Depression More Likely Among Patients With Diabetic Retinopathy

Yang (Alice) Zhang, MD, CM

Patients with any level of diabetic retinopathy are more likely to have depression, according to new research presented at the American Society of Retina Specialists (ASRS 2020) Virtual Sessions.

Yang (Alice) Zhang, MD, CM, and colleagues investigated the association between diabetic retinopathy, anxiety, and depression. The team found that while patients with all levels of the disease were more likely to have depression, the association was not universally present for anxiety.

The investigators included adults at least 18 years old with a documented ophthalmology clinic visit between July 2008 and July 2018. Patients were identified as having diabetic retinopathy, anxiety, and/or depression using ICD-9 and ICD-10 codes. Diagnosis data were obtained from the Carolina Data Warehouse for Health using the i2b2 interface.

The team used multiple logistic regression models to estimate odds ratios and 95% confidence intervals while adjusting for age and gender. A subset analysis was performed based on age and gender.

Overall, 95,575 patients were included in the analysis, a majority of which were female (57.1%). Of those in the study, 23.5% had diabetes mellitus, 18.8% had anxiety, and 21% had depression. Among the 4.5% with diabetic retinopathy, 30.9% had diabetic macular edema, 20.5% had anxiety, and 31.1% had depression.

Zhang and the investigators calculated odds ratios (ORs) for those with anxiety and varying degrees of diabetic retinopathy. For mild non-proliferative diabetic retinopathy, the OR was 1.381 (CI, 1.71-1.628; P <.001). The OR for moderate non-proliferative diabetic retinopathy was .898 (95% CI, .664-1.215; P <.001), while the OR for severe non-proliferative diabetic retinopathy was 1.399 (95% CI, .86-2.273; P <.001). The OR for proliferative diabetic retinopathy was .956 (95% CI, .83-1.101; P <.001).

The team also calculated the ORs for patients with depression. The OR for mild non-proliferative diabetic retinopathy was 1.84 (95% CI, 1.585-2.136), while it was 1.452 for moderate (95% CI, 1.128-1.87; P <.001). For severe non-proliferative diabetic retinopathy, the OR was 1.984 (95% CI, 1.281-3.074; P <.001). Among patients with depression, the OR for proliferative diabetic retinopathy was 1.41 (95% Ci, 1.249-1.591; P <.001).

Patients had an increased risk of having comorbid depression or a combination of anxiety and depression with the worsening severity of their non-proliferative diabetic retinopathy. Those with proliferative diabetic retinopathy also had an increased risk of having concurrent depression or a combination of anxiety and depression, though the chance was not as large as it was for the non-proliferative diabetic retinopathy group.

Younger patients between 18-64 years old had greater odds of comorbid depression or anxiety and depression than those at least 65 years old. Men and women both had higher risks of having comorbid anxiety, depression, or both compared to those without diabetic retinopathy.

The team noted there was not statistically significant increased odds ratios with comorbid anxiety alone.

“These findings support the importance of interdisciplinary coordination in patient care as ophthalmologists and primary care providers work to manage diabetes, diabetic retinopathy, and mental illness comorbidities in our patients,” Zhang and the team concluded.

The study, “Association Between Anxiety, Depression, and Severity of Diabetic Retinopathy,” was presented at ASRS 2020.