Illness Cognitions and Coping Self-Efficacy in Depression Among Persons With Low Vision.
To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision.



This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support.



The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001).



Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be efficacious in this population.
Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Bonnie A
BA
Sturrock
Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Jing
J
Xie
Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Edith E
EE
Holloway
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States.
Mark
M
Hegel
Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Robin
R
Casten
School of Psychology, Deakin University, Bundoora, Victoria, Australia.
David
D
Mellor
Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia 5Singapore Eye Research Institute (SERI), Singapore.
Eva
E
Fenwick
Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Gwyneth
G
Rees
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015354:Vision, Low / Q000523:psychology*; D014792:Visual Acuity