Gender Differences in Depression and Anxiety and role of self-esteem and Quality of Life among Visually Impaired individuals in Pakistan
DOI:
https://doi.org/10.54938/ijemdss.2026.05.1.699Keywords:
Depression, Anxiety, Quality of life, Visual impairment, , self-esteem, rehabilitation, PakistanAbstract
Self-esteem and quality of life are very necessary for psychological and social adjustment in individuals with visual impairment. Current research assessed gender differences in Anxiety and depression between visually impaired individuals in Pakistan and investigated the role of self-esteem and quality of life. This is a cross-cross-section research design that was used with total sample of 421 participants, in which 221 were with normal vision and 201 were with visual impairment, aged 15 to 35 from Pakistani special education and rehabilitation facilities. Standardized Instruments, including the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire-9 (PHQ-9), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Rosenberg Self-Esteem Scale (RSES), were administered. IBM SPSS-26 was used to compute descriptive analysis, independent sample t-test and correlation analysis. Outcomes proven significant differences in gender in psychological distress, as women reporting high level of depression and anxiety. Quality of life and self-esteem were notably correlated with Anxiety and depression negatively and have protective role in psychological health. The results of the research raise the importance of taking into consideration Anxiety and depression amongst persons with visual impairment with specifically attention to differences in gender. Consolidation of self-esteem and refining quality of life may serve as chief protective factors for reducing mental distress. This research underlines the necessity to integrate gender-sensitive psychological interventions, enhancement of self-esteem, and promotion of quality of life into psychological well-being and rehabilitation services to improve the psychological health of visually impaired individuals in Pakistan.
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References
Akbar, S., Iqbal, S., & Saleem, M. (2024). Psychosocial factors affecting mental health of students with visual impairment in Pakistan. Journal of Population Therapeutics and Clinical Pharmacology, 31(1), e00045.
Akram, R., Stafford, L., & Durocher, E. (2024). Mapping gaps and exploring impairment and disability prevalence: A scoping review. Disability and Rehabilitation: Assistive Technology. https://doi.org/10.1080/17483107.2024.2446666
Al-Jumaily, A., & Adeeb, A. (2024). Depression and anxiety among visually impaired individuals: A systematic review. International Journal of Environmental Research and Public Health, 21(3), 278.
Alghamdi, A. H., Alqarni, A., & Alghamdi, A. (2022). Depression and anxiety among women with visual impairment: A cross-sectional study. Journal of Ophthalmology, 2022, 8842593.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Amrina, R. (2022). Social exclusion, discrimination, and mental health among individuals with visual impairment. Journal of Disability and Social Inclusion, 3(1), 45-58.
Bartholomay, E. M., Stone, L. B., & Lyons, R. M. (2023). Depression and social anxiety symptoms explain substance use problems beyond amount/frequency of substance use. Current Psychology, 42(25), 21712–21721. https://doi.org/10.1007/s12144-022-03175-1
Bashir, A., Khan, M. A., & Ahmad, S. (2024). Rising burden of blindness and visual impairment in Pakistan: A public health perspective. Pakistan Journal of Ophthalmology.
Binder, K., Wrzesinska, M. A., & Kocur, J. (2020). Anxiety in persons with visual impairment. Psychiatria Polska, 54(2), 279-288.
Bonsaksen, T., Brunes, A., & Heir, T. (2023). Quality of life in people with visual impairment compared with the general population. Journal of Public Health, 1-9.
Boughner, E. (2020). Understanding anxiety: Symptoms, causes, and treatment approaches. Journal of Clinical Psychology, 76(5), 892-904.
Brunes, A., & Heir, T. (2019). Visual impairment and depression: Associations with characteristics of vision loss. SSRN Electronic Journal.
Bueno-Pacheco, A., Garcia, M., & Rodriguez, S. (2020). Psychometric properties of Rosenberg Self-Esteem Scale. Revista de Psicologia, 24(2), 234-249.
Choi, H. G., Lee, M. J., & Lee, S. M. (2018). Visual impairment and risk of depression: A longitudinal follow-up study using a national sample cohort. Scientific Reports, 8, 1620. https://doi.org/10.1038/s41598-018-20374-5
Cooper, J., Smith, P., & Russell, C. (2017). Psychometric properties of WHOQOL-BREF in visually impaired populations. Ophthalmic and Physiological Optics, 37(4), 478-487.
Coryell, W. (2023). Depressive disorders. In Merck Manual Professional Version. Merck & Co., Inc.
Ctori, I., Lucassen, P. L., & Smits, J. (2020). The relationship between anxiety and quality of life in visually impaired adults. Optometry and Vision Science, 97(9), 678-685.
Demmin, D. L., & Silverstein, S. M. (2020). Visual impairment and mental health: Unmet needs and treatment options. Clinical Ophthalmology (Auckland, N.Z.), 14, 4229-4251. https://doi.org/10.2147/OPTH.S258783
Dhira, D., Rahman, M. A., & Islam, S. (2021). Validation of the Generalized Anxiety Disorder scale (GAD-7) in Bangladeshi population. Asian Journal of Psychiatry, 66, 102874.
Donato, U. M., Nguyen, O. T., Alishahi Tabriz, A., Hong, Y. R., & Turner, K. (2024). Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms. Disability and Health Journal, 17(3), 101518.
Dong, Y., & Ng, S. H. (2020). Visual impairment and depression: Age-specific prevalence, associations with vision loss, and relation to life satisfaction. World Journal of Psychiatry, 10(4), 139-149.
Duggal, J., & Gaur, M. (2022). Quality of life among visually impaired individuals: A cross-sectional study. Indian Journal of Community Health, 34(2), 178-185.
Duvall, A., & Roddy, C. (2020). Anxiety: Prevalence and management strategies. In Mental Health in Special Populations (pp. 45-62). Academic Press.
Emerson, E., & Llewellyn, G. (2023). Mental health of young people with disabilities in low- and middle-income countries: A systematic review. International Journal of Environmental Research and Public Health, 20(5), 4234.
Endarti, A. T., Andriani, N., & Pambudi, E. S. (2020). Disability and depression among population aged 18-59 years in Central Sulawesi Province: Analysis of Riskesdas 2018. Media Kesehatan Masyarakat Indonesia, 16(4), 519-529. https://doi.org/10.30597/mkmi.v16i4.9826
Enoch, J., McDonald, L., Jones, L., Jones, P. R., & Crabb, D. P. (2019). Evaluating whether sight is the most valued sense. JAMA Ophthalmology, 37(11), 1317-1320.
Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London: Sage Publications.
Garro-Aburto, L., Flores, M., & Morales, A. (2023). Validation of Rosenberg Self-Esteem Scale in Latin American population. Revista Latinoamericana de Psicologia, 55(1), 67-78.
Gladyszewska-Cylulko, J. (2024). Self-esteem and psychological resilience in individuals with visual impairment. Journal of Visual Impairment & Blindness, 118(1), 78-91.
Gascoyne, B., Jolley, E., Penzin, S., Ogundimu, K., Owoeye, F., & Schmidt, E. (2022). Vision impairment and self-reported anxiety and depression in older adults in Nigeria: Evidence from a cross-sectional survey in Kogi State. International Health, 14(Suppl 1), i76–i83. https://doi.org/10.1093/inthealth/ihab070
Habib, M. A., & Irshad, M. (2018). Quality of life of visually impaired individuals in Pakistan. Pakistan Journal of Medical Research, 57(3), 112-118.
Haegele, J. A., Zhu, X., & Luginsland, L. A. (2023). The role of social support in the relationship between physical activity and health-related quality of life among adults with visual impairments. Disability and Health Journal, 16(2), 101518.
Hassan, B., Ahmed, R., Li, B., Noor, A., & Hassan, Z. U. (2019). A comprehensive study capturing vision loss burden in Pakistan (1990-2025): Findings from the Global Burden of Disease (GBD) 2017 study. PLoS ONE, 14(5), e0216492. https://doi.org/10.1371/journal.pone.0216492
Hulin, C., Netemeyer, R., & Cudeck, R. (2001). Measurement of psychological constructs: Scale development and validation. In Handbook of Industrial, Work and Organizational Psychology (Vol. 2, pp. 13-28). Sage.
Immanuel, J., & Christopher, P. (2024). Vision-related quality of life and psychosocial well-being among visually impaired individuals. Indian Journal of Ophthalmology, 72(3), 245-252.
Irtelli, F., & Durbano, F. (2020). Quality of life and biopsychosocial paradigm: A narrative review of the concept and specific insights. In Quality of Life and Biopsychosocial Factors (pp. 1-18). IntechOpen. https://doi.org/10.5772/intechopen.71633
Jolley, P. M., Kong, D. T., & Kim, K. Y. (2020). Social support at work: An integrative review. Journal of Organizational Behavior, 41(5), 481-502.
Jones, P. B., Burn, J., & Malla, A. (2021). The emergence of mental health disorders in youth: Timing and risk factors. The Lancet Psychiatry, 8(9), 826-838.
Kalfoss, M. H., Schale, M. L., & Lehman, J. (2021). Reliability and validity of WHOQOL-BREF. Scandinavian Journal of Caring Sciences, 35(2), 547-558.
Kazmi, S., Jabeen, A., & Gul, R. (2022). Rising glaucoma burden in Pakistan: A wake-up call for nationwide screening? Journal of the Pakistan Medical Association, 72(5). https://doi.org/10.47391/JPMA.3722
Khorrami-Nejad, M., Teimouri, S., & Akhlaghi, M. (2020). Self-esteem, dependency, and stigma in individuals with visual impairment. Iranian Journal of Psychiatry and Behavioral Sciences, 14(1), e100245.
Kigozi, N. G. (2021). Reliability and validity of GAD-7 in South African adults. South African Journal of Psychiatry, 27(0), a1687.
Kruithof, N., Pynoo, B., & Devolder, P. (2018). Construct validity of WHOQOL-BREF. Applied Research in Quality of Life, 13(2), 381-394.
Lee, S. H., Shin, J. S., & Park, E. C. (2020). Reliability and validity of GAD-7 in Korean adults. Psychiatry Investigation, 17(8), 769-776.
Leone, A. G. (2020). Women with disabilities and quality of life: The impact of sociocultural factors. Disability and Health Journal, 13(4), 100902.
Lopez-Sanchez, G. F., Smith, L., Lopez-Bueno, R., & Pardhan, S. (2022). Gender differences in the association between physical inactivity and mental-health conditions in people with vision or hearing impairment. International Journal of Environmental Research and Public Health, 19.
Maaswinkel, I. M., Aa, H. V., Rens, G., Beekman, A. T., Twisk, J. W., & Nispen, R. M. (2020). Mastery and self-esteem mediate the association between visual acuity and mental health: A population-based longitudinal cohort study. BMC Psychiatry, 20.
Manitsa, I. (2023). Conceptualising social inclusion and examining its relationship with social competence. British Journal of Visual Impairment.
Manzar, M. D., Alghadir, A. H., & Anwer, S. (2021). Psychometric properties of GAD-7 in Pakistani population. Journal of the Pakistan Medical Association, 71(4), 1231-1236.
Mathew, S. M., & Suja, S. (2019). Mental health interventions for youth with disabilities: A review. Indian Journal of Occupational Therapy, 51(3), 101-108.
Mitra, S., Posarac, A., & Vick, B. (2021). Disability prevalence and trends: A review of evidence. World Bank. https://openknowledge.worldbank.org/handle/10986/36432
Mustata, A. E. (2021). The relationships between coping mechanisms, depression, anxiety and sleep disorders in cardiovascular patients. Journal of Evidence-Based Psychotherapies, 21(1), 37–55.
Nguyen, T. H., Tran, H. T., & Pham, H. M. (2021). Validation of the Patient Health Questionnaire-9 (PHQ-9) in Vietnamese adults. Asian Journal of Psychiatry, 61, 102654.
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
Nwachukwu, C., Akinymi, L., & Okafor, C. (2020). Depression and anxiety among young people: Risk factors and intervention strategies. African Journal of Psychiatry, 23(1), a1523.
Okeke, A., Ejiakor, I., Onyia, O., Edema, O., Nkwogu, F., Ohanele, P., et al. (2023). Vision impairment and self-reported anxiety and depression in older adults in Nigeria: Evidence from a cross-sectional survey in Kogi State. BMC Public Health, 23, 432. https://doi.org/10.1186/s12889-023-15876-2
Onie, S., Linden, M., & Baldwin, P. A. (2020). Validation of the GAD-7 in Indonesian population. Asian Journal of Psychiatry, 53, 102386.
Owens, T. J., & Gary, L. (2019). Self-esteem. In Oxford Bibliographies in Sociology. Oxford University Press.
Panigrahi, A., Nageswar Rao, G. S., & Kumari Konar, A. (2021). Vision-related quality of life and its sociodemographic correlates among individuals with visual impairments. Journal of Visual Impairment & Blindness, 115, 319-328.
Policastro, F., Fernandez, J., & Medina, A. (2023). Reliability of PHQ-9 in Iraqi Kurdish population. Journal of Affective Disorders Reports, 52, 100789.
Potterton, J., Pettitt, L., & Goyvaerts, J. (2021). Psychosocial development and mental health in adolescents with visual impairment: A review. Child and Adolescent Mental Health, 26(2), 87-95.
Qasim, S. (2019). Self-esteem of people with visual impairment. The Routledge Handbook of Visual Impairment.
Quresh Bambora, A., Sharma, R., & Trivedi, P. (2020). Quality of life: Concept and assessment. International Journal of Health Sciences and Research, 10(3), 213-218.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
Safawi, A., & Akay Cenk, E. (2023). Falls, mobility impairments, and physical challenges in visually impaired individuals. Turkish Journal of Physical Medicine and Rehabilitation, 69(2), 178-186.
Saleem, M., Iqbal, S., & Akbar, S. (2023). Self-esteem as a determinant of psychological resilience in visually impaired youth. Pakistan Journal of Psychological Research, 38(2), 345-360.
Sanchez-Villena, A., Fernandez, M., & Perez, J. (2021). Cross-cultural validation of Rosenberg Self-Esteem Scale. Psicothema, 33(2), 245-253.
Sekimitsu, S., Nguyen, O. T., & Alishahi Tabriz, A. (2022). Effect of visual impairment on depression and anxiety during the COVID-19 pandemic in the United States. Canadian Journal of Ophthalmology, 59(4), e234-e242.
Shih, C. H., Hsieh, M. Y., & Lin, C. H. (2022). Validation of the Generalized Anxiety Disorder scale (GAD-7) in Taiwanese population. Taiwanese Journal of Psychiatry, 36(1), 34-42.
Soares, J., Leal, I., & Maroco, J. (2019). Quality of life in caregivers of people with disabilities: Gender differences. Health and Quality of Life Outcomes, 17, 131. https://doi.org/10.1186/s12955-019-1212-3
Spielberger, C. D. (2022). State-Trait Anxiety Inventory: Development and applications. In Handbook of Anxiety Disorders (pp. 123-145). Springer.
Stanimirov, K., Stanimirova, P., & Genchev, G. (2022). Quality of life and visual impairment: A review of current knowledge. Bulgarian Journal of Public Health, 14(2), 112-120.
Sun, J., Liang, K., & Chi, X. (2022). Reliability and validity of PHQ-9 in screening depression among Chinese adolescents. Journal of Affective Disorders, 298, 220-228.
Szczygiel, E., Zielonka, E., & Juraszczyk, M. (2018). Depression and anxiety among the elderly. Family Medicine & Primary Care Review, 20(4), 375-378.
Tabassum, R., Khan, M. A., & Ahmad, N. (2023). Quality of life domains among visually impaired youth in Pakistan. Journal of Social Sciences Review, 3(2), 865-873.
Tariq, M., Ahmad, S., & Khan, M. A. (2024). Depression and anxiety among adolescents in Pakistan: Gender differences and risk factors. Journal of Mental Health and Human Behaviour, 29(1), 45-52.
Tobias, M., Johnson, R., & Peters, S. (2024). Challenges faced by women with disabilities in daily life: Social engagement and access barriers. Disability and Rehabilitation, 46(12), 2789-2800.
Tolczyk, A., & Pisula, E. (2019). Self-esteem and quality of life in individuals with visual impairment: A review. Acta Neuropsychologica, 17(3), 265-278.
Trani, J. F., Bakhshi, P., & Brown, D. (2020). Visual impairment and mental health: The role of self-esteem and sense of mastery. Disability and Rehabilitation, 42(15), 2164-2171.
Tshuma, C., Ntombela, N., & Van Wijk, H. C. (2022). Challenges and coping strategies of the visually impaired adults: A brief exploratory systematic literature review. Prizren Social Science Journal.
Tutty, L., & Nixon, K. (2024). Challenges faced by women with visual impairments in low- and middle-income countries: A qualitative study. Disability and Rehabilitation, 46(8), 1567-1576.
Villarroel, M. A., & Terlizzi, E. P. (2020). Symptoms of depression among adults: United States, 2019. NCHS Data Brief, No. 379. National Center for Health Statistics.
Wang, X., Chen, H., & Li, M. (2023). Visual impairment: Definition, classification, and rehabilitation strategies. Journal of Ophthalmology, 2023, 4512678.
Westfall, R. S. (2020). Self-esteem: Conceptualization and measurement. In Encyclopedia of Personality and Individual Differences. Springer.
WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558.
World Health Organization (WHO). (1998). WHOQOL user manual. Geneva: WHO.
World Health Organization (WHO). (2024). Disability and health: Key facts. WHO Fact Sheets. https://www.who.int/news-room/fact-sheets/detail/disability-and-health
Wu, Z. (2024). Intersections of visual impairment and mental health: Exploring factors, onset, and implications. Lecture Notes in Education Psychology and Public Media.
Yasir Mohammad, A., Rahman, M. A., & Parvez, M. Z. (2024). Anxiety among visually impaired individuals: Validation of GAD-7. Journal of Visual Impairment & Blindness, 118(1), 45-58.
Yona, N., Kim, K., & Lee, H. (2021). Reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) among Hebrew-speaking adults. Israel Journal of Psychiatry and Related Sciences, 58(2), 78-85.
Zamzam, A. M. (2021). Understanding the correlation between visual impairment and mental health: A literature review. Sriwijaya Journal of Ophthalmology.
Zapata, M. A., & Pearlstein, J. G. (2022). Disability self-worth relates to lower anxiety and depression in people with visual impairment. Journal of Clinical Psychology.
Zimmerman, J., Eiseman, K., & Magri, R. (2023). Sleep quality and screen time as risk factors for anxiety and depression in adolescents with disabilities. Journal of Adolescent Health.
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