They say our eyes are the windows to our soul but apparently our eyes can also provide a pathway to the state of our mental health. Recent research by international development organization Sightsavers, University of Ilorin, and the Kogi State Ministry of Health in Nigeria has revealed links between vision impairment and poor mental health. The study estimates that blind people aged 50 years and over are nearly four times as likely to have self-reported symptoms of anxiety and/or depression than those with no vision impairment. May happens to be Mental Health Awareness Month and this year’s theme in the U.S. will amplify the message “Together for Mental Health.”

Did you know that 1 in 5 Americans live with a mental health condition and that 1 in every 20 Americans is living with a serious mental health condition like schizophrenia, bipolar disorder, or long-term recurring major depression, according to the National Alliance on Mental Illness.

It seems, our vision, or lack thereof, plays an important role in our mental and physical well-being. The study, published in the Royal Society of Tropical Medicine and Hygiene’s (RSTMH) International Health Journal shows individuals with severe vision impairment are almost three times as likely, and those with moderate visual impairment twice as likely to report having mental health issues.

Globally, at least 2.2 billion people have a visual impairment, yet little is understood about connections between eye health and mental health, particularly in low- to middle-income countries, where impacts of vision loss are exacerbated by poverty and difficulties accessing health services.

The study, supported by the UK Foreign, Commonwealth & Development Office, used a statistical model, vision impairment assessment data and Washington Group anxiety and depression-related questions, to estimate association between vision impairment and self-reported anxiety and/or depression of nearly 4,000 adults in Kogi State. It calls for more research to be done into the relationship between mental health and vision impairment, so they can be effectively addressed through appropriate strategies incorporated during design of eye health programs.

Globally 2.2 billion people have a vision impairment and of these, at least 1 billion people have a vision impairment or blindness that could have been prevented or is yet to be addressed. This burden weighs more heavily on poorer countries, and on marginalized communities. And projections show that global demand for eyecare is set to surge in the coming years, according to Sightsavers.

“The research highlights that there’s a substantial mental health burden among people with vision impairment and that eye health shouldn’t be considered in a silo—vision plays a critical role in overall health and well-being,” said Selben Penzin, senior program manager of Eye Health at Sightsavers, which helped with the research.

“It’s important for governments and organizations to be aware that people with vision impairments may be more likely to have additional mental health needs and design health services to be sensitive to this. Improving vision through targeted policies and integration of inclusive eye health services into national health and education systems will improve independence, productivity and well-being.

This chart shows statistically significant gender differences between blindness and symptoms of anxiety and/or depression, which increased with age. In other words, older men who were blind were more likely to experience moderate to severe symptoms compared with blind women of a similar age.

The study also noted that the relationship between mental health and vision impairment varies by age and gender. The probability of self-reported symptoms of anxiety and/or depression is estimated to be more than four times higher among men with severe visual impairment or blindness and more likely as men age, compared to women with the same levels of vision loss. Social and cultural norms, differences in gender roles and coping styles may account for the gender difference—men are often more economically active than women in Nigeria and may feel greater impact from visual impairment.

 
A recent Lancet Global Health Commission on Global Eye Health concluded that vision impairment has wide ranging impacts on individual health and well-being. It highlighted the findings of a systematic review that showed the hazard for all-cause mortality was higher in people with vision impairment compared with those with normal vision or only mild vision impairment.

Furthermore, the magnitude of this effect increased with the severity of vision loss. Another review underscored the link between vision impairment, eye diseases and quality of life, revealing that 75 percent of studies of ophthalmic interventions found evidence of improved quality of life.

Sightsavers’ Penzin and Emma Jolley, head of Portfolio, Health and Disability Research said “it is important for government, health professionals and other organizations to consider additional needs such as mental health in health service provision. All health services should be accessible to, and inclusive of, people with different needs.

“Building connections between eye health and mental health services would enable health professionals to support and direct people with interlinking health issues toward the appropriate additional support and specialists. Where possible and appropriate, health care workers providing eyecare services could also be trained on functional difficulties, including mental health needs.

“However, further research is required to understand how this can happen efficiently and appropriately within different countries, health systems and contexts.

“More research also needs to be done into the relationship between mental health and vision impairment, so they can be effectively addressed through appropriate strategies incorporated during design of eye health programs. For example, particularly in low- to middle-income countries, aligning eye health projects and health systems to ensure eye health is integrated into the mainstream health system,” Penzin and Jolley said.

“Findings also show the need for further research to understand the knock-on effects of sight loss on mental health, and collaboration between governments and organizations across the world to address the issues,” Penzin said.

Previous studies suggest factors contributing to the association between vision impairment and poor mental health include the impact vision loss can have on independence, isolation, poverty and employment opportunities.

The eye health issue of RSTMH’s International Health Journal, which this study was featured in, was published to highlight the important role international development organizations have in generating evidence to address the root causes of eye health, supporting governments to integrate eye health into national health systems, and advancing accessible eyecare for everyone.

Sightsavers is an international organization that works in more than 30 low and middle income countries to end avoidable blindness, treat and eliminate neglected tropical diseases, and promote equality of opportunity for people with disabilities. Sightsavers vision is of a world where no one is blind from avoidable causes and people with disabilities participate equally in society. It is a registered U.K. charity (Registered charity numbers 207544 and SC038110).

Sightsavers has been involved with the Royal Society of Tropical Medicine and Hygiene Society for many years. Several colleagues are members of the Society and have published papers in the peer-reviewed International Health Journal. Sightsavers is currently partnering with RSTMH on a three-part series in the International Health Journal. The research supplement on eye health is the first in the series and will be followed later this year by two further supplements exploring research from Sightsavers’ Ascend and Accelerate neglected tropical diseases elimination programs.

The partnership will help Sightsavers share their research and highlight the important role international development organizations have in generating evidence to address the root causes and solutions for poor eye health and neglected tropical diseases. High-quality research, data and evidence is critical to help the sector, global partners and governments to deliver health strategies and programs.