Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study

Background With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less ‘in control’ and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment remain unknown. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health. Methods A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA). Data on vision was available from the fifth cycle (2001), with a mean follow-up of 5.9 years. A community-based population was studied, containing older adults from eleven municipalities in three culturally distinct geographical regions in the Netherlands. A total of 2599 older adults (aged 55 to 85 years at baseline) were included, who were randomly selected from population registers in 1992. The first (2001) and last (2012) included measurements contained 1961 and 1522 participants, respectively. Primary study outcomes were logMAR visual acuity, sense of mastery, self-esteem, depression and anxiety. Instead of standard questionnaire scores, latent trait scores (θ) were obtained through -) Item Response Theory (IRT-) analysis. Results Mean age was 72 years, with 56% females and 2% qualifying as low vision. Visual impairment was associated with a lower sense of mastery (β = -0.477, p < 0.001), lower self-esteem (β = -0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated partially by self-esteem (25%) and fully by sense of mastery (76%). Conclusions Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.