Self-esteem and locus of control of individuals with visual impairments before and during the COVID-19 pandemic: A latent class analysis

Abstract

This study aims to investigate the effect of lockdowns on self-esteem and the locus of control (LoC) of individuals with visual impairments. This research question is important to be answered, as there is no previous research on the topic, and the findings of this study add significant elements to our knowledge on the subject. It is the first time that a study examines the effect of the pandemic on the self-esteem and LoC of individuals with visual impairments. The sample of the research consisted of 321 individuals with visual impairments; 176 of them participated in the pre-COVID period, 50 in the first wave of COVID period, and 95 in the second wave of COVID period. Two research instruments were used: the Rosenberg Self-Esteem Scale and the Rotter Internal–External LoC Scale. High self-esteem and a more internal LoC are positively associated with the pre-COVID period and negatively associated with first- and second-wave COVID periods. The participants with high self-esteem and internal LoC are most likely males, people with blindness, people who work, people who have a university degree, and people who frequently move independently. However, the individuals with low self-esteem and a more external LoC are most likely older people or people with higher age at onset of visual impairment. The first- and second-wave COVID periods are negatively associated with self-esteem and LoC of individuals with visual impairments.

Keywords

COVID-19 individual characteristics locus of control self-esteem visual impairments

Introduction

The World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic in March 2020. To limit its transmission, the governments announced the implementation of lockdowns and imposed restrictive measures. People with disabilities are among the population subgroups who may be at higher risk of being infected with COVID-19, experiencing consequences in their health or dying prematurely due to comorbidities, compared to those without disabilities (Lebrasseur et al., 2021; Senjam, 2021; Umucu & Lee, 2020). Furthermore, the lockdown restrictions may have a greater impact on them because they are dependent on other people or in need of certain services to have their needs met (Lebrasseur et al., 2021).

During the pandemic, the physical activity of people with disabilities was limited, as there were restrictions on transport and access to sports facilities. In addition, the access to specialized facilities and treatments decreased (Theis et al., 2021). This could have implications for the mental health of people with disabilities, as physical activity is considered beneficial for mental health and self-esteem (Theis et al., 2021). In particular, people with visual impairments experienced significant limitations in daily activities, such as getting their shopping and moving around independently, while their personal contacts were reduced or were non-existent (Gombas & Csakvari, 2022). Furthermore, in a study of visually impaired adults, it was reported that the respondents did not ask for help for fear of being infected or because they felt that sighted people were reluctant to provide assistance (Gombas & Csakvari, 2022).

Another way in which the pandemic affected the general population was that social contacts were reduced, resulting in negative effects on mental health and well-being, such as an increase in stress, anxiety, and depressive symptoms (Misamer et al., 2021). However, people with disabilities also showed a high risk of decreased social contact and loneliness (Holm et al., 2021; Na & Yang, 2022). Increased social isolation and loneliness may be due to the tighter social restrictions for people with disabilities but also to their greater needs for social support and health care (Na & Yang, 2022; Okoro et al., 2021). In a study of people with visual, motor, and intellectual impairments, it was found that people with visual impairments reported loneliness less often than people with motor or intellectual impairments (Holm et al., 2021), possibly due to the fact that caregivers of people with visual impairments reported more frequent care provision since the onset of the pandemic, which has a positive effect on reducing loneliness (Holm et al., 2021).

Generally, it appears that the pandemic has had a negative impact on the mental health of people with disabilities (Okoro et al., 2021; Pettinicchio et al., 2021). In addition to decreased social contacts and loneliness (Na & Yang, 2022), there are other factors that contributed to the deterioration of their mental health, such as stressors caused by the constraints of the pandemic; for instance, people with disabilities were concerned about accessing needed treatments, supplies or medications, or services (Okoro et al., 2021). In a study by Okoro et al. (2021), adults with disabilities had higher rates of depressive symptoms than those without disabilities. In particular, depressive symptoms were more severe for individuals with hearing and visual impairments (Okoro et al., 2021).

Two psychosocial characteristics of people with visual impairments that may have been negatively affected by the pandemic, and especially the lockdown, are self-esteem and locus of control (LoC). However, there is a lack of studies investigating this negative effect. This study seeks to fill this gap.

Coopersmith (1967) defined self-esteem as one’s positive and negative attitudes toward oneself. Self-esteem is the product of interactions between individuals and significant others, and it constitutes a measure of how we evaluate or appraise our own value (Alexander, 1996). According to Gold (2002), self-esteem levels may fluctuate based on changes in time, space, and demands on people’s lives. Moreover, feelings of inadequacy may alter a person’s self-esteem level (Gold, 2002). Vision loss could also have psychological consequences including lower morale, depression, social isolation, reduced feelings of self-esteem, diminished emotional security, and lower levels of social interaction (Branch et al., 1989). High self-esteem and social support are positively linked in individuals with visual impairments (Augestad, 2017; Huurre, 2000; Huurre & Aro, 1998; Huurre et al., 1999; Tuttle & Tuttle, 2004), as well as to independence in fulfilling daily activities (Beach et al., 1995), perceived independence (Tuttle, 1984), independent movement (Papadopoulos et al., 2014), and participation in sports (Nemček, 2017; Ponchillia et al., 2002). In all these areas, the restrictions brought about by the lockdown are noticeable, and for this reason, it is valuable to study the effect of the lockdown on self-esteem of individuals with visual impairments.

LoC and self-esteem are two complementary variables. LoC appears to be related to self-esteem in individuals with and without disabilities (Dodds, 1993; Papadopoulos et al., 2014; Saadat et al., 2012). In particular, individuals with an internal LoC show higher self-esteem. This is likely due to the fact that individuals with internal LoC tend to attribute their successes to themselves, thus their self-esteem is increased (Saadat et al., 2012). For Rotter (1966), LoC is the degree to which a person comprehends that there is a reward or that this may be dependent on their own behavior or attitude, contrary to the degree to which they feel that a reward is controlled by external forces and may occur irrespective of their actions. For instance, if an individual identifies more with the statement “No matter how hard one tries, some people just don’t like them” than with the statement “People who cannot make others like them do not understand how to get along with others,” or if they identify more with the statement “Heredity plays a significant role in determining one’s personality” than with the statement “One’s life experiences determine their personality,” they are likely to have a more external LoC. These statements are items of the “Rotter Internal–External LoC Scale” (Rotter, 1966), which is a commonly used instrument for assessing LoC and was also used in the current study.

The external LoC is associated with low social support (Erol, 2008; Sarason et al., 1983) and higher levels of depression (Dodds, 1993; Erol, 2008). Dodds (1993) argues that an external LoC is not only a result of vision loss but also of many other factors that affect the lives of people with visual impairments. Previous studies (Papadopoulos, 2014; Papadopoulos et al., 2013, 2014) have shown that people with visual impairments who move independently have a control center that is more internal than that of people who always or sometimes move with the assistance of a sighted guide. The social support received and the capacity to move and live independently were severely limited during the lockdown, and therefore one can assume that the lockdown has a negative effect on the LoC of individuals with visual impairments. This study aims to produce findings that examine this hypothesis.

Self-concept and self-esteem in the typical population also seem to have been negatively affected during the pandemic. In a study among adolescents aged 13–17 years, it appeared that their overall self-concept decreased during the COVID-19 pandemic (González-Valero et al., 2020). Self-concept was positively associated with emotional well-being, contact with family and peers, and physical activity. In addition, the adolescents’ overall and emotional self-concept was higher before the lockdown, while it decreased during the lockdown, and was associated with emotional well-being, family, and peer contact (González-Valero et al., 2020). In a study of teachers, it appeared that, during the pandemic, their self-esteem and self-efficacy were lower compared to the normative sample (Cataudella et al., 2021).

High self-esteem could prevent mental health risks during the pandemic by preventing anxiety and depressive symptoms (Rossi et al., 2020). It could also contribute to adaptive coping in such situations (Na &Yang, 2022).

The literature reports the association of internal LoC with mental and physical health (Misamer et al., 2021), while external LoC is associated with greater symptoms of depression, anxiety, and stress (Krampe et al., 2021; Sigurvinsdottir et al., 2020). Restrictive measures during the pandemic created the conditions for a shift from a more internal to a more external control center (Misamer et al., 2021). Furthermore, another study showed that people (without disabilities) who generally feel in control of their lives (i.e., more internal LoC) reported that the COVID-19 pandemic was easier to cope with (Krampe et al., 2021). Apparently, when people believe that they are in control of their destiny, and thus exhibit a more internal LoC, they could be protected from the negative effects of the pandemic on their mental health (Sigurvinsdottir et al., 2020).

This study aims to answer the following research question: what is the effect of lockdowns on self-esteem and the LoC of individuals with visual impairments?

Previous research has suggested that demographic characteristics may also have an impact on the self-esteem and LoC of individuals with visual impairments across the three periods examined in this study (pre-COVID period, first wave of COVID period, and second wave of COVID period). Therefore, this study aims to investigate the personal factors that may influence the self-esteem and LoC of individuals with visual impairments, alongside any possible effects of the pandemic, during the three periods under examination.

Study

Method

The study was carried out in three phases: (a) pre-COVID period (using research data from studies conducted between 2017 and 2019), (b) first wave of COVID period (from 10 April 2020 to 20 May 2020), and (c) second wave of COVID period (from 10 December 2020 to 15 February 2021).

Participants

The total sample of the research consisted of 321 individuals with visual impairments (Table 1); 176 of them participated in the pre-COVID period, 50 in the first wave of COVID period, and 95 in the second wave of COVID period.

Table 1.

Participants.

	Pre-COVID (n = 176)	First wave (n = 50)	Second wave (n = 95)
Gender	Males: 107 Females: 69	Males: 22 Females: 28	Males: 48 Females: 47
Age (years)	15–70 (M = 33.79)	14–67 (M = 35.90)	16–79 (M = 39.30)
Age at onset	Congenital: 104 Acquired: 72	Congenital: 18 Acquired: 32	Congenital: 39 Acquired: 56
Vision status	Blindness: 110 Severe v.i.: 66	Blindness: 30 Severe v.i.: 20	Blindness: 47 Severe v.i.: 48
Educational level	Primary school: 7 Secondary school: 17 High school: 50 University students: 41 University graduates: 61	Primary school: 0 Secondary school: 5 High school: 7 University students: 8 University graduates: 30	Primary school: 6 Secondary school: 7 High school: 18 University students: 19 University graduates: 45
Independent movement	Always: 40 Sometimes: 55	Always: 27 Sometimes: 23	Always: 40 Sometimes: 55
Work status	Employed: 72 Unemployed: 104	Employed: 22 Unemployed: 28	Employed: 42 Unemployed: 53

Participants were recruited from (a) student support units/offices for students with disabilities (e.g., accessibility units/offices) of Greek Universities, (b) Professional Training Institutes, (c) the Panhellenic Association of the Blind, (d) Associations of the people with visual impairments (e.g., athletic unions), and (e) groups of people with visual impairments in social media.

Pre-COVID period

Overall, 176 individuals with visual impairments, aged 15–70 years (M = 33.79, SD = 11.40), participated: 107 males and 69 females. All participants resided in Greece. Concerning the vision status of the participants, 110 of them were persons with blindness (visual acuity worse than 3/60, while at the same time, they were using Braille or screen reading software as reading media) and 66 of them were persons with severe visual impairments (visual acuity worse than 6/60 and better than 3/60, while at the same time, they were using large prints or low-vision aids). However, 104 of the participants stated that their vision loss was congenital or that it occurred before the age of 1 year, and 72 stated that their vision loss was acquired. Concerning educational level, 7 of the participants had primary school education, 17 had secondary school education (gymnasium), 50 had high school education (lyceum), 41 were university undergraduates, and 61 were university graduates. In addition, 72 (41%) of the participants were employed.

When asked the question “Are you able to move independently or do you need assistance from a sighted guide?,” 87 participants stated that they were able to move independently, and 89 participants stated that they sometimes needed assistance depending on the surrounding environment (how complex and familiar this was for them).

First-wave COVID period

Overall, 50 individuals with visual impairments, aged 14–67 years (M = 35.90, SD = 12.60), were participated: 22 males and 28 females. All participants resided in Greece. Concerning the vision status of the participants, 30 of them were persons with blindness and 20 of them were persons with severe visual impairments. However, 18 of the participants stated that their vision loss was congenital or that it occurred before the age of 1 year, and 32 stated that their vision loss was acquired. Concerning educational level, 5 of the participants had secondary school education (gymnasium), 7 had high school education (lyceum), 8 were university undergraduates, and 30 were university graduates. In addition, 22 (44%) of the participants were employed.

When asked the question “Are you able to move independently or do you need assistance from a sighted guide?,” 27 participants stated that they were able to move independently, and 23 participants stated that they sometimes needed assistance depending on the surrounding environment (how complex and familiar this was for them).

Second-wave COVID period

Overall, 95 individuals with visual impairments, aged 16–79 years (M = 39.30, SD = 15.10), participated: 48 males and 47 females. Of these, 50 of the participants lived in Greece and 45 participants lived in other countries. Concerning the vision status of the participants, 47 of them were persons with blindness and 48 of them were persons with severe visual impairments. However, 39 of the participants stated that their vision loss was congenital or that it occurred before the age of 1 year, and 56 stated that their vision loss was acquired. Concerning educational level, 6 of the participants had primary school education, 7 had secondary school education (gymnasium), 18 had high school education (lyceum), 19 were university undergraduates, and 45 were university graduates. In addition, 42 (44%) of the participants were employed.

When asked the question “Are you able to move independently or do you need assistance from a sighted guide?,” 40 participants stated that they were able to move independently, and 55 participants stated that they sometimes needed assistance depending on the surrounding environment (how complex and familiar this was for them).

Instruments and procedures

Apart from the questionnaire concerning the demographic/personal data of the participants, two more instruments were used: (1) the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and (2) the Rotter internal-external LoC scale (Rotter, 1966).

Demographic data

The following demographic data were collected from participants with visual impairments: gender, age, vision status (visual acuity, visual field, and reading media), age at onset of visual impairments, educational level, work status, and ability of independent movement. The participants were asked to report on their ability to move about independently (frequency of independent movement without needing any support from a sighted guide). This item was answered on a 5-point scale (never, seldom, sometimes, usually, and always).

The Rosenberg Self-Esteem Scale

The scale (Rosenberg, 1965) includes 10 items. The items are answered on a 4-point scale ranging from strongly agree to strongly disagree. The aforementioned scale was employed on the following basis: (a) the Rosenberg Self-Esteem Scale has been used in previous studies with individuals with visual impairments (Garaigordobil & Bernarás, 2009; Papadopoulos, 2014; Papadopoulos et al., 2013, 2014), (b) the items make no reference to visual impairment, and (c) the scale has been extensively used in samples of people of different ages and has been shown to have high reliability and validity when used in adolescents, adults, and older adults (Corcoran & Fischer, 1987; Mayordomo et al., 2020; Mullen et al., 2013; Robins et al., 2001). The findings of a large-scale study (Schmitt & Allik, 2005), conducted in 53 nations (the scale was translated into 28 languages) with 16,998 participants, indicate the reliability of the Rosenberg scale in different cultural contexts as well. In this research, the Cronbach’s alpha was .811. In this study, Cronbach’s alpha coefficient regarding self-esteem of participants with visual impairments was α = .88.

The Rotter internal–external LoC scale

The scale (Rotter, 1966) comprises 29 bidirectional statements, whereby participants are called upon to select the statement that they agree with more. The total score was calculated on the basis of 23 out of a total of 29 questions or elements (maximum score = 23). Six extra suggestions or statements are added to disorient the participant so that it will not be clear what the test is trying to measure or achieve (Beretvas et al., 2008). The aforementioned scale was employed on the following basis: (a) the Rotter internal–external LoC scale has been used in previous studies with individuals with visual impairments (Papadopoulos, 2014; Papadopoulos et al., 2013, 2014), (b) the scale has been used with a myriad of populations since the 1960s (see Beretvas et al., 2008), (c) the items make no reference to visual impairment, and (d) scores on the scale exhibited sufficient convergent/discriminant validity and satisfactory internal and test–retest reliability (Rotter, 1966). The scale has been validated in many situations, such as for use over time (Lange & Tiggemann, 1981). According to Rotter (1966), the corrected split-half reliabilities for males and females were .65, and .79, respectively, and Kuder–Richardson coefficients for various samples ranged from .69 to .76 (Domino & Domino, 2006). Test–retest reliability in various samples ranged from .49 to .83 (Domino & Domino, 2006). Moreover, there a lot of studies that support the construct validity of the scale (Domino & Domino, 2006). In this study, Cronbach’s alpha coefficient regarding LoC of participants with visual impairments was α = .68.

Procedures

The research was conducted in accordance with the guidelines of the Declaration of Helsinki (Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects). All instruments were developed in digital accessible format, using SurveyMonkey (https://www.surveymonkey.co.uk/). Participants would respond to the questionnaires via a link, which they would receive in their email or messenger and via a link which they would receive from posts made by the authors in groups (of people with visual impairments) on Facebook.

Statistical analysis

Latent class analysis (LCA) is a model-based cluster analysis, which based on a member of input variables and certain response patterns can divide the participants into clusters/groups, named latent classes (LC) (Clogg, 1995; Dayton, 1998). LCA as a psychometric model of measurement assumes that both the latent and the observable variables are categorical; however, its capabilities have been extended to include observables at ordinal and interval level of measurement, where it is referred as latent profile analysis. Contrary to the traditional cluster analysis methods, which are based on differences, the classification procedure in LCA is based on similarities and specifically on common conditional probabilities patterns. A conditional probability is the probability of providing a certain response to an item, given that the subject belongs to the specific cluster. LCA applies Bayes’ theorem

p_{(X = c / Y = y)} = \frac{p_{(Y = y / X = c)} \times p_{(X = c)}}{p_{(Y = y)}}

(1)

achieving a latent class assignment via the posterior probability of belonging to a class c given an observed response pattern y, P(X = c/Y = y).

The main advantage of LCA is that it can identify unknown clusters or segments of the data, where individuals share identical or alike values or properties. In addition, the ensued cluster-memberships can be used as dependent or independent variables and be associated with covariates or distal outcomes (Stamovlasis et al., 2018; Vermunt, 2017). There are the one-step approach and the step-wise method to perform LCA with covariates, with the latter to be preferable, because of its options to apply various bias correction procedures.

The goodness-of-fit of an LC model is assessed by a number of indices, such as the number of parameters (Npar), likelihood ratio statistic (L²), Bayesian information criterion (BIC), Akaike’s information criterion (AIC), degrees of freedom (df), and bootstrapped p-value. Non-significant p-value values greater than .05 are desired indicating a good fit between theoretical model and data (Vermunt & Magidson, 2002).

LCA with covariates was carried out following the step-wise method, which includes three steps: (1) the number of clusters (latent classes) were identified based on a set of indicator variables, (2) the individuals are assigned to latent classes, and (3) the resulted class-memberships are associated with a number of covariates (Stamovlasis et al., 2018; Vermunt, 2017). In this study, self-esteem and LoC were implemented as input variables, while as covariates, a number of variables, such as gender, education, age, age onset of visual impairments, vision status (blindness vs low vision), work status, period (pre-COVID, first-wave COVID, second-wave COVID), and frequency of independent movement, were used. Figure 1 shows a schematic representation of the LCA model, including the measurement and the structural parts. The former depicts the input variables on which the classification is based, and the latter includes the set of covariates that affect the ensued cluster/profile memberships.

Results

Table 2 shows the LCA results, where the three-cluster model appears as the best parsimonious LC solution with the minimum BIC value.

Table 2.

LCA results.

	LL	BIC (LL)	Npar	L ²	df	p	Class. Err.
1-Cluster	−1482.272	3203.487	43	2035.863	216		0
2-Cluster	−1445.752	3152.675	47	1962.823	212	.080	.1061
3-Cluster	−1430.311	3144.021	51	1931.942	208	.088	.1483
4-Cluster	−1424.327	3154.280	55	1919.974	204	.120	.1396
5-Cluster	−1419.594	3167.042	59	1910.508	200	.142	.141

LCA: latent class analysis; LL: lower limit; BIC: Bayesian information criterion; Npar: number of parameters; L²: likelihood ratio statistic; df: degrees of freedom; p-value: bootstrapped p-value; Class. Err.: classification error.

The resulted three clusters, Cluster 1, Cluster 2, and Cluster 3, include 47.12%, 34.10% and 18.78% of the sample, respectively. Figure 2 shows the conditional probabilities of the ensued three clusters for the scales Self-Esteem and LoC. The conditional probabilities express the probability a subject to score high in self-esteem and LoC, given that it belongs to a certain cluster. Cluster 1 corresponds to high self-esteem and low (more internal) LoC, Cluster 2 corresponds to medium self-esteem and medium LoC, and Cluster 3 corresponds to low self-esteem and high (more external) LoC.

Consequently, the cluster-membership was implemented as dependent variables and the effects of a number of covariates were estimated. Table 3 shows these associations.

Table 3.

Associations of covariates with the cluster-memberships.

	Cluster 1	Cluster 2	Cluster 3
	High SELow LoC	Medium SEMedium LoC	Low SEHigh LoC
Cluster size	.4712	.341	.1878
Period
Pre-COVID	2.06***	.1702	−2.23***
First-wave COVID	−1.08**	.1644	.917**
Second-wave COVID	−.976***	−.3346	1.31***
Visual status
Blindness	.332***	.285*	−.617***
Reduced vision	−.332***	−.285*	.617***
Gender
Men	.478***	−.0564	−.422***
Women	−.478***	.0564	.422***
Education
Elementary education	.1095	−.1839	.0744
Gymnasium	−.0701	−.1593	.2295
Lyceum	−.5079	.0838	.424
University student	.0439	.6573	−.7012
University graduate	.425*	−.3979	−.0267
Work status
Working	.298***	−.0984	−.1998
Non-working	−.298***	.0984	.1998
Age-onset	.0052	−.336***	.330***
Age	.0185	−.505***	.486***
Independent movement
Low	−.315**	.037	.277*
High	.315**	−.037	−.277*

SE: self-esteem; LoC: locus of control.

p < .05, **p < .01, ***p < .001.

Cluster 1, corresponding to high self-esteem and low (more internal) LoC, is positively associated with the pre-COVID period (b = 2.06, p < .001), and negatively associated with first-wave COVID (b = −1.08, p < .01) and second-wave COVID periods (b = −.976, p < .001), while Cluster 3, which corresponds to low self-esteem and high (more external) LoC, is negatively associated with the pre-COVID period (b = −2.23, p < .001), and positively associated with first-wave COVID (b = .917, p < .01) and second-wave COVID periods (b = 1.31, p < .001).

Cluster 1 is associated with male gender (b = .478, p < .001), holding a university degree (b = .425, p < .05), and work status (b = .298, p < .001). Cluster 1 is also associated with visual status. Blind individuals are more likely to possess high self-esteem and a more internal LoC (b = .322, p < .001), while the opposite holds for individuals with low vision, which are associated with low self-esteem and a more external LoC (Cluster 3, b = .617, p < .001).

Cluster 3 is positively associated with female gender, age, and age at onset of visual impairments. That is, individuals with low self-esteem and a more external LoC are most likely women (b = .422, p < .001), older people (b = .486, p < .001) and individuals with higher age at onset of visual impairments (b = .330, p < .001).

Finally, Cluster 1 is positively associated with the frequency of independent movement (b = .315, p < .01). However, Cluster 3 is negatively associated with the frequency of independent movement (b = .277, p < .01). People who frequently move alone most likely have high self-esteem and a more internal LoC.

Discussion

The findings of this study suggest that high self-esteem and internal LoC are positively associated with the pre-COVID period and negatively associated with first- and second-wave COVID periods. However, low self-esteem and external LoC are negatively associated with the pre-COVID period and positively associated with first- and second-wave COVID periods. This finding suggests that the transition from the pre-COVID period to the first- and second-wave COVID periods is accompanied with a decrease in self-esteem and an increase (a more external) in LoC.

Similar studies conducted in typical population showed that self-concept and self-esteem decreased during the pandemic (Cataudella et al., 2021; González-Valero et al., 2020). High self-esteem is positively related to contact with family and peers (González-Valero et al., 2020), and social support from parents and friends contributes significantly to strengthening the self-esteem, particularly in adolescents with visual impairments (Huurre et al., 1999). Therefore, since contact in person decreased or did not exist at all for people with visual impairments during the pandemic (Gombas & Csakvari, 2022), and people with disabilities in general showed an increased risk of decreased social contacts and loneliness (Holm et al., 2021; Na &Yang, 2022), it is possible that the decrease in self-esteem during the pandemic was due to the social isolation and inadequate social support they received as a consequence of the lockdown (Huurre & Aro, 1998). Furthermore, the pandemic had a negative impact on the mental health of people with disabilities (Okoro et al., 2021; Pettinicchio et al., 2021), which may affect their self-esteem (González-Valero et al., 2020).

The restrictive measures imposed during the pandemic, apart from influencing self-esteem, created the conditions for a transition from a more internal to a more external LoC (Misamer et al., 2021), which is related to greater symptoms of depression, anxiety, and stress (Krampe et al., 2021; Sigurvinsdottir et al., 2020). Literature also reports that LoC seems to be related to self-esteem in individuals with or without disabilities (Papadopoulos et al., 2014; Saadat et al., 2012), as individuals with internal LoC show higher self-esteem, while the external LoC is related to low social support (Erol, 2008; Sarason et al., 1983). Moreover, the existence of a more external LoC during the pandemic may have been due to the conditions of isolation created by the lockdown, which made the isolated person feel powerless to determine their own life (Rotter, 1966). Generally, in the population of people without disabilities, research showed that the COVID-19 pandemic was easier to be managed by people who generally feel that they have an influence on their own lives, that is, people with internal LoC (Krampe et al., 2021). Obviously, when a person believes that they are in control of their own destiny, and thus they develop an internal LoC, this can protect them from the negative effects of the pandemic on their mental health (Sigurvinsdottir et al., 2020).

Besides the impact of the pandemic on self-esteem and LoC of individuals with visual impairments, the findings of this study suggest that the participants with high self-esteem and a more internal LoC are most likely males, people who work, and people who have a university degree. However, the individuals with low self-esteem and a more external LoC are most likely women, older people, or individuals with higher age at onset of visual impairment (acquired visual impairment).

The findings of this study are not consistent with those of previous studies, which do not support the effect of gender on self-esteem of individuals with visual impairments (Papadopoulos, 2014; Papadopoulos et al., 2013, 2014). It is possible, therefore, that the pandemic had a stronger negative effect on females than on males. The effect interactions with friends have on self-esteem appears to be stronger for female than for male adolescents with visual impairments (Huurre et al., 1999). Therefore, it is possible, as the lockdowns reduced interactions with friends, that females with visual impairments became more affected than males, and therefore showed lower self-esteem than males.

The findings of this study are consistent with those of a previous study (Papadopoulos, 2014), which support the effect of the individual’s educational level on self-esteem of young adults with visual impairments; young adults with low educational level show lower self-esteem than their peers with higher educational level (Papadopoulos, 2014). However, the findings of previous studies (Papadopoulos, 2014; Papadopoulos et al., 2013, 2014) do not support the effect of the educational level of individuals with visual impairments on their LoC. However, in individuals without disabilities, the higher educational level was found to have a positive effect on LoC since individuals with a university education had a more internal LoC (Angelova, 2016).

The findings of this study are not consistent with those of previous studies (Papadopoulos, 2014; Papadopoulos et al., 2014), which do not support the effect of employment status to self-esteem and LoC of individuals with visual impairments. However, in individuals without disabilities, LoC seems to be influenced by their employment status, with working individuals having a more internal LoC (Angelova, 2016).

The age at loss of sight appeared in previous studies too, to be a variable affecting self-esteem (Papadopoulos, 2014; Papadopoulos et al., 2013) and LoC (Papadopoulos et al., 2014) of individuals with visual impairments; the participants with visual impairments with recent vision loss have a more external LoC (Papadopoulos et al., 2014).

In this study, the high self-esteem and a more internal LoC are associated with visual status. Blind individuals are more likely to possess high self-esteem and a more internal LoC, while the opposite holds for individuals with low vision, which are associated with low self-esteem and a more external LoC. Previous studies have shown similar findings; adults with blindness (Papadopoulos et al., 2013) and young adults with blindness (Papadopoulos, 2014) have a higher self-esteem than adults or young adults with low vision (Papadopoulos, 2014; Papadopoulos et al., 2013). In addition, adults and young adults with blindness have a more internal LoC than those with low vision (Papadopoulos, 2014; Papadopoulos et al., 2013).

The findings of this study also suggest that individuals with visual impairments who frequently move independently are most likely to have to high self-esteem and a more internal LoC. Previous studies have also shown that people with visual impairments who move independently, that is, without the support of a sighted guide, have a more internal LoC (Papadopoulos, 2014; Papadopoulos et al., 2013, 2014) as compared to individuals who move with the assistance of a sighted guide, and individuals who move ways (both independently and with the assistance of a sighted guide). Also, individuals with visual impairments who move independently have higher self-esteem (Augestad, 2017; Papadopoulos et al., 2014; Tuttle, 1984). It is possible that when they move independently, they feel in control of their daily lives, which increases their self-confidence (Papadopoulos et al., 2014).

The results of this study highlight the importance of providing support to individuals with visual impairments in the post-COVID-19 period. While all individuals with visual impairments have been negatively affected by the pandemic, specific groups with lower self-esteem and a more internal LoC, such as females, individuals with low vision, unemployed individuals, those with a lower educational level, older adults, individuals with acquired visual impairments, and those who do not move independently, may benefit the most from such support. This support can take various forms, such as informal support from social networks, such as family and friends, and formal support from professionals involved in the education and rehabilitation of individuals with visual impairments, such as teachers, psychologists, and rehabilitation specialists.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Konstantinos Papadopoulos

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