Association Between Visual Impairment and Depression in Patients Attending Eye Clinics

Abstract

IMPORTANCE Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients.OBJECTIVE To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services.DATA SOURCES MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched.STUDY SELECTION Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy.DATA EXTRACTION AND SYNTHESIS Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Proportion of depression.RESULTS A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51). CONCLUSIONS AND RELEVANCEThe results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.

Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients

“…A possible explanation for this finding is the fact that our sample size was relatively small to allow us to detect a significant effect for depression. On a larger sample of eye disease patients, we could expect less statistical noise and the effect of depression on patients’ quality of life to be stronger, as suggested by previous studies 4 , 5 , 8 . Another plausible hypothesis to explain these findings is the possible indirect effect of visual acuity on depression.…”

“…Chronic eye diseases, including AMD and DR, are associated with increased risk for mental health problems, particularly depression which is likely to affect 1.59 times more eye disease patients than healthy controls (OR 1.59; 95% CI 1.40–1.81) 4 . Among eye disease patients, depression has an estimated prevalence of 25%, as shown in two meta-analysis 4 , 5 . Anxiety is also highly prevalent in eye disease patients, with a previous systematic review suggesting a prevalence rate ranging from 9.6 to 30% among AMD patients 6 .…”

“…Some factors are, therefore, expected to have a potential moderating effect on the relationship between visual acuity and health-related quality of life in eye disease patients. It is known that mental health problems can be highly comorbid in eye disease patients 4 , 5 , and that they are likely to deteriorate patients’ health-related quality of life, as depression is in itself an important source of disability 33 , 34 . However, it is still not clear whether mental health outcomes such as symptoms of depression and anxiety can moderate the relationship between visual acuity and health-related quality of life in eye disease patients.…”

Vision impairment and self-reported anxiety and depression in older adults in Nigeria: evidence from a cross-sectional survey in Kogi State

“… 6 Two recent meta-analyses of studies of patients receiving eye care services found that the pooled prevalence of depression in patients with vision problems was as high as 25%; the prevalence did not vary by severity of vision impairment but was found in patients visiting both eye clinics and rehabilitation centres. 7 , 8 In China, results from a 16-y longitudinal study also showed unoperated cataract was associated with an increased risk of developing depression over time, and was similar among both males and females, and older and younger patients. 9 However, the relationship between vision impairment and mental health in LMICs, and the effect of gender and age on this relationship, is not well explored.…”

Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability

“…Eye conditions and vision impairments are associated with many negative consequences such as vision loss, psychological distress, impaired everyday functioning, social isolation and loneliness, uncertainty in illness, and deteriorated socioeconomic status; therefore, compared to normally-sighted persons, persons with eye conditions and vision impairments are more likely to develop mental health problems, in particular depression (1,(6)(7)(8)(9)(10). For example, the prevalence rates of depressive symptoms in middle-aged and older adults with glaucoma, patients with cataracts, patients attending eye clinics, patients with chronic thyroid eye disease, patients with legal blindness, attendees at low-vision rehabilitation centers, and patients with dry eye disease are 10.9, 23.9, 25.0, 28.0, 29.0, 43.0, and 61.0%, respectively (11)(12)(13)(14)(15)(16)(17).…”