Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
PLoS One. 2019 Oct 25;14(10):e0224340. doi: 10.1371/journal.pone.0224340. eCollection 2019.
Fatigue is a disabling problem in patients with visual impairment, but its etiology is still poorly understood. Our objective was to identify the determinants of fatigue in adults with visual impairment compared to adults with normal sight.
Cross-sectional data on fatigue and sociodemographic, psychological and health-related factors was obtained with validated questionnaires. Structural equational modeling using hypothesized relationships and explorative analyses were used to identify (in)direct pathways contributing to fatigue in 247 adults with visual impairment. The model was then tested in a reference group of 151 adults with normal sight.
The final model explained 64% of fatigue variance in participants with visual impairment and revealed the following factors to be directly associated with fatigue: depressive symptoms (β = 0.723, p<0.001), perceived health (β = -0.158, p = 0.004), accommodative coping (β = 0.116, p = 0.030) and somatic comorbidity (β = 0.311, p = 0.001). Self-efficacy demonstrated a beneficial indirect effect on fatigue (β = -0.228, p<0.001) mediated by depression, accommodative coping and perceived health. Sleep disorder had an indirect effect on fatigue (β = 0.656, p<0.001) mediated by depression and perceived health. After removal of sleep disorder, the model explained 58% of the fatigue variance in normally sighted adults but pathways involving accommodative coping and somatic comorbidity were not confirmed.
These findings suggest that depression and perceived health are important mediating factors that contribute to fatigue in persons with visual impairment and normal sight. In contrast, somatic comorbidity, sleep disorders and accommodative coping seem to have a specific contribution to vision-related fatigue. These factors should be addressed in interventions to assist individuals with visual impairment in dealing with fatigue.
疲劳是视力障碍患者的一种致残问题，但病因仍知之甚少。我们的目的是确定与视力正常的成年人相比，导致视力障碍成年人疲劳的决定因素。
使用经过验证的问卷获得关于疲劳以及社会人口统计学、心理和健康相关因素的横断面数据。使用假设关系和探索性分析的结构方程建模来确定导致 247 名视力障碍成年人疲劳的（直接和间接）途径。然后在 151 名视力正常的参考组中测试该模型。
最终模型解释了视力障碍参与者疲劳方差的 64%，并显示以下因素与疲劳直接相关：抑郁症状（β=0.723，p<0.001）、感知健康（β=-0.158，p=0.004）、适应性应对（β=0.116，p=0.030）和躯体共病（β=0.311，p=0.001）。自我效能通过抑郁、适应性应对和感知健康对疲劳产生有益的间接影响（β=-0.228，p<0.001）。睡眠障碍对疲劳有间接影响（β=0.656，p<0.001），通过抑郁和感知健康介导。去除睡眠障碍后，模型解释了视力正常成年人 58%的疲劳方差，但涉及适应性应对和躯体共病的途径未得到证实。
这些发现表明，抑郁和感知健康是导致视力障碍和视力正常者疲劳的重要中介因素。相比之下，躯体共病、睡眠障碍和适应性应对似乎对视相关疲劳有特定的贡献。这些因素应在干预措施中加以考虑，以帮助视力障碍者应对疲劳。
