Why visually impaired older adults often do not receive mental health services: the patient's perspective.
OBJECTIVE
Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen's behavioural model.


METHODS
A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ).


RESULTS
About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance.


CONCLUSIONS
Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.
Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands, h.vanderaa@vumc.nl.
Hilde P A
HP
van der Aa
Mirke
M
Hoeben
Linda
L
Rainey
Ger H M B
GH
van Rens
Hilde L
HL
Vreeken
Ruth M A
RM
van Nispen
D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000453:epidemiology*