11 Mental Health and Emotional Development

Increased Risk

Blind and low vision children are at increased risk of experiencing mental health challenges when compared with their sighted peers (Augestad, 2017a; Kuld et al., 2021; Sims et al., 2021). Their mental health can be affected by concerns about their visual condition or its progression, social isolation, stress or trauma from medical procedures, reduced mobility, and experiences of stigma or discrimination, whether real or perceived. Routine mental health screening and monitoring, particularly for anxiety and depression, is recommended for youth and adults (Demmin & Silverstein, 2020; Lundeen et al., 2022; Robertson et al., 2021). Boagey and colleagues (2022) emphasized that “any mention of suicidal ideation should be taken very seriously, as sight loss has been linked to an increased risk of suicide” (p. 29).

Adjustment to disability

Blind and low vision youth may struggle to adjust to their disability. This adjustment process may be fluid and ongoing as the students face new environmental demands and expectations over time. Tuttle and Tuttle’s (2004) personal adjustment to vision loss model includes the following stages:

• Trauma
• Shock and Denial
• Mourning and Withdrawal
• Succumbing and Depression
• Reassessment and Reaffirmation
• Coping and Mobilization
• Self-Acceptance and Self-Esteem

While various models exist, adjustment to vision loss depends on individuals and their situations. Some may move quickly or slowly through stages, skip a stage, or cycle through the stages. Generally, the process includes a reaction to the vision loss and rebuilding phase.

When individuals have not adjusted to their vision loss, they may be less likely to access the services and resources that could improve their daily functioning and quality of life. For instance, students may be reluctant to utilize their assistive devices for fear of bringing attention to their visual condition or appearing different from their peers. However, infrequent use of assistive technology may reduce independence and efficiency in academic or vocational tasks. 

Blind and low vision youth may benefit from support in exploring the intersectionality of their visual condition, culture, gender orientation, sexual orientation, race, physical ability, and nationality to gain an integrated sense of identity. Self-identity refers to how people define themselves in terms of physical or personality traits, values, abilities, and social roles. All of these may change over time with life experiences. Internal and external variables, such as interactions with others and their environment, may influence self-identity. Augestad (2017b) highlights the importance of experiences that promote cooperation, independent mobility, and opportunities to engage in activities with peers to build positive self-esteem and self-concept.

Services and interventions that address psychological and practical daily living skills assist in adjusting to vision loss. Examples include instruction on skills unique to disability-specific needs of blindness and low vision, social and recreational supports, connections with blind and low vision community groups, and counseling. Consider whether the student may benefit from counseling to adjust to their blindness or low vision. Counseling may assist with accepting their visual condition, developing a more integrated sense of identity, and increasing the use of services and tools to enhance independence.

References

Augestad, L. B. (2017a). Mental health among children and young adults with visual impairments: A systematic review. Journal of Visual Impairment & Blindness, 111, 411-425. https://doi.org/10.1177/0145482X1711100503

Augestad, L. B. (2017b). Self-concept and self-esteem among children and young adults with visual impairment: A systematic review. Cogent Psychology, 4(1), 1-12. https://doi.org/10.1080/23311908.2017.1319652

Boagey, H., Jolly, J. K., & Ferrey, A. E. (2022). Psychological impact of vision loss. Journal of Mental Health and Clinical Psychology, 6(3): 25-31. https://www.mentalhealthjournal.org/articles/psychological-impact-of-vision-loss.pdf

Demmin, D. L., & Silverstein, S. M. (2020). Visual impairment and mental health: Unmet needs and treatment options. Clinical Opthalmology, 14, 4229–4251. https://doi.org/10.2147/OPTH.S258783

Kúld, P. B., Kef, S., & Sterkenburg, P. S. (2021). Bibliometric mapping of psychological well-being among children with a visual impairment. British Journal of Visual Impairment, 39(2), 131–146. https://doi.org/10.1177/0264619620915245

Lundeen, E. A., Saydah, S., Ehrlich, J. R., & Saaddine, J. (2022). Self-reported vision impairment and psychological distress in U.S. adults. Ophthalmic Epidemiology, 29(2), 171-181. https://doi.org/10.1080/09286586.2021.1918177

Robertson, A. O., Tadić, V., & Rahi, J. S. (2021). This is me: A qualitative investigation of young people’s experience of growing up with visual impairment. PLOS ONE, 16(7), e0254009. https://doi.org/10.1371/journal.pone.0254009

Sims, S. V., Celso, B., & Lombardo, T. (2021). Emotional and behavioral assessment of youths with visual impairments utilizing the BASC-2. Journal of Visual Impairment & Blindness, 115(4), 310–318. https://doi.org/10.1177/0145482X211028939

Tuttle, D. W., & Tuttle, N. R. (2004). Self-esteem and adjusting with blindness: The process of responding to life’s demands (3rd ed.). Charles C. Thomas Publisher Ltd. https://www.ccthomas.com/details.cfm?P_ISBN13=9780398075095