RecognEYEze: recognizing and discussing depression and anxiety

Mental health

With a background in behavioral sciences, Edine van Munster conducts her PhD research as an external PhD candidate working at the Robert Coppes Foundation. Her PhD focusses on recognizing and discussing depression and anxiety in adults with vision impairment, and is conducted in collaboration with Bartiméus and Royal Dutch Visio.


Edine van Munster


PhD candidate


ZonMw Expertisefunctie Zintuiglijk Gehandicapten, VIVIS



RecognEYEze study

Why are we doing this study?

One in three adults with vision impairment experience symptoms of depression and/or anxiety, which is twice as common as in general population. However, more than half of those with depression or anxiety lack psychological support. This might be caused by a lack of recognition and discussion about depression and anxiety in adults with vision impairment.

What is the aim of our study?

The aim of our study is to gain more insight into the recognition and discussion of depression and anxiety in adults with vision impairment, in order to provide recommendations to improve current practice. Barriers and facilitators in this process are examined from both clients’ perspective and healthcare providers’ perspective. In addition, risk factors for depression in adults with vision impairment are determined, and we will study implementation of an existing screening instrument for depression and anxiety within Dutch low vision services.

How do we conduct this study?

Semi-structured interviews with sixteen clients were conducted to gain more insight into their experiences in recognizing and discussing depression and anxiety, in which we also specifically examined the role of healthcare providers. In a survey study among healthcare providers working at Bartiméus, Royal Dutch Visio and the Robert Coppes Foundation, we investigated how they assess symptoms of depression and anxiety, and determined factors influencing them discussing their client’s feelings. Subsequently, in collaboration with universities in Wales and Australia, data from three studies among healthcare providers was analyzed to develop a prediction model for depression by ophthalmic personnel and low vision service workers. Moreover, implementation of a screening instrument for depression and anxiety was investigated in three phases: 1) usability study, 2) feasibility study and 3) barriers and facilitators of implementation, in which clients, healthcare providers and managers were involved as stakeholders. This research is concluded by developing a prediction model for symptoms of depression based on data collected in two previous studies among adults with vision impairment (n=274, n=247). Finally, recommendations for current practice will be written and an educational program for healthcare providers who work with adults with vision impairment will be developed.

Preliminary results & conclusion

Adults with vision impairment report several barriers and facilitators of which many can be linked to being visually impaired. Family members and healthcare providers can support them in recognizing and discussing mental health problems, for example by healthcare providers starting a conversation about the impact of being visually impaired on their mental health. However, they wonder whether all healthcare providers have sufficient knowledge, attitude and skills to recognize and discuss depression and anxiety with their clients.

Healthcare providers from Bartiméus, Royal Dutch Visio and the Robert Coppes Foundation often attribute symptoms of depression and anxiety to mental health problems, but also to being visually impaired. Female healthcare providers, those who are highly educated, have the intention to discuss suspicions of depression or anxiety, feel comfortable discussing their own suspicions and perceive social support within the organization, are more likely to start a conversation about their client’s feelings.

Our implementation study to use of the Patient Health Questionnaire (PHQ)-4 in Dutch low vision services showed that the PHQ-4 is suitable for adults with vision impairment. Both clients and healthcare providers were positive about the PHQ-4. However, several barriers and facilitators in implementation were determined and should be taken into account during implementation, f.e. confidence of healthcare providers, openness of clients and embedment of the PHQ-4 in current practices.

In conclusion, a vision impairment can create barriers in adults recognizing and discussing depression and anxiety. According to them, healthcare providers can play an important role in stimulating a discussion about mental health problems. Implementation of a screening instrument can support healthcare providers in discussing depression and anxiety. Knowledge about depression and anxiety, and developing skills to recognize and discuss mental health should be included in a tailored educational program.


Prof.dr. Ruth van Nispen, Dr. Hilde van der Aa