Vision Impairment Associated with Greater Depression, Anxiety in Children

New findings from a recent systematic review suggest vision impairment is associated with greater symptoms of depression and anxiety among children.

Meanwhile, study investigators observed a significant improvement of depression and anxiety symptoms following strabismus surgery among children.

“This review also underscored the importance and potential impact of early detection and treatment of strabismus in children and provides evidence in favor of insurance coverage for timely strabismus surgery to help improve children's overall health and, in turn, decrease costs for future mental health disorders,” wrote study author Nathan Congdon, PhD, MD, School of Medicine, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen’s University.

Despite the prevalence of ocular morbidity, depression, and anxiety being lower among children compared to adults, the total burden may be higher for children if the disorders are not identified and treated. Previous systematic reviews reported the overall association between vision impairment and mental health was inconsistent among children, while the effect of strabismus on children has additionally not been studied extensively.

The current systematic review analyzed published literature to determine if vision impairment, ocular morbidity, and their treatment are associated with depression and anxiety in children. Investigators searched a total of nine electronic databases from inception to February 2021. The criteria included ophthalmic observational and interventional studies assessing whether vision impairment and/or ocular morbidity and their treatment are associated with depression and/or anxiety in children and young adults (<18 years).

Investigators used narrative synthesis and meta-analysis with the residual maximum likelihood method. They identified a total of 28,988 articles during initial database searches, of which 28,956 (99.9%) were excluded as duplicates or unrelated content.

From the 36 included studies, investigators identified 21 (58.3%) as observational studies concerning vision impairment, 8 (22.2%) as observational studies concerning strabismus, and 7 (19.4%) as interventional studies.

A total of 11 studies (n = 3,926; 54.3 vision-impaired) that reported scores for depression were included in a meta-analysis. Data show children with vision impairment had higher depression scores (pooled standardized mean difference [SMD]: 0.57; 95% confidence interval [CI], 0.26 - 0.89) compared to the control group.

Moreover, a total of 14 studies (n = 5245, 60.1% vision-impaired) reporting anxiety scores were included in a meta-analysis. Children with visual impairment had higher anxiety scores (pooled SMD: 0.61, 95% CI, 0.40 - 0.82) compared to normally-sighted children.

When myopia was the cause of vision impairment, children experienced higher scores of depression (SMD, 0.59; 95% CI, 0.36 - 0.81; 6 studies) than normally-sighted children.

Further, investigators observed strabismus surgery significantly improved symptoms of depression (SMD, 0.59; 95% CI, 0.12 - 1.06; 3 studies) and anxiety (SMD, 0.69; 95% CI, 0.24 - 1.14; 4 studies) in children.

“We suggest that further RCTs on myopia correction and its impact on mental health are needed to identify strategies to improve myopic children’s mental health,” Congdon concluded.

The study, “Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: A systematic review,” was published in Ophthalmology.