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Journal Articles

Depression, Anxiety, Stress Symptoms and their Determinants among Secondary Students with Vision Impairment in Rural Northwestern China during the COVID-19 Pandemic

Frontiers in Public Health, 2024

Objective: The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children’s mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.

Methods: A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.

Results: Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63–0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81–0.97) and longer study time (OR, 0.82, 95% CI: 0.74–0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08–1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66–0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04–1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85–0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01–1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.28) and older age (OR,1.12, 95% CI: 1.004–1.24).

Conclusion: A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

Barriers to Uptake of Cataract Surgery among Elderly Patients in Rural China: A Cross-sectional Study

BMJ Open, 2023

Journal Articles

Impact of Vision Impairment and Ocular Morbidity and their Treatment on Depression and Anxiety in Children: A Systematic Review

Ophthalmology, 2022

Topic
This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity and their treatment are associated with depression and anxiety in children.

Clinical Relevance
Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favour of insurance coverage for timely strabismus surgery.

Methods
We searched nine electronic databases from inception to February 18, 2021, including observational and interventional studies assessing whether vision impairment and/or ocular morbidity and their treatment are associated with depression and/or anxiety in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (PROSPERO, CRD42021233323).

Results
Among 28,992 studies, 28,956 (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 (58.3%) were observational studies concerning vision impairment, eight (22.2%) were observational studies concerning strabismus, and seven (19.4%) were interventional studies. Vision-impaired children experienced significantly higher scores of depression (Standard Mean Difference [SMD] 0.57, 95% Confidence Interval (CI) 0.26-0.89, 11 studies) and anxiety (SMD 0.61, 95% CI 0.40-0.821, 14 studies) than normally-sighted children. In particular, myopic children experienced higher scores of depression (SMD 0.59, 95% CI 0.36-0.81, six studies) than normally-sighted children. Strabismus surgery significantly improved symptoms of depression (SMD: 0.59 95% CI 0.12-1.06, three studies) and anxiety (SMD: 0.69 95% CI 0.24-1.14, four studies) in children.

Discussion
Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.

Journal Articles

The Prevalence and Correlates of Vision Impairment and Glasses Ownership among Ethnic Minority and Han Schoolchildren in Rural China

PLOS ONE, 2021

Journal Articles

Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association

BMJ Ophthalmology, 2020

Journal Articles

Safety of Eyeglasses Wear for Visual Acuity among Middle School Students in Northwestern Rural China: A Cluster-randomised Controlled Trial

BMJ Open Ophthalmology, 2020

Journal Articles

Impact of Spectacles Wear on Uncorrected Visual Acuity among Urban Migrant Primary School Children in China: A Cluster-Randomised Clinical Trial

British Journal of Opthalmology, 2020

Journal Articles

Effect of Chinese Eye Exercises on Change in Visual Acuity and Eyeglasses Wear among School-Aged Children in Rural China: A Propensity-Score-Matched Cohort Study

BMC Complementary Medicine and Therapies, 2020

Journal Articles

Visual Impairment and Spectacles Ownership among Upper Secondary School Students in Northwestern China

Hong Kong Medical Journal, 2020

Journal Articles

Impact of Various Types of Near Work and Time Spent Outdoors at Different Times of Day on Visual Acuity and Refractive Error Among Chinese School-Going Children

PLoS ONe, 2019

Journal Articles

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial

International Journal of Environmental Research and Public Health, 2018

Journal Articles

The Cost-Effectiveness of Alternative Vision Screening Models among Preschool Children in Rural China

Acta Ophthalmologica, 2018

Journal Articles

Teachers' Influence on Purchase and Wear of Children's Glasses in Rural China: The PRICE Study

Clinical & Experimental Ophthalmology, 2018

Journal Articles

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

JAMA Ophthalmology, 2018

Journal Articles

Cluster-randomized Controlled Trial of the Effects of Free Glasses on Purchase of Children's Glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) Study

PLOS ONE, 2017

Journal Articles

Effect of providing free glasses on children's educational outcomes in China: The "Seeing is Learning" cluster-randomized controlled trial

British Medical Journal, 2014

Journal Articles

Accuracy of Rural Refractionists in Western China

Investigative Ophthalmology & Visual Science , 2013

Publications

Depression, Anxiety, Stress Symptoms and their Determinants among Secondary Students with Vision Impairment in Rural Northwestern China during the COVID-19 Pandemic

Barriers to Uptake of Cataract Surgery among Elderly Patients in Rural China: A Cross-sectional Study

Impact of Vision Impairment and Ocular Morbidity and their Treatment on Depression and Anxiety in Children: A Systematic Review

The Prevalence and Correlates of Vision Impairment and Glasses Ownership among Ethnic Minority and Han Schoolchildren in Rural China

Visual Impairment in Rural and Migrant Chinese School-Going Children: Prevalence, Severity, Correction and Association

Safety of Eyeglasses Wear for Visual Acuity among Middle School Students in Northwestern Rural China: A Cluster-randomised Controlled Trial

Impact of Spectacles Wear on Uncorrected Visual Acuity among Urban Migrant Primary School Children in China: A Cluster-Randomised Clinical Trial

Effect of Chinese Eye Exercises on Change in Visual Acuity and Eyeglasses Wear among School-Aged Children in Rural China: A Propensity-Score-Matched Cohort Study

Visual Impairment and Spectacles Ownership among Upper Secondary School Students in Northwestern China

Impact of Various Types of Near Work and Time Spent Outdoors at Different Times of Day on Visual Acuity and Refractive Error Among Chinese School-Going Children

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial

The Cost-Effectiveness of Alternative Vision Screening Models among Preschool Children in Rural China

Teachers' Influence on Purchase and Wear of Children's Glasses in Rural China: The PRICE Study

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China A Cluster Randomized Clinical Trial

Cluster-randomized Controlled Trial of the Effects of Free Glasses on Purchase of Children's Glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) Study

Impact of a Teacher Incentive on Children’s Use of Eyeglasses: A Cluster-Randomized Controlled Trial

Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial

Population Prevalence of Need for Spectacles and Spectacle Ownership Among Urban Migrant Children in Eastern China

Safety of Spectacles for Children's Vision: A Cluster-Randomized Controlled Trial

Factors Underlying Different Myopia Prevalence between Middle- and Low-income Provinces in China

Poor Vision Among China’s Rural Primary School Students: Prevalence, Correlates and Consequences

An Investigation of Vision Problems and the Vision Care System in Rural China

Effect of providing free glasses on children's educational outcomes in China: The "Seeing is Learning" cluster-randomized controlled trial

Accuracy of Rural Refractionists in Western China