Retinitis Pigmentosa Diagnosis Intensifies Risk of Depressive Disorder

Yong Joon Kim, MD, PhD

Credit: The American Society of Retina Specialists

A new analysis of a nationwide population-based cohort in Korea revealed an elevated incidence of newly diagnosed depressive disorder in registered patients with retinitis pigmentosa compared with the general population.¹

According to these estimates, the 10-year cumulative incidence of depressive disorder reached approximately 18% in patients with retinitis pigmentosa without prior diagnosis of depressive disorder, with a higher incidence in female patients and individuals aged ≥40 years.

“Considering the increasing emphasis on the management of depressive disorders, these findings suggest that providing emotional support or social assistance to patients with retinitis pigmentosa should be considered,” wrote the investigative team, led by Yong Joon Kim, MD, PhD, department of ophthalmology, institute of vision research, Yonsei University College of Medicine.

Vision impairment and mental disorders are both significant causes of social and psychological disability, warranting an investigation into the connection between mental illness in ocular disease and emotional adjustment in relevant individuals.²

Retinitis pigmentosa, affecting 1 to 3000–7000 individuals, is a heterogeneous group of inherited retinal dystrophies, with symptoms typically rising in the early teenage years, leading to tunnel vision and blindness by age 40–50.³ Given the burden of disease progression, leading to blindness, retinitis pigmentosa is linked to a high risk of mental health conditions.

However, few large-scale clinical trials are exploring this link, with a lack of data on the association between visual impairment and mental health in young patients.¹ This cohort study collected data from the Korean Health Insurance Review and Assessment service between 2008 and 2022, identifying 10,879 individuals with newly diagnosed retinitis pigmentosa between January 2011 and December 2021.

The study population was categorized into 3 cohorts based on age at diagnosis: <20 years (n = 638), 20–39 years (n = 2233), and ≥40 years (n = 8008). The nationwide incidence of depressive disorder was calculated after excluding those diagnosed with depressive disorder before retinitis pigmentosa.

Upon analysis, the incidence of retinitis pigmentosa during the study period was 1.91 (95% CI, 1.88–1.95), 1.82 (95% CI, 1.77–1.87), and 2.01 (95% CI, 1.96–2.06) per 100,000 person-years in the total population. The incidence rate of newly diagnosed depressive disorder after retinitis pigmentosa was 21.52 (95% CI, 20.23–22.87), with an estimated 10-year cumulative incidence of 17.67 (95% CI, 16.57–18.84) in people with retinitis pigmentosa.

Subgroup analysis revealed a higher 10-year cumulative incidence of depressive disorder in female patients (hazard ratio [HR], 1.46; 95% CI, 1.29–1.65; P <.001) and those aged ≥40 years (HR, 1.93; 95% CI, 1.63–2.29; P <.001). Investigators also calculated age- and sex-adjusted standardized incidence ratios (SIRs) using the incidence rate of depressive disorder in the general adult population.

They found the overall SIR of depressive disorder in retinitis pigmentosa was 1.19 (95% CI, 1.12–1.27; P <.001), indicating a depressive disorder risk higher than the general population. Both male and female patients showed incidence incidence of depressive disorder and SIRs of depressive disorder (all P <.001) versus the general population.

Further subgroup analysis by age group revealed that, while the data showed a higher incidence in older groups, the SIR peaked in those aged 20–29 years (SIR, 1.50; 95% CI, 1.17–1.90; P = .006) and those aged ≥60 years (SIR, 1.25; 95% CI, 1.14–1.37; P <.001).

In their summary, Kim and colleagues noted an earlier diagnosis of retinitis pigmentosa points to major visual discomfort requiring an ophthalmic examination. As these individuals are more likely to have an advanced disease stage at the time of diagnosis, they could have experienced severe vision loss during the study period.

“Considering the progressive nature of the disease and that it is not completely curable, even in the early stage of retinitis pigmentosa, younger patients may experience severe anxiety and stress,” they wrote. “These factors could also increase the risk of depressive disorder in patients diagnosed with retinitis pigmentosa in their 20s.”

References

1. _{Kim HR, Lee NK, Suh Y, et al. Incidence and Risk of Depressive Disorder in Patients With Retinitis Pigmentosa. JAMA Ophthalmol. Published online September 19, 2024. doi:10.1001/jamaophthalmol.2024.3641}
2. _{Demmin DL, Silverstein SM. Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clin Ophthalmol. 2020;14:4229-4251. Published 2020 Dec 3. doi:10.2147/OPTH.S258783}
3. _{Ferrari S, Di Iorio E, Barbaro V, Ponzin D, Sorrentino FS, Parmeggiani F. Retinitis pigmentosa: genes and disease mechanisms. Curr Genomics. 2011;12(4):238-249. doi:10.2174/138920211795860107}