Diabetic Retinopathy Patients More Likely to Experience Depression, Anxiety

Daniel Olson, MD

Results of a new analysis suggest patients with a diagnosis of diabetic retinopathy had greater odds of being diagnosed with 2 common mental health conditions than the general population.

Published on ARVOLearn due to the cancellation of the 2020 Association for Research in Vision and Ophthalmology (ARVO) annual meeting, the 95,000-person analysis suggests patients with diabetic retinopathy had greater odds of having a diagnosis of depression and anxiety than their counterparts without the ophthalmic disorder.

“This study illustrates patients with diabetic retinopathy of all stages have an increased risk of psychiatric comorbidities, which correlates to patients progression of retinopathy to a point,” said study investigator Daniel Olson, MD, of the University of North Carolina (UNC), during his presentation on ARVOLearn. “These findings support the importance of interdisciplinary coordination in patient care as ophthalmologists and primary care providers work to manage diabetes, diabetic retinopathy, and mental illness comorbidities in our patients.”

In an effort to evaluate whether patients with diabetic retinopathy had greater odds of concurrent diagnoses of anxiety or depression—and how disease severity might impact this relationship—Olson and a team of colleagues designed the current study using data from the Carolina Data Warehouse. From the database, which is a central data repository containing clinical, research, and administrative data sourced from the UNC Health Care System, investigators identified a cohort of 95,575 patients 18 years of age and older with data related to eye exams for inclusion in their study.

All subjects included were evaluated for a multiple comorbidities such as diabetic retinopathy, anxiety, depression, and diabetes, between July 2008-July 2017 through use of ICD-9 and ICD-10 codes. The primary goal of the analysis was to calculate odds ratios for subjects with anxiety and/or depression while adjusting for age of subjects. Investigators pointed out a subanalysis was performed to compare prevalence rates in those with diabetic retinopathy with and without cystoid macular edema.

In regard to the study cohort, 23.5% were diagnosed with diabetes mellitus, 18.8% with anxiety, 21.0% with depression, and 4.5% with diabetic retinopathy—of those with diabetic retinopathy, 30.9% had diabetic macular edema. Overall, 21.5% of patients with diabetic retinopathy also had a diagnosis of anxiety compared to 18.7% without diabetic retinopathy. When examining prevalence of depression, 33.0% of patients with diabetic retinopathy also had a diagnosis of depression compared to 20.4% of patients without diabetic retinopathy.

Investigators’ analyses indicated varying odds ratios (OR) for both anxiety and depression when stratifying based on severity of disease. Investigators were able to calculate ORs for anxiety and mild nonproliferative diabetic retinopathy (NPDR) (OR 1.381; 95% CI, 1.171-1.628; P <.001), moderate NPDR (OR 0.898; CI, 0.664-1.215; P <.001), severe NPDR (OR 1.399; CI, 0.860, 2.273; P <.001), and proliferative diabetic retinopathy (OR 0.956; CI, 0.830-1.101; P <.001).

For depression, investigators were able to calculate ORs for depression and mild NPDR (OR 1.840; 95% CI, 1.585-2.136; P <.001), moderate NPDR (OR 1.452; CI 1.128-1.870; P <.001), severe NPDR (OR 1.984; CI 1.281-3.074; P <.001), and PDR (OR 1.410; CI 1.249-1.591; P <.001).

This study, “Association Between Anxiety, Depression, and Severity of Diabetic Retinopathy,” was published on ARVOLearn.