Vision Impairment Associated with Developing Mental Health Conditions

Credit: LinkedIn

The prevalence of mental health conditions was highest among patients with retinal vein occlusion and age-related macular degeneration (AMD) compared to other ocular conditions.¹

The study, led by Neha Sharma, BA, MPH, from Case Western Reserve University School of Medicine in Cleveland, sought to identify the prevalence of mental health conditions in patients with uveitis, glaucoma, retinal vein occlusion, AMD, and diabetic retinopathy with or without vision impairment. Findings were presented at the 127th Annual American Academy of Ophthalmology (AAO) conference in San Francisco.

About 2.2 billion people have vision impairment—and that number is projected to grow. Vision loss progresses with age, and with increases in the average lifespan, there will be a greater number of people in the population experiencing vision impairment. Because the relationship between visual impairment and developing mental conditions like anxiety or depression is not well-studied, the investigators wanted to explore this topic. Though, a Centers for Disease Prevention and Control (CDC) study found 1 in 4 adults with vision loss reported anxiety or depression.² Also, younger adults with vision loss had nearly 5 times more of a risk of developing anxiety or depression than adults > 65 years old.

Sharma and colleagues conducted a cross-sectional study using the TriNetX Analytics Network, a US database with over 87 million patients.¹ The team used ICD-10 codes to identify patients with ocular conditions, visual impairment (either low vision or blindness), and mental health conditions including depression, anxiety, and suicide attempt or ideation. The control group was patients aged > 50 years old.

The investigators arranged prevalence odds by sex and racial demographics. Patients with diabetic retinopathy patients increased the odds of depression and suicide compared to the control group. The odds of developing depression in 1 year was 1.27 (95% CI, 1.23 – 1.31),

in 3 years 1.29 (95% CI, 1.26 – 1.33), and in 5 years 1.30 (95% CI, 1.27 – 1.34). The odds for anxiety were low. In the first year the odds were 0.91 (95% CI, 0.88 – 0.950), and the odds for anxiety in 3 and 5 years had also been similar with odds of 0.95 and 0.97 respectively.

Though, suicide had increased odds. In 1 year, the odds were 1.40 (95% CI, 1.30 – 1.50), in 3 years but dropped for 3 years (95% CI, 1.27 – 1.44) and in 5 years (95% CI, 1.27 – 1.43) (odds both 1.35).

Meanwhile, patients with glaucoma had increased odds for all mental health conditions but higher odds for suicide or suicide ideation. For year 1, suicide odds were 1.96 (95% CI, 1.86 – 2.06), There was a drop in suicide odds by 3 years (1.69; 95% CI, 1.62 – 1.77) and 5 years (1.62; 95% CI, 1.55 – 1.69).

Then, for patients with AMD, there was increased odds for depression, but not for anxiety or suicide. By 1 year, depression odds were 1.03 (95% CI, 1.00 – 1.06), by 3 years odds were 1.05 (95% CI, 1.03 – 1.08), and by 5 years the odds were 1.07 (95% CI, 1.06 – 1.10).

The team did not share the odds and confidence interval for retinal vein occlusion, but they did state the prevalence of depression and anxiety was the highest for this disease compared to other ocular conditions. The prevalence of depression was 16.50% and for anxiety it was 12.53%. Also, after looking at race and ethnicities, the investigators found female Hispanic patients with retinal vein occlusion had the highest prevalence of anxiety odds.

Moreover, Black and Hispanic/Latino females have increased odds of developing depression for several ocular conditions—especially compared to White males. White females had increased odds of depression for all the ocular conditions.

“Certain patient populations are disproportionately affected by these mental health conditions, which showcases an increased need to screen minority patients who have higher odds of depression and anxiety,” investigators wrote.

References

1. ^{Sharma, N, Chu, J, Shaia, J, et al. Characterizing the Prevalence of Visual Impairment, Ocular Comorbidities and Mental Health Conditions in the United States. American Academy of Ophthalmology. November 3, 2023.}
2. ^{Vision Loss and Mental Health. Centers for Disease Control and Prevention. https://www.cdc.gov/visionhealth/resources/features/vision-loss-mental-health.html#:~:text=Loss%20of%20vision%20has%20been,loss%20reported%20anxiety%20or%20depression. Accessed November 17, 2023.}