Quality of Life Research

, Volume 24, Issue 4, pp 969–978 | Cite as

Why visually impaired older adults often do not receive mental health services: the patient’s perspective

  • Hilde P. A. van der Aa
  • Mirke Hoeben
  • Linda Rainey
  • Ger H. M. B. van Rens
  • Hilde L. Vreeken
  • Ruth M. A. van Nispen



Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen’s behavioural model.


A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ).


About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance.


Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.


Low vision Depression Anxiety Mental health services Perceived needs 



Perceived Need for Care Questionnaire


Centre for Epidemiologic Studies Depression


Hospital Anxiety and Depression Scale-Anxiety subscale


Mini International Neuropsychiatric Interview


EuroQol-5 Dimensions



This work was supported by ‘ZonMw InZicht’, the Netherlands Organisation for Health Research and Development—InSight Society [Grant Number 60-0063598108]; and ‘Stichting Blindenhulp’, a Dutch independent foundation to support people with a visual impairment.

Conflict of interests

The authors declare that they have no competing interests.

Ethical standard

The present study has been approved by the Medical Ethics Committee of the VU University Medical Centre (Amsterdam, the Netherlands) and the University Hospital Leuven (Belgium) and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave written consent to participate in the present study.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Hilde P. A. van der Aa
    • 1
    • 2
  • Mirke Hoeben
    • 1
    • 2
  • Linda Rainey
    • 1
    • 2
  • Ger H. M. B. van Rens
    • 1
    • 2
    • 3
  • Hilde L. Vreeken
    • 1
    • 2
  • Ruth M. A. van Nispen
    • 1
    • 2
  1. 1.Department of OphthalmologyVU University Medical CentreAmsterdamThe Netherlands
  2. 2.EMGO+ Institute for Health and Care Research (EMGO+)VU University Medical CentreAmsterdamThe Netherlands
  3. 3.Department of OphthalmologyElkerliek HospitalHelmondThe Netherlands

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