interest in sleep;
5. Change in activity: restless or lethargic;
6. Fatigue or loss of energy;
7. Feelings of worthlessness or excessive or inappropriate guilt;
8. Find it difficult to think or concentrate or an inability to make decisions; and
9. Thoughts of death or suicide, and
I would like to add:
10. Outbursts of anger, irritability, seemingly inappropriate for the situation.
While the disability of vision loss can be emotionally upsetting, it is the change in the ability to function normally that results in frustration and subsequent depression and anxiety.
Vision impairment changes the quality of life, especially in older adults. Depression arises from a loss of self-worth, loss of independence, and an overall loss of control of one’s life.
This reduction in quality of life creates a change in mental health resulting in a cascade of negative conditions. The mental health of the individual causes a further decrease in quality of life, which can result in a negative impact on the overall health and well-being of the visually disabled adult.
Prevalence of Depression among the Visually Impaired
The population of developed countries is aging, accompanied by an increase in vision impairments in these older adults.
Multiple studies have found that about a third (1/3) of recently impaired adults have clinical depression. This is twice as high as those in the same age group who do not have a vision impairment. The highest rate is among those who have most recently lost vision.
Risk factors for depression:
Living alone. Feeling like a prisoner in your home due to insecurity about moving out of the familiar. Those with vision loss often suffer from social isolation.
Financial worries. Those that lose vision may have to stop working. There may be an increase in medical bills. Financial responsibilities may fall on another family member. These changes in the family dynamic can cause additional stress.
Vision loss at a relatively younger age (ages 40 -59)as opposed to older (>60). Most middle aged people are actively involved in work and activities. This vision loss is now an unanticipated obstacle and a hindrance to future plans and expectations.
Poor functional vision. How the individual feels about their vision and how they are able to function affects their mental status and level of depression. The increased level of frustration and depression results in lower visual functioning capability.
Unable to accept vision loss. Those that live with hope that somehow vision will return, that a treatment exists, or a miracle cure will arise. Those who do not accept and move on to adjusting and adapting are susceptible to depression.
Macular degeneration. AMD is the most common cause of low vision in adults over the age of 60 in the developed countries.
Other health problems. Poor physical health in and of itself is a risk factor for depression. Sight loss can be a compounding factor placing additional restrictions on activates and work.
Ref: Depressive symptoms in people with vision impairment: …BMJ open
Anxiety
Depression is often accompanied by anxiety. Anxiety persists much like depression. Anxiety is worrying. It is fears big and small. Anxiety affects behavior and the willingness to adjust and adapt.
Little fears may keep you from trying something new. Loss of confidence and frustration of small failures, like pressing the wrong button on the stove, not using the TV remote for fear of making a mistake you are pretty sure you can’t fix.
Big fears may keep you home and isolated for fear of social interactions. Fear of social judgment or pity and sympathy. Fear of traveling alone. Fear of social embarrassment from making a seemingly stupid mistake just because you can’t see something.
Not being able to read non-verbal cues of body or facial expressions creates anxiety. You feel as though you are in a void and others don’t realize why your response or lack of response may be inappropriate. There may be little visual jokes that are lost on you because you just can’t see the details.
Low vision and problems with facial recognition article: Why Those with Low Vision have a Problem with Facial Recognition
The feeling is one of ‘alone in a crowd.’ Small embarrassments cause you to anticipate that others are making judgments about your capabilities and limitations. Because of the anxiety that these situations create, the visually impaired will avoid social situations, a form of self-isolation.
The biggest fear of all; Blindness.
In her classic book, Clinical Low Vision, Dr. Eleanor Faye was able to best describe the dilemma of the visually impaired:
“The terms “sighted” and “blind” represent groups possessing well established stereotypes and culturally expected rules of behavior. The position and role of the partially sighted person is much less clear owing to the tremendous range of variability in partially sighted types. Generally society views them as sighted and expects them to function as such.”
In general others do not understand the disability, especially if you are able, in most situations, to function normally. (I discuss ‘passing’ in another article.) Failure to meet those expectations, even if it is only evident to you, hits at self esteem and creates anxiety.
Article on ‘passing’ Pretending not to be Visually Impaired: Passing with a Disability
Do visually impaired children get depressed and anxious?
Children who acquire low vision may not be able to express their concerns or their disability to others. Their understanding of how they are different may not be clear to the visually impaired child.
These early years are the time for the development of ‘self.’ Their perception is a reflection of those around them. Others may treat them differently. The visually disabled child may seem to be ‘slow’ or ‘dim.’ Adults may be overly helpful (those that don’t understand the disability). The child may develop a lack of confidence and an insecurity in their capabilities.
Sighted children may observe the disabled child’s low vision behaviors (holding objects close, using magnifiers and thick glasses) and ridicule them, as children will often do. The low vision child will not be able to participate in all activities that the sighted will. These young disabled children can develop low self-esteem and self-worth.
Children will also pick up on parent’s anxiety. Worried parents desperately seeking out help can transfer that sense of fear and worry to the child.
Like adults, persistent sadness or persistent fears can be signs of depression and anxiety. The child may not be able to express their feelings. Watch for signs of anxiety:
- Irritability,
- fear of school and social situations.,
- fatigue, or
- trouble sleeping,
- stomachaches, and
- nausea.
Signs of depression are similar to adults:
- Persistent sadness,
- reluctance to participate in activities,
- changes in eating patterns – eating a lot more or a lot less than usual,
- changes in sleep patterns – sleeping a lot more or a lot less than normal,
- low or overly agitated energy level– being tired and sluggish or tense and restless a lot of the time,
- having a hard time paying attention,
- low self-esteem, low self-confidence, and
- exhibits self-injury and self-destructive behavior.
Ref: Centers for Disease Control and Prevention
Helping your visually disabled child with depression and anxiety
Life with a vision impairment is not over. There are many stories of the blind and visually impaired that go on to college, fulfilling jobs, and even the Olympics
Help your child to discover for themselves solutions to their problems. Don’t let them use the disability as an excuse, it will hold them back. Give love, affection, and moral support, but not over dominate their life. Find groups of friends or support groups to help them with social skills. They will learn to cope with your help. A qualified therapists can help both parent and child to better understand the child’s feelings. A reader made a recommendation for an article that takes a deeper dive into Teenage Depression
Treatment of Depression for the Visually Disabled
Depression is often not identified and goes untreated. People are often reluctant to admit to depression as it is a mental health issue. Others may assume it comes with old age and no one has a cure for that. It may be difficult to ask for help if one is in denial, and accepts it as just being “sad.”
It takes a village
Success involves a low vision evaluation by a low vision specialist (often an optometrist), a rehabilitation therapist (an occupational therapist trained in low vision rehabilitation), and psychiatrist trained in counseling of those with disabilities.
Tips on coping with vision loss, read my articles: How to Adjust to Vision Loss, 7 Keys to Coping
Low Vision Evaluation
Low vision evaluation is for problem solving. The individual who is depressed or anxious has the opportunity to learn about and gain back some functional capabilities. Their goal is not to treat the disease process in a medical sense, as with medications or surgery , but to create new strategies to compensate for vision loss and expand functionality of the remaining vision.
Here are the reasons to get a low vision evaluation;
1. To Advocate for Yourself;
2. Introduction to Visual Aids and Techniques;
3. Education and Counseling, and
4. Appropriate Referrals.
The goal is to regain a better quality of life. The process of the low vision evaluation is to increase functional residual vision to rebuild self-confidence and motivation to adjust. New technologies, optical and non-optical aids can help the visually impaired regain independence and more control over their life.
I like to think that technology makes things easier and makes things possible.
See this other article on:
6 Reasons Why the Visually Impaired Refuse Low Vision Aids
As wonderful as all this new assistive technology is, it may not solve all the issues associated with depression and anxiety.
Rehabilitation
I have addressed in previous articles the emotional state of the visually impaired and the likelihood of their rejection of optical aids and participating in the rehabilitation process:
Why the visually impaired resist therapy
The rehabilitation process is designed to help those with vision loss to reset their life by learning how to do things differently. Skills are taught to promote independence and increase positive feeling of self worth. The goals of the rehabilitation must meet the goals of the individual rather than just teaching a set of skills to one who may lack motivation due to feelings of depression and anxiety.
Psychotherapy
A qualified therapist can help with the interpersonal issues and family counseling. The therapist can identify and help the individual deal with social interactions and to cope with other people’s perceptions of them. They must also learn to deal with the grief and sadness of their disabled situation. Therapy can help with the transition to a new life as a disabled person.
Just as important, family members can also benefit from counseling as the family dynamics and financial burdens have changed. Living with a disabled person can strain relationships. The changing role of the family members can create stress, resentment, anger, and/or anxiety. Joint counseling will help family members and the disabled to work through these changes.
Additional article on fear, depression, anxiety, and secondary gain: Why the Visually Impaired Resist Therapy
In the end;
Depression and anxiety among the visually impaired is often undetected. Treatment and rehabilitation concerns often supersede mental health concerns, under the premise that rehabilitation will solve the problem, So depression and anxiety go unrecognized or untreated.
Advocate for yourself for mental health services if it is not offered to you. There is no shame in getting help. Depression is a well- known aspect of acquired disability (and old age.) Treatment can be an important step in regaining a sense of well-being and a good quality of life.
He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has. Epictetus (Greek Stoic philosopher)
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