# Self-efficacy and quality of life mediate self-reported mental health outcomes in visual snow syndrome

## TL;DR

People with visual snow syndrome have lower self-efficacy and quality of life, which may explain their higher risk of depression and suicidal thoughts.

## Contribution

This study identifies self-efficacy and quality of life as serial mediators linking visual snow syndrome to mental health outcomes.

## Key findings

- VSS patients had significantly lower self-efficacy and quality of life compared to healthy controls.
- Self-efficacy and quality of life sequentially mediate the relationship between VSS and depression or suicidal ideation.
- Lower self-efficacy and quality of life may serve as modifiable targets for early intervention in VSS.

## Abstract

Visual snow syndrome (VSS) is a chronic neurological disorder associated with impaired mental health. While self-efficacy and quality of life (QOL) are known to influence mental health outcomes (depression and suicidal ideation) in clinical populations, their roles in VSS remain unexplored. This study aimed to examine the associations among VSS, self-efficacy, QOL, mental health outcomes and the potential serial mediation roles of self-efficacy and QOL. A cross-sectional study compared 64 VSS patients and 67 healthy controls matched with age, sex and education level. Participants completed validated questionnaires assessing self-efficacy (GSES), QOL (WHOQOL-BREF), depression (CES-D), and suicidal ideation (BSSI, first five items). Analyses included group comparisons, correlation analyses to examine variable relationships, multimodel linear regression and serial mediation modeling to test the hypothesized sequential pathway from VSS through self-efficacy and quality of life to mental health outcomes. Compared with controls, VSS patients demonstrated significantly lower self-efficacy (VSS: 23.6 ± 6.2; Controls: 30.6 ± 6.0; p < 0.001) and QOL (VSS: 62.5 ± 9.5; Controls: 73.6 ± 8.8; p < 0.001), alongside elevated depression (median [IQR]: VSS: 28 [21,34]; Controls: 11 [7, 15]; p < 0.001) and suicidal ideation (VSS: 6 [5, 7]; Controls: 5 [5,6]; p < 0.01). Serial mediation analysis revealed that the effects of VSS on depression and suicidal ideation were mediated through self-efficacy and QOL sequentially. The total indirect effect for depression was 7.73 (95% CI [5.64–9.85]), with QOL accounting for 49.09% of the total effect. For suicidal ideation, the total indirect effect was 0.80 (95% CI [0.39–1.22]). Lower self-efficacy and QOL appear to serially mediate the associations between VSS and mental health impairments. These preliminary, cross-sectional findings indicate that 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. Clinicians should prioritize routine assessments of these factors to guide early intervention strategies, although longitudinal studies are needed to confirm these causal pathways.