title: Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis.
abstract: To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years).
  
  
  
  The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials (RCTs), non-RCTs and before and after comparisons (BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences (SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non-RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data.
  
  
  
  The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non-RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms (SMD -0.30, 95% confidence interval (CI) -0.60 to -0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms (b = 0.03, 95% CI 0.01 to 0.05), psychological stress (b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being (b = -0.03, 95% CI -0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained.
  
  
  
  There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients.
authors: Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
authors: Hilde P A
authors: HP
authors: van der Aa
authors: School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
authors: Tom H
authors: TH
authors: Margrain
authors: Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.|Department of Ophthalmology, Elkerliek Hospital, Helmond, the Netherlands.
authors: Ger H M B
authors: GH
authors: van Rens
authors: Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands.
authors: Martijn W
authors: MW
authors: Heymans
authors: Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
authors: Ruth M A
authors: RM
authors: van Nispen
mesh_terms: D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control; D014786:Vision Disorders / Q000523:psychology*
keywords: anxiety; depression; mental health; meta-analysis; systematic review; vision impairment