Promoting and protecting mental health of people living with adventitious blindness and low vision: A scoping review of protective and risk factors

Introduction: People living with visual impairment (VI) have a higher prevalence of mental health challenges versus those without VI. The occurrence of clinical depression has been estimated at 10% to 40% among this population. Specifically, adults of working age (18-65 years) living with adventitious VI have a higher risk of severe psychological distress, disruption of employment status and attendant loss of income. Hence, our overall research question was: What is known from existing literature about the protective and risk factors for mental health of working age adults (18-65 years) with adventitious total bilateral blindness and low vision? Methods: Using Joanna Briggs Institute guidance, articles in English were systematically searched across six databases: MEDLINE, PsycINFO, CINAHL, EMBASE, PsycArticles, Web of Science. Searches were also conducted in various websites such as: World Blind Union, World Vision, African Union, and Royal National Institute of Blind People. Two reviewers independently screened titles and abstracts. Full texts were then reviewed by the team. Of 4,352 identified titles, 92 were included. We thematically analysed the evidence using inductive and deductive approaches with the latter informed by Dahlgren and Whitehead’s socioecological model. Results: Thirteen (13) risk and 10 protective themes were identified. Rehabilitation (protective) was the commonest theme in 30.4% of studies, followed by negative social support (risk) at 17.4%. Most research was conducted in the US (43.5%). Critical findings included: strong socially determined nature of mental health; coexistence of positive and negative social support and limited studies of lived experience. Our analysis also revealed layers of under and mis-representation; these included scarce research from low- and middle-income countries (LMICs), non-uniformity in definitions of blindness and incomplete reporting of participant characteristics. Conclusion: This is the first scoping review to comprehensively explore protective and risk factors for mental health for people living with adventitious total bilateral blindness and low vision. This study reports multiple upstream drivers acting singularly and in concert to exert a profound determining influence on the mental health of our target population. It also highlights the institutional ways that the condition and related issues are reported, recorded and researched.