Risk and Protective Factors Associated With Depressive Symptoms in Older Adults With Visual Impairment: A Systematic Review

BACKGROUND AND OBJECTIVES: This systematic review aimed to synthesize risk and protective factors associated with depressive symptoms in older adults with visual impairment. RESEARCH DESIGN AND METHODS: We included quantitative studies that examined factors associated with depressive symptoms in adults aged 60 or older with visual impairment. Five electronic bibliographic databases (PubMed, Web of Science, Embase, PsycINFO, and CINAHL Complete) were searched in November 2025 in collaboration with medical librarians. Two reviewers independently screened titles, abstracts, and full texts, and any discrepancy was resolved by a third reviewer. The National Heart, Lung, and Blood Institute's Quality Assessment Tool was used to assess risk of bias in individual studies. The included studies were qualitatively synthesized to summarize the evidence. RESULTS: Out of 14,963 records identified, 13 studies met the eligibility criteria. These studies comprised 15 reports, including 11 cross-sectional and 4 longitudinal designs. Most reports were assessed as "fair" quality due to a lack of sample size justification and the inability to establish temporality. Risk factors included older age, being widowed, severe visual impairment, severe self-reported visual difficulty, poor self-rated health, and greater ADL/IADL limitations. Protective factors included better adaptive coping strategies, a greater level of social support, and the use of rehabilitation services and optical aids. DISCUSSION AND IMPLICATIONS: Findings suggest adaptive coping strategies and social support may be key modifiable protective factors for depressive symptoms among older adults with visual impairment. Findings may guide novel interventions enhancing psychological adaptation to visual impairment and maintaining functional independence.