Lower self-efficacy and quality of life appear to serially mediate the associations between visual snow syndrome and mental health impairments, suggesting they may serve as modifiable intervention targets for depression and suicidal ideation in VSS.
Key Findings
Results
VSS patients demonstrated significantly lower self-efficacy compared to healthy controls.
VSS patients scored 23.6 ± 6.2 on the General Self-Efficacy Scale (GSES) versus 30.6 ± 6.0 for controls (p < 0.001).
Cross-sectional study compared 64 VSS patients and 67 healthy controls matched for age, sex, and education level.
Self-efficacy was assessed using the validated GSES questionnaire.
Results
VSS patients demonstrated significantly lower quality of life compared to healthy controls.
VSS patients scored 62.5 ± 9.5 on the WHOQOL-BREF versus 73.6 ± 8.8 for controls (p < 0.001).
QOL was assessed using the validated WHOQOL-BREF questionnaire.
The difference represents a clinically meaningful reduction in perceived quality of life among VSS patients.
Results
VSS patients had significantly elevated depression scores compared to healthy controls.
Median depression score (CES-D) was 28 [IQR: 21, 34] for VSS patients versus 11 [IQR: 7, 15] for controls (p < 0.001).
Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D).
The VSS group's median score of 28 substantially exceeds commonly used clinical thresholds for significant depressive symptoms.
Results
VSS patients had significantly elevated suicidal ideation compared to healthy controls.
Median suicidal ideation score (BSSI, first five items) was 6 [IQR: 5, 7] for VSS patients versus 5 [IQR: 5, 6] for controls (p < 0.01).
Suicidal ideation was assessed using the first five items of the Beck Scale for Suicidal Ideation (BSSI).
Results
The effect of VSS on depression was serially mediated through self-efficacy and quality of life sequentially.
The total indirect effect for depression was 7.73 (95% CI [5.64–9.85]).
QOL accounted for 49.09% of the total effect on depression.
Serial mediation modeling tested the hypothesized sequential pathway from VSS through self-efficacy and then QOL to mental health outcomes.
Analyses included multimodel linear regression and serial mediation modeling.
Results
The effect of VSS on suicidal ideation was serially mediated through self-efficacy and quality of life sequentially.
The total indirect effect for suicidal ideation was 0.80 (95% CI [0.39–1.22]).
The confidence interval excludes zero, indicating a statistically significant mediation pathway.
Both self-efficacy and QOL functioned as sequential mediators in the pathway from VSS to suicidal ideation.
Conclusions
Self-efficacy and QOL are identified as potentially modifiable intervention targets for mental health impairments in VSS.
The authors note these are 'preliminary, cross-sectional findings' and that 'longitudinal studies are needed to confirm these causal pathways.'
Clinicians are advised to 'prioritize routine assessments of these factors to guide early intervention strategies.'
Self-efficacy and QOL 'may serve as modifiable intervention targets that mediate or moderate the risk of depression and suicidal ideation in individuals with VSS.'
Huang Q, Yu X, Gao H, Lin X, Wang J, Su P, et al.. (2026). Self-efficacy and quality of life mediate self-reported mental health outcomes in visual snow syndrome.. Scientific reports. https://doi.org/10.1038/s41598-026-36347-y