Mental disorders on rise among visually impaired vets

British veterans with visual impairment suffer from high rates of mental disorder, according to researchers from King's College, London.

Twenty-five percent show signs of anxiety, 10% show signs of depression and 10% show signs of post traumatic stress disorder (PTSD), the researchers report in the British Journal of Ophthalmology.

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"It is important that clinicians, ophthalmologists, other health professionals as well as the (wider) family of the person affected are aware that the visual impairment has far reaching consequences and that they need to provide optimal support," they write.

Previous research has found an association between depression and visual impairment among civilians, and between physical impairment and mental disorders among soldiers. But few studies have examined the effects of visual impairment on mental health among soldiers.

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Between July 2004 and May 2008, 630 British service personnel who were deployed in Iraq or Afghanistan survived a major trauma, and 63 of these sustained an injury to the eye.

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To understand the mental health effects of these injuries, the researchers surveyed members of Blind Veterans UK who were under 55 years of age. Those with central scotomas who retain peripheral vision are eligible for membership if they have a Snellen visual acuity of 6/60 or less in the better eye. Those with peripheral visual field loss were eligible if their remaining field in the better, or both eyes, was less than 5 degrees from fixation.

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The researchers invited 99 eligible people to participate. Seventy-seven agreed, and 74 finished the interviews. Twenty had a combat-related visual impairment, and 54 had a visual impairment that was not combat-related.

Mental illness burden high among ex-service members with visual impairments

Of those with a combat-related visual impairment, only 20% reported long-term health problems not related to the event that caused the visual impairment, compared to 63% of those whose injury was not combat-related. The difference was statistically significant (P < 0.01).

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Among those with combat-related visual impairment, 25.0% screened positive for probable depression, probable anxiety or probable PTSD, compared to 29.6% of those with a non-combat related visual impairment, a difference that was not statistically significant.

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The most prevalent problem was alcohol abuse, identified among 65% of the combat group and 37% of the non-combat group. It was followed by probable anxiety (25% combat, 18.5% non-combat), PTSD (10% combat, 17% non-combat), and depression (2% combat, 10% non combat). The differences in these disorders between those whose visual impairment was combat-related and those whose visual impairment was not combat-related were not statistically significant. However, a qualitative component of the study conducted among 30 men suggested that those who lost their vision in combat were proud about the circumstances, whereas those who lost their vision in other circumstances felt guilty or ashamed.

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Regardless of the differences or lack of differences related to the circumstances of the visual impairment, the study authors emphasised that the burden of mental illness is high among ex-service members with visual impairments. By comparison, the Adult Psychiatric Morbidity Survey found that 2% of the general population in the United Kingdom screened positive for probable depression, 4% for probable anxiety, and 3% for probable PTSD.

"Research should be directed into best ways of providing support and care to enable the visually impaired person to cope with this, often experienced as traumatic, life-changing event," the authors conclude.