Mental Health of US Children With Vision Impairment: An Analysis of the National Health Interview Survey

Abstract

Objective

While the psychological effects of vision loss in adults has been investigated, few studies focus on the adolescent population. Identifying the mental health burden of vision impairment in children may inform future detection and management of these symptoms. The purpose of this study is to characterize the association between mental health indicators and vision impairment in US children.

Design

Cross-sectional study.

Participants

Participants were children age 0 to 17 years from the 2022 National Health Interview Survey. Participants completed a household interview survey and Mental Health Assessment from the Strengths and Difficulties Questionnaire. Inclusion criteria is noninstitutionalized US civilians. Exclusion criteria is no fixed household address, active military duty, persons in correctional facilities or long-term care.

Methods

A population-based study using multistage complex probability sampling strategy to provide representative national estimates for children nationwide.

Main Outcome Measures

Caregiver-reported visual impairment and measures of psychological health including mental health (depression and anxiety), cognition (difficulties learning and remembering), behavior (social and emotional challenges), and access to services (mental health therapy and special education).

Results

In a sample of 6429 US children, 5% had visual impairments despite correction with glasses or contacts. Vision-impaired children had higher rates of depression (44%) and anxiety (64%) compared to nonvision-impaired children (33% and 53%, respectively). Adjusted models revealed that vision-impaired children had 1.2 times higher odds of depression (95% CI: 1.03-1.33) and 1.3 times higher odds of anxiety (95% CI: 1.13-1.46). They also had greater odds of learning difficulties (OR: 1.9; 95% CI: 1.29-2.86) and remembering difficulties (OR: 1.4; 95% CI: 0.99-1.82). Vision-impaired children showed higher total Strengths and Difficulties Questionnaire scores (OR = 1.1; 95% CI: 1.05-1.11), indicating more peer relationship issues, hyperactivity/inattention, and emotional symptoms. Additionally, there was a 30% to 50% decrease in the usage of mental health therapy and special education between youth with severe vs moderate depression and anxiety.

Conclusions

In this nationally representative 2022 sample, visually impaired children exhibit greater odds of depression, anxiety, cognitive impairments, and behavioral difficulties compared to nonvisually impaired children. Further understanding these relationships may improve the mental health outcomes of children at the population level.