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Bonsaksen, T. Post-Traumatic Stress Disorder in People with Visual Impairment. Encyclopedia. Available online: https://encyclopedia.pub/entry/19585 (accessed on 06 July 2024).
Bonsaksen T. Post-Traumatic Stress Disorder in People with Visual Impairment. Encyclopedia. Available at: https://encyclopedia.pub/entry/19585. Accessed July 06, 2024.
Bonsaksen, Tore. "Post-Traumatic Stress Disorder in People with Visual Impairment" Encyclopedia, https://encyclopedia.pub/entry/19585 (accessed July 06, 2024).
Bonsaksen, T. (2022, February 17). Post-Traumatic Stress Disorder in People with Visual Impairment. In Encyclopedia. https://encyclopedia.pub/entry/19585
Bonsaksen, Tore. "Post-Traumatic Stress Disorder in People with Visual Impairment." Encyclopedia. Web. 17 February, 2022.
Post-Traumatic Stress Disorder in People with Visual Impairment
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This entry is adapted from the peer-reviewed paper 10.3390/ijerph19020619

People with a visual impairment appear to have an increased risk of experiencing potentially traumatizing life events and possibly also subsequently developing post-traumatic stress disorder (PTSD). 

visual impairment post-traumatic stress disorder adverse life events

1. Introduction

Visual impairment—the partial or complete loss of vision—affects a great number of people worldwide. In 2020, it was estimated that 295 million people lived with a moderate to severe visual impairment, of whom 43 million were blind [1]. In everyday life, vision loss affects the person’s ability to obtain information about their surroundings [2] and thus makes it difficult to predict and avoid potentially dangerous situations. As a result, visual impairments have been shown to increase the risk of potentially traumatic events, such as falls and injuries [3][4]. A recent Norwegian study found that people with a visual impairment had greater exposure to a broad range of serious life events compared with the general population [5]. Substantial differences between the two populations were observed for exposure to fire or explosion, serious accidents, exposure to toxic substance, sexual assaults, war events, life-threatening illness or injury, and severe human suffering.
A higher exposure to potentially traumatic events also suggests the possibility of more mental health problems among people with a visual impairment. In support of this reasoning, previous studies have linked visual impairments to a high prevalence of post-traumatic stress disorder [6], higher risk of depression and anxiety [7][8], and also with burdensome life experiences, such as loneliness [9]. While mental health disorders have been found to be more frequent among young people with a visual impairment compared with their older counterparts [10], studies have also indicated that older adults in this population have a higher prevalence of a range of mental health disorders compared with similarly-aged people in the general population [11]. Thus, the notion that people with a visual impairment are at an elevated risk of mental health problems appears to be valid across age groups.
While the current state of knowledge suggests that people with a visual impairment are more exposed to potentially traumatic events, few studies have examined the prevalence of post-traumatic stress disorder (PTSD). PTSD may follow an exceptionally threatening or horrifying event, where the person experiencing it felt a severe threat of injury or death. Common symptoms of PTSD are re-experiencing the event in the form of flashbacks or nightmares, avoidance of stimuli associated with the event, alterations in cognition and mood, and increased arousal and reactivity [12]. As identified in a recent review [13], the one study that assessed PTSD prevalence specifically in people with a visual impairment was concerned with adolescents in a war conflict area. Researchers found a lower prevalence of PTSD among those with impaired vision or hearing compared with those without impairments (4.2% versus 11.4%) [14], which was explained by a lower exposure to traumatic events among those with impairments. However, in previous reviews, the prevalence estimates of PTSD in populations prone to visual impairments (older people, primary care patients) have ranged from 1.7% to 32.5% [15][16], which is both higher and lower than those found in general population samples [17][18]. Thus, more research is needed to conclude whether individuals with a visual impairment are at a higher risk of PTSD. Further, research is needed to assess which life events are responsible for the possible difference in the PTSD prevalence between the visually impaired population and the general population.

2. Prevalence of PTSD

When controlling for the factors known to be associated with PTSD [19][20][21], both men and women with a visual impairment had substantially higher odds of PTSD compared with men and women in the general population. This finding appears to fill a gap in the literature, as previous studies have found high prevalence rates of PTSD in people with a visual impairment [6] but have been unable to conclude whether they have a higher risk of PTSD compared with the general population [13].
Among men, the illness or injury that caused the vision loss was the most frequent event that caused PTSD. Among women, several event categories caused PTSD more often than in the general population, with sexual assault being the most frequent. Thus, the higher incidence of PTSD in the visually impaired population is partly due to the illness or injury that led to the vision loss and partly due to the people with vision loss appearing to be more vulnerable through exposure to other types of potentially traumatizing events. Previous research has indicated that adverse events, such as bullying and abuse, are commonly experienced among people with a visual impairment—such experiences have been reported among 20–30% of the visually impaired population—and reporting such experiences has been associated with higher levels of depression [22]. People with a visual impairment are also more likely to report discrimination in general [23]. Moreover, sexual abuse has been found to be more prevalent among women with a visual impairment than in the general population (17.4% versus 10.0%) [24]. Thus, in comparison with the general population, the higher levels of PTSD among people with a visual impairment may be a direct result of their higher exposure to potentially traumatizing events.
However, it is also possible that exposure to adverse events may elicit stronger reactions among those with a visual impairment. Due to their limited access to information, people with a visual impairment may have difficulty creating a mental image of the event or knowing their role in the event. This can hinder them from processing or overcoming what they have experienced and thus, create stronger stress reactions than if they could easily process the event [25]. Vision loss may also decrease the person’s ability to respond appropriately in the face of adverse events of any kind, be they natural disasters, traffic accidents or assaults. Having lower self-efficacy under stressful circumstances may increase the susceptibility to experiencing more stress reactions, as previously demonstrated in different populations [26][27].
To the extent that a resource such as education serves to decrease the risk of PTSD among those exposed to trauma, people with a visual impairment appear to have less access to this resource compared with the general population. In turn, this may add to the PTSD burden among those with a visual impairment.

3. Factors Associated with PTSD

A lower age and female gender were associated with a higher risk of PTSD. The higher risk of PTSD in women with a visual impairment is identical to the pattern found in general population samples [19][28][29] and almost half of the women with PTSD had the disorder caused by having experienced sexual assault. Researchers also found that a younger age was associated with PTSD. This association was not found to be statistically significant in the previous study of the Norwegian general population [19], whereas it has been significantly associated with PTSD in several studies investigating post-traumatic stress reactions in the population during the early stage of the COVID-19 outbreak [30][31][32]. Thus, sociodemographic covariates to PTSD among people with a visual impairment appear to largely mirror those found in the general population.
Having acquired the vision loss and having other impairments in addition to the vision loss were also associated with a higher risk of PTSD. For adults who lost their vision early in life, the condition may be considered a part of who they are rather than something that has happened to them. Conversely, acquired vision loss caused by illness or injury may represent a severe trauma and existential crisis [6], and many of those with PTSD referred to the illness or injury causing the vision loss as the event causing PTSD. Having additional impairments was also associated with a higher risk of PTSD. Having other impairments, such as movement impairments, hearing loss, and cognitive limitations, may create additional barriers to mobility and human movement compared with the vision loss alone or decrease the person’s ability to predict and prevent accidents and other serious life events [3][4]. Multiple impairments may also increase the vulnerability to stress reactions and adverse mental health in general [22].

4. Strengths and Limitations

The relatively large probability sample of adults with a visual impairment and the use of validated instruments in the assessment of serious life events and PTSD are strengths of the study. Moreover, the ability to compare estimates for people with a visual impairment with estimates from a representative general population sample increases the value of the study.
The limitations of the study include the representativeness of the population of people with a visual impairment. The sample was recruited via a member organization for the blind and partially sighted. Compared with census data from Statistics Norway [33], gender, employment, and place of residence did not differ for the study participants, but their level of education was higher. The rates of people with self-rated blindness were also higher than reported previously [34]. In addition, the use of self-reports on serious life events may have affected the validity of the results. For example, recall bias is a common problem related to the retrospective reports of serious life events. Some events may be forgotten or no longer considered important, whereas others may be amplified in the participant’s memory [35].
While the PCL-5 is a questionnaire designed to be completed in writing, the gold standard for establishing a PTSD diagnosis is the Structured Clinical Interview according to DSM-V (SCID) [36]. However, a previous study found that results from the Norwegian version of the PCL-5 corresponded well with the results from SCID interviews, and the PCL-5 is therefore considered a good measure for assessing PTSD in the general population [37]. The PCL-5 was used as an interview, where the participants had questions and response options read out loud to them. Therefore, using the PCL in the form of an interview serves as a combination of the two methods and the results are likely to be valid and reliable.
Lastly, non-participation may have caused biased prevalence estimates in both study samples. The available information about non-participants is limited and researchers do not know how non-responding might have affected the results.

5. Implications

The high prevalence of PTSD in people with a visual impairment has important implications for prevention and treatment. Mental health adversities due to high levels of exposure to serious life events calls for the facilitation of security in the physical environment [5]. Emphasis should be placed on universal design, and safety and ease of use for people with vision loss. Adaptations must apply to housing, schools, workplaces, leisure activities, the transport sector, and the public sphere.
The high PTSD rates due to the physical and sexual abuse of women suggest a need for preventive measures as well as professional assistance when such events occur. Strategies for prevention include raising public awareness and professional knowledge about the vulnerability of specific groups [38]. The stress reactions caused by a loss of vision appear to have a major impact on mental health. The loss of vision can occur suddenly or develop gradually, with stress caused by not knowing how the vision loss will progress. The risk of mental health problems, such as PTSD, in people who lose their sight must be recognized and met with information about common mental reactions and an offer of follow-up by professionals.

References

  1. Bourne, R.; Steinmetz, J.D.; Flaxman, S.; Briant, P.S.; Taylor, H.R.; Resnikoff, S.; Casson, R.J.; Abdoli, A.; Abu-Gharbieh, E.; Afshin, A.; et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. Lancet Glob. Health 2021, 9, e130–e143.
  2. Cattaneo, Z.; Vecchi, T. Blind Vision: The Neuroscience of Visual Impairment; MIT Press: Cambridge, MA, USA, 2011.
  3. Legood, R.; Scuffham, P.; Cryer, C. Are we blind to injuries in the visually impaired? A review of the literature. Inj. Prev. 2002, 8, 155–160.
  4. Reed-Jones, R.J.; Solis, G.R.; Lawson, K.A.; Loya, A.M.; Cude-Islas, D.; Berger, C.S. Vision and falls: A multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas 2013, 75, 22–28.
  5. Brunes, A.; Heir, T. Serious life events in people with visual impairment versus the general population. Int. J. Environ. Res. Public Health 2021, 18, 11536.
  6. Van der Ham, A.J.; van der Aa, H.P.; Brunes, A.; Heir, T.; de Vries, R.; van Rens, G.H.; van Nispen, R.M. The development of posttraumatic stress disorder in individuals with visual impairment: A systematic search and review. Ophthal. Physiol. Opt. 2021, 41, 331–341.
  7. Zheng, Y.; Wu, X.; Lin, X.; Lin, H. The prevalence of depression and depressive symptoms among eye disease patients: A systematic review and meta-analysis. Sci. Rep. 2017, 7, 46453.
  8. Demmin, D.L.; Silverstein, S.M. Visual impairment and mental health: Unmet needs and treatment options. Clin. Ophthal. 2020, 14, 4229–4251.
  9. Brunes, A.; Hansen, M.B.; Heir, T. Loneliness among adults with visual impairment: Prevalence, associated factors, and relationship to life satisfaction. Health Qual. Life Outcomes 2019, 17, 24.
  10. Brunes, A.; Heir, T. Visual impairment and depression: Age-specific prevalence, associations with vision loss, and relation to life satisfaction. World J. Psychiatry 2020, 10, 139–149.
  11. Court, H.; McLean, G.; Guthrie, B.; Mercer, S.W.; Smith, D.J. Visual impairment is associated with physical and mental comorbidities in older adults: A cross-sectional study. BMC Med. 2014, 12, 181.
  12. American Psychiatric Association. Diagnostic and Statistical Manual of the Mental Disorders–DSM-5; American Psychiatric Association: Philadelphia, PA, USA, 2013.
  13. Brunes, A.; Hansen, M.B.; Heir, T. Post-traumatic stress reactions among individuals with visual impairments: A systematic review. Disabil. Rehabil. 2019, 41, 2111–2118.
  14. Shaar, K.H. Severe war trauma and post-traumatic stress disorder in adolescents with sensory impairments: A cross-sectional study. Health Psychol. Res. 2013, 1, e16.
  15. Volkert, J.; Schulz, H.; Härter, M.; Wlodarczyk, O.; Andreas, S. The prevalence of mental disorders in older people in Western countries—A meta-analysis. Ageing Res. Rev. 2013, 12, 339–353.
  16. Spottswood, M.; Davydow, D.S.; Huang, H. The prevalence of posttraumatic stress disorder in primary care: A systematic review. Harv. Rev. Psychiatry 2017, 25, 159–169.
  17. Goldstein, R.B.; Smith, S.M.; Chou, S.P.; Saha, T.D.; Jung, J.; Zhang, H.; Pickering, R.P.; Ruan, W.J.; Huang, B.; Grant, B.F. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc. Psychiatry Psychiatr. Epidemiol. 2016, 51, 1137–1148.
  18. Bromet, E.J.; Atwoli, L.; Kawakami, N.; Navarro-Mateu, F.; Piotrowski, P.; King, A.J.; Aguilar-Gaxiola, S.; Alonso, J.; Bunting, B.; Demyttenaere, K.; et al. Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys. Psychol. Med. 2017, 47, 227–241.
  19. Heir, T.; Bonsaksen, T.; Grimholt, T.K.; Ekeberg, Ø.; Skogstad, L.; Lerdal, A.; Schou-Bredal, I. Serious life events and post-traumatic stress disorder in the Norwegian population. BrJPsych Open 2019, 5, e82.
  20. Konnert, C.; Wong, M. Age differences in PTSD among Canadian veterans: Age and health as predictors of PTSD severity. Int. Psychogeriatr. 2014, 27, 297–304.
  21. Ditlevsen, D.N.; Elklit, A. The combined effect of gender and age on post traumatic stress disorder: Do men and women show differences in the lifespan distribution of the disorder? Ann. Gen. Psychiatry 2010, 9, 32.
  22. Brunes, A.; Heir, T. Social interactions, experiences with adverse life events and depressive symptoms in individuals with visual impairment: A cross-sectional study. BMC Psychiatry 2020, 20, 224.
  23. Jackson, S.E.; Hackett, R.A.; Pardhan, S.; Smith, L.; Steptoe, A. Association of perceived discrimination with emotional well-being in older adults with visual impairment. JAMA Ophthal. 2019, 137, 825–832.
  24. Brunes, A.; Heir, T. Sexual assaults in individuals with visual impairment: A cross-sectional study of a Norwegian sample. BMJ Open 2018, 8, e021602.
  25. Saur, R.; Hansen, M.B.; Jansen, A.; Heir, T. Visually impaired individuals, safety perceptions and traumatic events: A qualitative study of hazards, reactions and coping. Disabil. Rehabil. 2017, 39, 691–696.
  26. Blackburn, L.; Owens, G.P. The effect of self efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans. J. Clin. Psychol. 2015, 71, 219–228.
  27. Regehr, C.; Hill, J.; Knott, T.; Sault, B. Social support, self-efficacy and trauma in new recruits and experienced firefighters. Stress Health 2003, 19, 189–193.
  28. Olff, M. Sex and gender differences in post-traumatic stress disorder: An update. Eur. J. Psychotraumatol. 2017, 8 (Suppl. S4), 1351204.
  29. Knipscheer, J.; Sleijpen, M.; Frank, L.; de Graaf, R.; Kleber, R.; ten Have, M.; Dückers, M. Prevalence of potentially traumatic events, other life events and subsequent reactions indicative for posttraumatic stress disorder in the Netherlands: A general population study based on the Trauma Screening Questionnaire. Int. J. Environ. Res. Public Health 2020, 17, 1725.
  30. Bonsaksen, T.; Heir, T.; Schou-Bredal, I.; Ekeberg, Ø.; Skogstad, L.; Grimholt, T.K. Post-Traumatic Stress Disorder and Associated Factors during the Early Stage of the COVID-19 Pandemic in Norway. Int. J. Environ. Res. Public Health 2020, 17, 9210.
  31. Hong, S.; Kim, H.; Park, M.K. Impact of COVID-19 on post-traumatic stress symptoms in the general population: An integrative review. Int. J. Ment. Health Nurs. 2021, 30, 834–846.
  32. Lei, L.; Zhu, H.; Li, Y.; Dai, T.; Zhao, S.; Zhang, X.; Muchu, X.; Su, S. Prevalence of post-traumatic stress disorders and associated factors one month after the outbreak of the COVID-19 among the public in southwestern China: A cross-sectional study. BMC Psychiatry 2021, 21, 545.
  33. Statistikkbanken . Available online: https://www.ssb.no/statbank/ (accessed on 1 December 2021).
  34. Cumberland, P.M.; Rahi, J.S. Visual Function, Social Position, and Health and Life Chances: The UK Biobank Study. JAMA Ophthal. 2016, 134, 959–966.
  35. Heir, T.; Piatigorsky, A.; Weisæth, L. Longitudinal changes in recalled perceived life threat after a natural disaster. Br. J. Psychiatry 2009, 194, 510–514.
  36. First, M.B.; Williams, J.B.W.; Karg, R.S.; Spitzer, R.L. Structured Clinical Interview for DSM-5—Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV); American Psychiatric Association: Arlington, VA, USA, 2015.
  37. Hem, C.; Hussain, A.; Wentzel-Larsen, T.; Heir, T. The Norwegian version of the PTSD Checklist (PCL): Construct validity in a community sample of 2004 tsunami survivors. Nord. J. Psychiatry 2012, 66, 355–359.
  38. Brown, H. Safeguarding Adults and Children with Disabilities Against Abuse; Council of Europe: Strasboug, France, 2003.
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