Individuals with blindness or visual impairment are disproportionately affected by anxiety and depression and have a higher prevalence of these disorders throughout the COVID-19 pandemic, according to a study published in the Canadian Journal of Ophthalmology. These findings highlight the need for increased access to mental health services among this patient population, the report suggests.
Researchers retroscopically reviewed data from 324,915 participants who had blindness or visual impairment (n=7526; 29.4% Black; 26.2% Hispanic) and control group participants (n=317,389; 20.8% Black; 18.2% Hispanic) enrolled in the All of Us Research Program — a National Institute of Health database consisting of individuals who are frequently underrepresented in biomedical research. Baseline anxiety and depression were determined by SNOMED codes 441542 and 440383, respectively, or a prescription for anxiolytics or antidepressants prior to March 30, 2020. Meeting the same criteria after this date indicated new, pandemic-related anxiety or depression.
Patients completed the Generalized Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9 survey as subjective measures of depression and anxiety during the pandemic.
Individuals with blindness or visual impairment had a higher prevalence of baseline anxiety and depression (50.4% vs 28.7%, P <.001), new cases of anxiety and depression (0.98% vs. 0.66%, P <.001), and worsened anxiety and depression throughout the pandemic (0.19% vs. 0.07%, P <.001) compared with control group participants.
Stratified by ethnicity, individuals with blindness and visual impairment who were White had higher baseline rates of anxiety and depression compared with participants who were Black or Asian (58%, 44.5%, and 27.6%, respectively). Overall, non-Hispanic individuals had higher baseline anxiety compared with participants of Hispanic ethnicity (52.0% vs. 45.9%). Individuals who were Black and participants who were White had the highest rates of new anxiety and depression (1.09% and 1.05%, respectively) and both had higher rates of worsened, pandemic-related anxiety (0.09% and 0.31%, respectively). Participants of all ethnic groups had worsening anxiety during the pandemic except for those who were of Asian ethnicity.
“In this large study of All of Us participants, we found a higher likelihood of [electronic health record] defined baseline, new, and worsened anxiety/depression during the COVID-19 pandemic among individuals who are blind and/or visually impaired,” the study authors note. Coupled with self-reported data indicating higher levels of depression and anxiety, the researchers suggest, “together, these findings indicate that individuals with visual impairment are suffering disproportionately throughout the pandemic and highlight an important need to promote access to mental health services among this population.”
Study limitations include limited definitions of blindness and visual impairment, anxiety, and depression according to SNOMED codes and an insufficient sample size of PHQ-9 and GAD-7 scores for individuals of understudied racial groups.
Sekimitsu S, Shweikh Y, Zebardast N. The impact of visual impairment on depression and anxiety during the COVID-19 pandemic in the United States. Can J Ophthalmol. Published online November 30,2022. doi:10.1016/j.jcjo.2022.11.019