圍繞心理健康和視力的公共衛生案例.pdf

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1、Varshini Varadaraj,MD,MPHResearch AssociateJohns Hopkins Disability Health Research CenterPublic Health Case Around Mental Health and VisionSESSION 2:Why the Eye:Forum on the Public Health Connection Between Mental Wellness and Vision Shifting the paradigm from Shifting the paradigm from living with

2、 a disabilityliving with a disability to to thriving with a disabilitythriving with a disabilityVisual Visual Impairment Impairment is is Varma et al.JAMA Ophthal.2016.Swenor et al.Gerontologist.2019.“Some of the limitations of disability stem from the psychological environment rather than physical

3、impairment.”Silverman&Cohen.Pers Soc Psychol Bull.2014.Older adults with Older adults with visual visual impairments impairments more likely to more likely to have depression have depression and anxietyand anxietyVan der Aa et al.IOVS.2015.A higher proportion of persons with visual impairment report

4、ed lonelinessBrunes et al.Health Qual Life Outcomes.2019.WhyWhy does vision loss does vision loss impact psychosocial impact psychosocial health?health?“Loss of eyesight described as the worst ailment that could happen relative to losing memory,speech,hearing,or a limb.”Scott et al.JAMA Ophthal.2016

5、.Swenor et al.Gerontologist.2019.Stigma&Stigma&DiscriminationDiscriminationNonNon-inclusiveinclusive&Inaccessible&Inaccessible environments environments“I just dont want to have a perception of limitations.”“I dont want people to feel sorry for me.”“I think it hurts them,because they are targeted as

6、 different.They are targeted as not a whole person,as being a lesser person.I do feel that people feel rejected rejected in general.”Kumar et al.JVIB.2022.DiscriminationDiscriminationShakarchi et al.JAMA Ophthal.2020.Adults with dual sensory impairment experience more frequent perceived discriminati

7、on.1.Being treated with less respect.2.Others acting as though the person with VI was not smart.DiscriminationDiscriminationOlder adults with reported VI more likely to report discriminationDiscrimination higher levels of depressive symptoms&loneliness and lower quality of lifeJacksons et al.JAMA Op

8、hthal.2019.English Longitudinal Study of AgeingStigma&Stigma&DiscriminationDiscriminationNonNon-inclusiveinclusive&Inaccessible&Inaccessible environments environments Vision impaired Vision impaired participate in fewer participate in fewer cognitive activitiescognitive activitiesVaradaraj et al.J G

9、erontol Med Sci.2020.Unlike race,ethnicity,gender,Unlike race,ethnicity,gender,and age,and age,disability datadisability data are not are not routinely collected routinely collected 9.4%Accessibility Need ReportedAccessibility need requested in 23,510(9.4%)encountersVaradaraj et al.JAMA Netw Open.20

10、22.Accessibility Requests Mobility:cane,crutches,motorized scooter,walker,wheelchair,stretcher,assistance standing,or transport services Sensory:assistance due to visual,hearing or speech impairment Intellectual:assistance due to an intellectual/developmental disability Other:requiring assistance wi

11、th filling forms for other reasons,or use of a service animal80%13%2%6%MobilitySensoryIntellectualOther55,722 patients250,932 patient encounters Varadaraj et al.JAMA Netw Open.2022.accessibility accessibility needsneedsdisabilitydisabilityStandardize data collection for:%of patients with a disabilit

12、y%of patients with disability-related accessibility need requestsThe DisabilityThe DisabilityDashboards Dashboards ApproachApproachCOVIDCOVID-19 Vaccine 19 Vaccine Accessibility DashboardAccessibility Dashboard Assessed website accessibility#and types of errors Health department websites 50 states,D

13、C,5 US territoriesJo et al.DHJO.2022 disabilityhealth.jhu.edu Jo et al.DHJO.2022“Our results underscore the addressable,yet persistent inequities in the pandemic response for the disability community.”COVID-19 vaccine information website accessibility“Limited or uncertain availability of nutritional

14、ly-adequate or safe foods”Food security is central to health&wellFood security is central to health&well-beingbeing L Linked to poor mental and physical health inked to poor mental and physical health No VIVIVI VI have higher ohave higher odds of dds of Food InsecurityFood InsecurityKumar et al.Opht

15、halmic Epi.2022.No VIVision ImpairedRef2.2(2.0-2.3)The DisabilityThe DisabilityDashboards Dashboards ApproachApproachSNAP Disability SNAP Disability DashboardDashboardSNAP Disability DashboardSNAP Disability DashboardTotal scores(18 pts):Flexibility(6 pts)Efficiency (6 pts)Accessibility(6pts)disabil

16、ityhealth.jhu.eduSamuel et al.DHJO.2022.Impact of the COVIDImpact of the COVID-19 19 PandemicPandemicZhang et al.Journals of Gerontology:Psych Sci.2022.Older adults with VI depressive symptoms Video calling,but not phone calling,mitigated this effect Facial expressions improve bonding by signaling a

17、ctive social engagement Epstein et al.Disability&Health.2021.“If the gap exists before a major health crisis,you better believe that thats gonna become the Grand Canyon when something like this happens to us.”Epstein et al.Disability&Health.2021.“Food access was as scary to me,if not scarier than CO

18、VID.”Epstein et al.Disability&Health.2021.“The paratransit systems in my area will not deliver you or pick you up from a testing site.If you cant get there on the bus or on your own,you cant do it.anxiety and depression loneliness and social isolation Stigma&discrimination Inaccessible environmentSU

19、MMARY“Everyone,if they live long enough,will experience at least 1 eye condition.”WHO.World Report on Vision.2019.“Disability is part of being human.Almost everyone will temporarily or permanently experience disability at some point in their life.”Accessibility Accessibility is all our is all our re

20、sponsibility responsibility Shift from solely focusing on fixing VI to prevent or cure mental health issuesBroaden to creating inclusive environments barriers to information,programs,facilitiesAccess must be equally effective and integrateddisabilityhealth.jhu.eduJHUDisabilityIncludedPodvvarada2jhu.eduLearn more!Learn more!