Patients with diabetic retinopathy more likely to have depression
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Researchers from the University of North Carolina, Chapel Hill, found that patients with any type of diabetic retinopathy were more likely than the general population to have depression, with a higher incidence seen in men and in younger patients.
Daniel Olson, MD, an ophthalmology resident, reported during the virtual Association for Research in Vision and Ophthalmology meeting that he and his colleagues collected data from the University of North Carolina health care system on patients older than 18 years who had eye exams between July 2008 and July 2017 with diagnosis codes indicating diabetic retinopathy, anxiety and depression.
Of the 95,575 participants, 57.1% were women, 23.5% were diagnosed with diabetes, 18.8% had anxiety, 21% had depression and 4.5% had diabetic retinopathy.
The researchers also identified which patients had different stages of nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
“As we calculated the rate of anxiety and depression in the subjects with diabetic retinopathy, we found that they were higher, 21.5% and 33%, respectively,” Olson said. “We also calculated the prevalence of anxiety and depression in our study population excluding subjects with diabetic retinopathy and found these rates to be similar to the general population, 18.7% and 20.4%, respectively.
“The rate of depression in subjects with diabetic retinopathy was significantly higher statistically compared to those without diabetic retinopathy,” he continued. “There was no such relationship with anxiety.”
Olson said that he and his colleagues also found that participants with NPDR had increased odds of having comorbid depression; however, the odds of having concurrent depression dropped in the PDR group.
One possible reason, he said, could be when patients are diagnosed and told that they could lose vision and may need lasers and injections, it may lead to depression, but when they finally reach the PDR stage they have accepted their situation or decide the treatments are not as bad as they expected.
Or it could mean that these patients are not following up with a primary care physician and getting that diagnosis of depression, Olson added.
He said the finding that younger participants were more likely to have comorbid anxiety was consistent with rates in the general population. However, the finding that men had higher odds of having both comorbid anxiety and depression conflicts with what is typically found in population studies.
“One reason for this may be that men are more visual creatures, and the prospect of losing sight weighs more heavily on them, though this is only a hypothesis,” Olson said.
He concluded: “These findings support the importance of interdisciplinary coordination in patient care as [eye care providers] and primary care physicians work to manage diabetes, diabetic retinopathy and mental illness comorbidities in our patients.”
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Olson D, et al. Association between anxiety, depression and severity of diabetic retinopathy. Presented at: Association for Research in Vision and Ophthalmology meeting; May 6, 2020 (virtual meeting).
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