Robert Coppes Foundation, Vught, The Netherlands.
Amsterdam UMC, Vrije Universiteit, Ophthalmology and The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMC Psychiatry. 2024 Mar 18;24(1):209. doi: 10.1186/s12888-024-05635-0.
Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people's daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future.
A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder.
Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people's physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences.
VI and comorbid MD have a major impact on people's daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients' perspectives.
患有视力障碍（VI）合并精神障碍（MD）的患者预计会对其日常生活功能产生重大影响，因此需要提供定制的支持。然而，这方面的研究几乎没有。因此，本研究旨在：（1）确定 VI 和合并 MD 对重要生活领域功能的影响；（2）深入了解当前用于支持该目标群体的最佳实践；（3）确定未来优化护理的策略。
采用四步定性德尔菲法，向 31 名从事该目标群体工作的荷兰专业人员（84%为女性，平均年龄为 46 岁，平均从事目标群体工作 11 年）征求意见。使用自立矩阵来确定 VI 和（1）自闭症谱系障碍、（2）精神病性障碍、（3）强迫症、（4）反社会人格障碍、（5）边缘型人格障碍、（6）依赖性人格障碍患者日常生活各个方面的影响。
专家们描述了一个脆弱和易受伤害的群体，其中 VI 和 MD 通常对人们的身心健康产生累积的负面影响。患者经常感到焦虑、抑郁、疲劳和睡眠障碍。此外，许多人常常忽视自我护理，药物滥用也很常见。他们在依赖他人的同时，往往难以信任他人。由于沟通障碍（例如无法识别面部）和社交无能或回避，社交互动和人际关系变得复杂。专家建议考虑跨诊断因素，使用基于间歇性方法的基于证据的心理治疗选择，并提供多学科护理。他们强调建立信任、表现出耐心和同理心、激发赋权、涉及非正式网络和利用积极经验的重要性。
VI 和合并 MD 对人们的精神、身体、社会和环境层面的日常生活功能产生重大影响。本研究提供了支持该目标群体的最佳实践的深入了解。根据专家的意见，需要开展更多的研究，旨在调查定制的诊断方法和治疗选择，并纳入客户的观点。
