Abstract / Summary
Abstract Background: Older adults with vision impairment face unique challenges that may contribute to depression, including limitations in vision-dependent daily activities (e.g., driving, reading, face recognition). However, existing conceptual models for this population broadly encompass functional and psychosocial outcomes and do not specifically focus on depression. Objective: This study aimed to: 1) identify key concepts and their interrelationships related to depression experiences from published qualitative studies, and 2) develop a conceptual model that characterizes depression among older adults with vision impairment. Methods: We included qualitative studies that described depression among adults aged 60 or older with vision impairment. We searched five electronic bibliographic databases (PubMed, Web of Science, Embase, PsycINFO, and CINAHL Complete) in December 2025 in collaboration with a medical librarian. Two reviewers independently screened titles, abstracts, and full texts, and a third reviewer resolved discrepancies. We performed a machine learning-based concept mapping analysis using Leximancer software, followed by researcher-led interpretation of concept relationships and iterative conceptual model development. Results: Out of 6,084 records identified, 26 qualitative studies representing 508 participants met the eligibility criteria. Concept mapping analysis using Leximancer identified seven themes: loss (204 hits), activities (149), drive (67), time (62), fear (39), cope (30), and depression (14). Notably, loss- and activity-related concepts predominated in the concept map, whereas the explicit concept of depression was relatively infrequent. Based on concept mapping findings, we developed the Vision Impairment Depression Pathways Model (VIP Model), in which vision impairment was linked to depression through functional limitations and three psychosocial pathways: social isolation, loss of independence, and loss of identity. Conclusions: The concept mapping findings suggest that older adults with vision impairment may describe their experiences of depression using language related to functional and social loss (e.g., difficulties in performing everyday tasks, reduced social interactions) rather than clinical depressive symptom language. The VIP Model could inform future prevention strategies and assistive technology designs to address late-life depression.