Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, PO Box 7057, De Boelelaan 1117, Amsterdam, 1007 MB, the Netherlands.
Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, the Netherlands.
BMC Psychiatry. 2024 Aug 21;24(1):572. doi: 10.1186/s12888-024-06014-5.
Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.
Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.
The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.
Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.
严重疲劳是视力障碍患者的常见症状，对情绪功能、认知、工作能力和日常生活活动都有不利影响。先前的研究发现，抑郁是疲劳的最重要决定因素之一，但在这一患者群体中，与疾病特异性相关的因素知之甚少。本研究旨在探索低视力成人的视力损伤严重程度与疲劳之间的直接和间接关系，潜在的中介因素包括视力特异性因素和抑郁。
通过电话访谈收集了 220 名荷兰低视力服务患者的横断面数据。疲劳被定义为严重程度和对日常生活影响的潜在变量。潜在的中介因素包括与视力相关的症状、对视力丧失的适应和抑郁。在 Mplus 中构建假设的结构方程模型，以测试视力损伤严重程度（轻度/中度、重度、失明）通过上述变量对疲劳的（直接/间接）影响。
最终模型解释了 60%的疲劳方差，显示视力损伤严重程度对疲劳有显著的总效应。与轻度/中度视力损伤相比（β=-0.50，95%置信区间偏倚校正[BC CI]为[-0.86，-0.16]），严重视力损伤（参考组）的患者疲劳症状明显更高，与失明患者相比（β=-0.44，95%BC CI [-0.80，-0.07]）。眼疲劳和光干扰、抑郁和视力相关的活动能力在严重和轻度/中度视力损伤之间的疲劳差异中起中介作用。严重视力损伤和失明之间的疲劳差异仅由眼疲劳和光干扰解释。此外，抑郁症状（β=0.65，p<0.001）和眼疲劳和光干扰（β=0.19，p=0.023）与疲劳有直接关系，而与视力损伤严重程度无关。
我们的研究结果表明，低视力患者的视力损伤严重程度与疲劳之间存在倒 U 型关系。这种关系的复杂性可能是由视力障碍的后果解释的，特别是眼睛疲劳和抑郁情绪，而不是残疾本身的严重程度。
