A total of 59 individuals with VI participated in the study. The mean score of the SUS was 48.6 ± 10.7 (range: 23-68) and the mean score of each category of NAS-J was as follows: anxiety/depression (75.5 ± 20.9, range: 16.67-100); self-esteem (52.8 ± 25.0, range: 6.25-100); self-efficacy (63.6 ± 21.3, range: 0-100); acceptance of VI (53.2 ± 22.3, range: 8.3-95.8); locus of control (71.3 ± 19.2, range: 16.6-100); and attitude to disability (36.9 ± 21.2, range: 0-93.75).
Regarding the VI-related factors, 22.0% (n = 13) were congenital and 88.1% were severely impaired (Grade 1: n = 35; Grade 2: n = 17; Grade 3: n = 1; Grade 4: n = 3; and Grade 5: n = 3). The mean VI duration was 22.1 ± 13.4 (range: 2–68) years, and their better and worse eye-corrected visual acuity (logMAR) were 2.23 ± 0.94 (0.52–3.30) and 2.60 ± 0.87 (0.05–3.30), respectively. Regarding their sociodemographic profile, 78% (n = 46) had graduated from high school or higher education. Regarding their employee status, 44.1% (n = 26) were employed while 49.2% (n = 29) were unemployed and 6.8% (n = 4) were on temporary leave. When it comes to the annual income, 28.8% (n = 26) earned less than 2 million yen; 44.1% (n =43) earned between 2 and 4 million; 15.3% (n = 9) earned between 4 and 6 million, and 11.9% (n = 7) earned more than 6 million. 33.9% (n = 20) lived alone, and 66.1% (n = 39) lived with family members. In addition, 55.9% of them (n = 33) received support for daily activities. 33.9% (n = 24) claimed systemic diseases such as depression (n = 2), chronic pancreatitis (n = 3), diabetes (n = 7), high blood pressure (n = 5), chronic pain (n = 2), orthopedic disease (n = 2), hearing loss (n = 2), and atopic dermatitis (n = 1).
Associations between strengths use (SUS) and psychological adjustment to disability (NAS-J)
To investigate the association between strengths use and PA to VI, we conducted a simple regression analysis to identify significant factors affecting each of the dimensions of NAS-J. The results are shown in Table 1, and the associations between SUS and each of the NAS-J components are illustrated in Figure 1.
Table 1. Simple regression analysis for the association between Nottingham Adjustment Scale Japanese version and other variables
|
Β
|
Dependent
Variables
|
Anxiety
depression
|
Self-esteem
|
Self-efficacy
|
Acceptance of
VI
|
Locus of
control
|
Attitude to disability
|
SUS
|
0.44**
|
0.56**
|
0.44**
|
0.42**
|
0.23
|
0.10
|
Age
|
0.38**
|
0.33*
|
-0.09
|
-0.18
|
-0.03
|
-0.14
|
SexA
|
-0.13
|
-0.20
|
0.32*
|
0.17
|
-0.04
|
0.22
|
BCVA
|
0.17
|
0.17
|
0.09
|
0.00
|
0.00
|
0.04
|
WCVA
|
-0.07
|
-0.10
|
0.04
|
0.04
|
0.08
|
-0.00
|
History of VIB
|
0.03
|
0.43**
|
0.08
|
0.21
|
0.06
|
-0.05
|
Duration of VI
|
0.06*
|
0.43**
|
0.02
|
0.06
|
-0.03
|
0.09
|
Disability grades
|
0.19
|
-0.03
|
-0.08
|
-0.01
|
0.07
|
0.11
|
Systemic diseasesC
|
-0.04
|
0.03
|
0.14
|
0.16
|
0.09
|
0.17
|
Live independentlyD
|
-0.07
|
0.16
|
0.12
|
-0.01
|
0.23
|
-0.06
|
Support for DAE
|
0.01
|
-0.20
|
-0.22
|
0.03
|
-0.15
|
-0.04
|
EducationF
|
0.23
|
0.10
|
-0.03
|
-0.18
|
0.09
|
0.05
|
Employment statusG
|
-0.29
|
-0.20
|
-.008
|
0.16
|
-0.01
|
-0.25
|
Annual incomeH
|
0.25
|
0.02
|
-0.09
|
-0.02
|
0.11
|
0.16
|
A male = 1, female = 2; B congenital = 1, acquired = 2; C no systemic disease = 0, presence of any systemic diseases = 1; D living alone = 1, living with family = 2; E presence of any support for daily activities = 1, no support for daily activities = 2, F high school or lower = 1, beyond high school = 2; G employed = 1, unemployed = 2, temporarily leave =3; H < 2 million = 1, ≥ 2 million/< 4 million = 2, ≥ 4 million/< 6 million = 3, ≥ 6 million = 4.
Abbreviations, SUS: Strengths Use Scale; VI: visual impairment; BCVA: better eye-corrected visual acuity; WCVA: worse eye-corrected visual acuity. *P < 0.05. ** P < 0.01.
Fig 1. Simple regression analysis results for association between Strengths Use Scale and components of the Nottingham Adjustment Scale Japanese version
Four (anxiety/depression, self-esteem, self-efficacy, and acceptance of VI) of six components of the Nottingham Adjustment Scale were significantly correlated with SUS. Abbreviations; VI: visual impairment; SUS: Strengths Use Scale.
|
We identified that the SUS score was significantly associated with anxiety/depression, self-esteem, acceptance of VI, and self-efficacy, respectively. In contrast, there was no significant association between the SUS score and locus of control as well as attitude to disability.
Our subsequent multiple regression analysis tested the most significant independent variables related to each of the items of NAS-J since several significant factors were identified in the simple regression analysis with anxiety/depression, self-esteem, and self-efficacy (Table 2). This analysis identified that the SUS score was the most significant factor affecting anxiety/depression, self-esteem, and self-efficacy in the NAS-J.
Table 2. Multiple regression analysis for the association between Nottingham Adjustment Scale Japanese version and selected variables
|
β (P-Value)
|
Dependent Variables
|
Anxiety/depression
|
Self-esteem
|
Self-efficacy
|
SUS
|
0.31* (0.02)
|
0.48** (< 0.001)
|
0.38** (< 0.001)
|
Age
|
0.23 (0.07)
|
0.14 (0.30)
|
-
|
SexA
|
-
|
-
|
0.21 (0.09)
|
Duration of VI
|
0.12 (0.36)
|
0.26 (0.06)
|
-
|
History of VIB
|
-
|
-0.09 (0.49)
|
-
|
Employment statusC
|
-0.11 (0.41)
|
-
|
-
|
A male = 1, female = 2; B congenital = 1, acquired = 2; c employed = 1, unemployed = 2, temporarily leave =3.
Abbreviations, SUS: Strengths Use Scale; VI: visual impairments. *P < 0.05. **P < 0.01.