Aims Visual impairment (VI) is associated with heightened levels of loneliness, anxiety, and depression, yet few people with VI use mental healthcare services (MHS). The reasons for this are incompletely understood. Here, we aimed to understand possible financial barriers by analyzing the association of VI with delaying or foregoing MHS due to cost in a population database. Methods We conducted a cross-sectional study using the National Health Interview Survey (NHIS) of the U.S. Centers for Disease Control and Prevention (2019 to 2022). The primary outcome measure was the rate of delaying and foregoing obtaining MHS due to cost among participants with VI. Secondary outcomes included associations between sociodemographic characteristics and delaying or foregoing MHS due to cost. Logistic regressions were adjusted for demographic characteristics including household income. Results Among 18,475 participants, 27% reported VI. Participants with VI were more likely to be older, female, have lower income, and had lower educational attainment than those without VI. VI was associated with greater odds of delaying (adjusted odds ratio (aOR): 1.5, 95% confidence interval (CI) 1.3-1.6) and foregoing (aOR: 1.5, 95% CI 1.3-1.6) MHS due to cost. Among individuals with VI, those who were female and younger had higher odds of delaying and foregoing MHS due to cost. Conclusions Individuals with VI and depression or anxiety may be at higher risk of delaying or foregoing MHS due to cost. These findings underscore the importance of addressing financial barriers to ensure equitable access to MHS for individuals with VI.

The authors have declared no competing interest.

This project was funded by The Joseph Albert Hekimian Fund.

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We analyzed publicly available and de-identified data for US adults from the sample adult core questionnaire from the National Health Interview Survey (NHIS) administered by the United States CDC. Ref: National Health Interview Survey (NHIS). https://www.cdc.gov/nchs/nhis/index.htm

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