Prevalence of all forms of depression during the COVID19 pandemic was found to be 20% in a study population of 113,285 individuals.(1) Not unexpectedly, this is higher than the pre-pandemic rate. Compounded with already high levels of depression among those who are socially isolated due to visual impairment (2), this gives cause for increased concern about the mental health of older visually impaired people.
Clinical depression is characterized by persistent, and nearly constant, states of these sadness and grief. Signs and symptoms include any of the following presenting for 2 or more weeks:(3)
Persistent sadness
Loss of interest in hobbies
Fatigue
Restlessness
Difficulty concentrating
Difficulty sleeping or getting out of bed
Changes in appetite
Thoughts of suicide
AMD is a common cause of visual impairment and blindness that affects nearly 196 million individuals worldwide, which is approximately 9% of the global population.(4) Depression and anxiety are more common in adults with visual impairment. Clinically significant subthreshold symptoms of depression are found in approximately one-third of older adults with AMD and impaired vision, which is nearly twice as high as the lifetime prevalence rates in the general older population.(4,5)
AMD is associated with increased functional disability and emotional stress, leading to an increased risk of mental health problems. Compared with other eye diseases, the rate of depression in older adults with AMD is the highest.(4) Other mental conditions, such as agoraphobia and social phobia, also are prevalent among those with visual impairment due to AMD.(4)
Although research has shown that behavioral interventions can treat or prevent depression in AMD(4), at this time, traditional low vision rehabilitation is considered the best treatment option, along with referral for mental health care when necessary. Because AMD can affect functional and psychological well-being, AMD patients should be aware that symptoms of depression can also be alleviated by treatments such as medication and psychotherapy(4) In addition, the National Suicide Prevention Lifeline is available 24 hours: 1-800-273-8255.
As social isolation requirements are beginning to ease, people affected by low vision and blindness should make an increased effort to re-enter circles of friends and family. Socialization is an important factor in living well with low vision, so now is the time to renew and create acquaintences that are so necessary to healthy minds and bodies.
Author: Dan Roberts
1. Audun Brunes, Trond Heir. Social interactions, experiences with adverse life events and depressive symptoms in individuals with visual impairment: a cross-sectional study. (BMC Psychiatry. 2020 May 12;20(1):224. doi: 10.1186/s12888-020-02652-7. PMID: 32398122)
2. Ram Lakhan, Amit Agrawal, Manoj Sharma. Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic(PMID: 33144785 PMCID: PMC7595780 DOI: 10.1055/s-0040-1716442)
3. Depression. National Institute of Mental Health. Updated February 2018. Accessed May 13, 2021. https://www.nimh.nih.gov/health/topics/depression/index.shtml
4. Zhang X, Olson DJ, Le P, Lin FC, Fleischman D, Davis RM. The association between glaucoma, anxiety, and depression in a large population. Am J Ophthalmol. 2017;183:37-41. doi:10.1016/j.ajo.2017.07.021
5. Brody BL, Gamst AC, Williams RA, et al. Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology. 2001;108(10):1893-1900; discussion 1900-1901. doi:10.1016/s0161-6420(01)00754-0