Influence of visual acuity on anxiety, panic and depression disorders among young and middle age adults in the United States

Vision Impairment and Psychosocial Function in US Adults

Importance

Vision impairment and psychosocial function, including symptoms of depression and anxiety and social isolation, are a major cause of morbidity in the US. However, there is a lack of nationally representative studies assessing associations between both objective and subjective vision impairment with psychosocial function following the COVID-19 pandemic.

Objective

To provide updated national estimates on the associations of vision impairment with depressive and anxiety symptoms and social isolation in US adults 65 years and older.

Design, Setting, and Participants

This was a cross-sectional analysis of the National Health and Aging Trends Study round 9 (2019) and 11 (2021), a nationally representative sample of Medicare beneficiaries aged 65 years and older. Binocular distance visual acuity, near visual acuity, and contrast sensitivity were tested. Objectively measured vision impairment was defined as having vision impairment in either distance visual acuity (worse than 20/40), near visual acuity (worse than 20/40), or contrast sensitivity (worse than 1.55 logCS). Self-reported vision impairment was defined based on participants' report on their vision status. Data were analyzed in May 2023.

Main Outcomes and Measures

Depressive and anxiety symptoms assessed via the Patient Health Questionnaire. Social isolation was defined based on living arrangement, communication frequency, and activity participation responses.

Results

Among 2822 community-dwelling adults sampled from a population of 26 182 090, the mean (SD) age was 78.5 (5.6) years; 1605 individuals (54.7%) were female; 1077 (32.3%) had objectively measured vision impairment, and 203 (6.4%) had self-reported vision impairment. In adjusted models, all outcomes were significantly associated with objectively measured vision impairment, including depressive symptoms (odds ratio [OR], 1.81; 95% CI, 1.26-2.58), anxiety symptoms (OR, 1.74; 95% CI, 1.13-2.67), and severe social isolation (OR, 2.01; 95% CI, 1.05-3.87). Similarly, depressive symptoms (OR, 2.37; 95% CI, 1.44-3.88) and anxiety symptoms (OR, 2.10; 95% CI, 1.09-4.05) but not severe social isolation symptoms (OR, 2.07; 95% CI, 0.78-5.49) were significantly associated with self-reported vision impairment.

Conclusions and Relevance

In this study, vision impairment was associated with several psychosocial outcomes, including symptoms of depression and anxiety and social isolation. These findings provide evidence to support prioritizing research aimed at enhancing the health and inclusion of people with vision impairment.

Association between vision impairment and depression: a 9-year, longitudinal, nationwide, population-based cohort study in South Korea

BACKGROUND/AIMS

Vision impairment (VI) increases the risk of various comorbidities, including depression. However, the relationship between depression and VI is unclear, and existing findings are inconsistent. We therefore investigated the risk of depression in adults before and after their registration as visually impaired.

METHODS

In this longitudinal, nationwide, retrospective cohort study, 131 434 patients (aged ≥18 years) with newly registered VI during 2005-2013 were evaluated using the Korean National Health Insurance Service database. Using 1:1 propensity score matching, randomly selected patients (control group) were compared with patients with VI (patient group) according to age, sex, residential area and household income. Each patient was tracked from 3 years before and 5 years after registration. The risk of depression before and after VI registration was evaluated using a conditional logistic regression model.

RESULTS

The risk of depression gradually increased from 3 years before registration (OR, 1.186; 95% CI 1.089 to 1.290), then peaked at the time of registration (OR, 1.925; 95% CI 1.788 to 2.073), and then gradually decreased until 5 years after registration (OR, 1.128; 95% CI 1.046 to 1.216). Male patients, those with severe VI and those aged 18-29 years had a higher risk of depression.

CONCLUSIONS

Patients with VI had an increased risk of depression from 3 years before to 5 years after registration. Significant risk factors included severity, male sex and younger age. Thus, public mental health services are necessary to provide appropriate support and interventions to people before and after registration as visually impaired.

Self-Reported Vision Impairment and Psychological Distress in U.S. Adults

PURPOSE

Examine the relationship between vision impairment and psychological distress in adults ≥18 years.

METHODS

Using the 2016-2017 cross-sectional, U.S. National Health Interview Survey, we analyzed self-reported data (n = 57,644) on: Kessler psychological distress scores; general vision impairment (GVI), defined as difficulty seeing even when wearing glasses or contacts; and visual function impairment (VFI), measured using six visual function questions. Multinomial logistic regression was used to estimate adjusted odds ratios (aOR) for mild/moderate and serious psychological distress, by GVI and VFI status, and identify predictors of psychological distress among those with GVI or VFI.

RESULTS

Among adults, 10.6% (95% CI: 10.2, 11.0) had GVI; 11.6% (CI: 11.1, 12.0) had VFI. One in four adults with GVI had psychological distress (14.9% [CI: 13.8, 16.0] reported mild/moderate and 11.2% [CI: 10.2, 12.3] reported serious). Individuals with GVI, versus those without, had higher odds of mild/moderate (aOR = 2.24; CI: 2.00, 2.52) and serious (aOR = 3.41; CI: 2.96, 3.93) psychological distress; VFI had similar findings. Among adults with GVI, odds of serious psychological distress were higher for those aged 18-39 (aOR = 4.46; CI: 2.89, 6.90) or 40-64 (aOR = 6.09; CI: 4.33, 8.57) versus ≥65 years; smokers (aOR = 2.45; CI: 1.88, 3.18) versus non-smokers; physically inactive (aOR = 1.61; CI: 1.22, 2.11) versus active; and with arthritis (aOR = 2.18; CI: 1.66, 2.87) or chronic obstructive pulmonary disease (aOR = 1.65; CI: 1.15, 2.37) versus without.

CONCLUSION

Adults with self-reported vision impairment had higher odds of psychological distress. These findings may inform screening interventions to address psychological distress, particularly among younger working-age adults vision impairment.

[Validation study on self-reported visual impairment among undergraduate students at the Federal University of Pelotas]

The objectives of the study were to assess the prevalence of self-reported visual impairment among undergraduate students between 18 and 39 years of age at the Federal University of Pelotas, and to validate a question about visual impairment in a subsample of the participants. A cross-sectional study was conducted by asking the question "Do you have any difficulty seeing up close and/or in the distance?" As the gold standard for the validation study, visual acuity (VA) was measured using the Snellen chart. Patients with VA less than 20/40 in either eye were considered to have reduced VA. The prevalence of self-reported visual impairment was 37.3% (95% CI: 35.1-39.6) and VA less than 20/40 in either eye was 6.9% (95% CI: 5.3-8.9). The question revealed sensitivity of 71.4% (95 CI: 57.8-82.7), specificity of 66.9% (95% CI: 63.4-70.2), positive predictive value of 13.8% (95% CI: 10.0-18.3), and negative predictive value of 96.9% (95% CI: 95,1-98.2). The results indicated a high prevalence of self-reported visual impairment among university students. The question showed reasonable sensitivity and specificity and high negative predictive value and may be used for screening for ophthalmological evaluation among young adult university students.

Knowledge of patient emotional health status: impact on clinical care in glaucoma and retinal services

Objective

Knowledge of a patient’s emotional health status and using patient-centred communication may be key to providing early intervention and referral to appropriate treatment/support services for ophthalmology patients. This study aims to determine if and how ophthalmologists use anxiety and depression scores to determine clinical care of patients with chronic eye disease.

Methods and analysis

This cross-sectional study included 10 ophthalmologists and a convenience sample of 100 of their patients (>18 years). The Patient Health Questionnaire (PHQ-9) for depression and the Generalised Anxiety Disorder (GAD-7) tool were administered to patients. Scores from these instruments were provided to ophthalmologists just prior to the clinic visit. After the visit, ophthalmologists were given a questionnaire to assess self-reported change in clinical practice and whether knowledge of scores impacted their communication style, treatment plan and follow-up protocol.

Results

Of these patients (mean age=63), 27% reported mild-moderate anxiety or depression as their worst score, while 2% reported suicidal thoughts; 20% reported neither anxiety nor depression. Ophthalmologists’ response to patients with mild or worse anxiety or depression was to change clinical approach (28%) and communication style (31%), both metrics increasing with severity of symptoms (Fisher’s exact p<0.05). None reported changing their choice of treatment or modifying follow-up protocols; referral to social work/psychiatry services was 60%, 3.7% and 0% for patients with moderately severe or worse, mild-to-moderate, or minimal scores, respectively.

Conclusion

Providing ophthalmologists with knowledge of the emotional health of their patients may change the clinical approach and referral pattern.

Blindness and Visual Impairment in the Medicare Population: Disparities and Association with Hip Fracture and Neuropsychiatric Outcomes

Purpose: Vision loss has been associated with negative health outcomes, but population-level data on vision loss are lacking, and there are limited data on low vision-associated outcomes among women, minorities, and older age groups. The objective of this study was to determine the prevalence of vision loss in a nationally representative sample of older US adults and examine its association with hip fracture, depression, anxiety, and dementia. Methods: Cross-sectional analysis of Medicare claims data from 2014. Blindness and low vision, hip fracture, depression, anxiety, and dementia were identified using Chronic Condition Warehouse indicator variables based on ICD-9 and CPT codes. Multivariable logistic regression models were built to examine whether sociodemographic factors were associated with vision loss and to determine the relationships between vision loss and hip fracture and neuropsychiatric outcomes. Results: The prevalence of low vision in the Medicare population was 994/100,000 and increased significantly with age, Black (1,854/100,000) or Hispanic (2,862/100,000) race/ethnicity, female gender (1,181/100,000), and Medicaid eligibility (2,975/100,000). After adjusting for relevant comorbidities, low vision was significantly associated with hip fracture (adjusted odds ratio [AOR] 2.54, 95% CI: 2.52-2.57), depression (AOR 3.99, 95% CI: 3.97-4.01), anxiety (AOR 2.93, 95% CI: 2.91-2.95), and dementia (AOR 3.91, 95% CI: 3.88-3.93). Conclusion: Blindness and low vision are common in older Americans, especially among racial and ethnic minorities and lower income individuals, and associated with hip fracture, depression, anxiety, and dementia. The prevention and treatment of vision loss may reduce health disparities and negative health outcomes in the aging population.

Effects of self-reported hearing or vision impairment on depressive symptoms: a population-based longitudinal study

AIMS

The aims of this study were to investigate the effects of either hearing, vision or dual sensory impairment on depressive symptoms and to identify subgroups that are vulnerable and significantly affected.

METHODS

Data from the 2006-2014 Korean Longitudinal Study of Aging (KLoSA) were used and a total of 5832 individuals were included in this study. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D10) scale. Sensory impairment was assessed according to the levels of self-reported hearing or vision, which were categorised as either good (excellent, very good or good) or poor (fair or poor). The changes in hearing or vision from records of previous survey were investigated. Changes from good to poor, which indicates new onset, were defined as hearing impairment or vision impairment. Interactions of changes in hearing and vision were considered in the analysis. Dual sensory impairment was indicated when hearing impairment and vision impairment both developed at the same time. Demographic, socioeconomic and health-related factors were considered as potential confounders and were adjusted for in the generalised estimating equation model.

RESULTS

Individuals with hearing impairment demonstrated significantly more severe depressive symptoms [β = 0.434, standard errors (s.e.) = 0.097, p &lt; 0.001] than those who had good hearing. Those with vision impairment also showed significantly elevated depressive symptoms (β = 0.253, s.e. = 0.058, p &lt; 0.001) than those with good vision. When the interactions between hearing and vision were considered, participants with dual sensory impairment showed significantly more severe depressive symptoms (β = 0.768, s.e. = 0.197, p &lt; 0.001) than those with good hearing and vision. The effect of a single and dual sensory impairment on depressive symptoms was significant in both sexes and across age groups, except for vision impairment in male participants.

CONCLUSIONS

Hearing, vision and dual sensory impairment are significantly associated with depressive symptoms. Our results suggest that treatment or rehabilitation of either hearing or vision impairment would help prevent depression.

Facial Sadness Recognition is Modulated by Estrogen Receptor Gene Polymorphisms in Healthy Females

Polymorphisms of the estrogen receptor ESR1 and ESR2 genes have been linked with cognitive deficits and affective disorders. The effects of these genetic variants on emotional processing in females with low estrogen levels are not well known. The aim was to explore the impact of the ESR1 and ESR2 genes on the responses to the facial emotion recognition task in females. Postmenopausal healthy female volunteers were genotyped for the polymorphisms Xbal and PvuII of ESR1 and the polymorphism rs1256030 of ESR2. The effect of these polymorphisms on the response to the facial emotion recognition of the emotions happiness, sadness, disgust, anger, surprise, and fear was analyzed. Females carrying the P allele of the PvuII polymorphism or the X allele of the Xbal polymorphism of ESR1 easily recognized facial expressions of sadness that were more difficult for the women carrying the p allele or the x allele. They displayed higher accuracy, fast response time, more correct responses, and fewer omissions to complete the task, with a large effect size. Women carrying the ESR2 C allele of ESR2 showed a faster response time for recognizing facial expressions of anger. These findings link ESR1 and ESR2 polymorphisms in facial emotion recognition of negative emotions.

Physical activity, visual impairment, and eye disease

Numerous studies have demonstrated physical activity is a strong factor in overall health and well-being, and a growing body of literature, reviewed herein, suggests that several eye conditions, including glaucoma, age-related macular degeneration, and diabetic retinopathy, are associated with lower activity levels. Likewise, physical activity levels are lower in persons with worse vision. Research in this area has utilized both self-reported physical activity measures as well as objective measures of activity (i.e., accelerometers), each of which have their own strengths and limitations. Putative mechanisms explaining the association of various eye conditions with physical activity are discussed. It is possible that activity restriction occurs as a downstream consequence of eye disease/visual impairment, that activity restriction causes eye disease/visual impairment, or that causality is bidirectional; evidence supporting each of these theories is put forth. An improved understanding of the relationship between physical activity and eye disease will highlight potential secondary health risks resulting from eye disease, and can help determine whether activity might serve as a readily available preventative measure to prevent specific eye conditions.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

OBJECTIVE

Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex.

METHODS

Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3.

RESULTS

MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes.

CONCLUSION

PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.

Myopia and depressive symptoms among older Chinese adults

Purpose

Few population-based data support the hypothesis that refractive errors are associated with depressive symptoms. We aim to assess the impact of myopia on the risk of having depressive symptoms in a community-based cohort of elderly Chinese.

Methods

A community-based cross-sectional study of 4611 Chinese adults aged 60 years or older was conducted. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9) depression scale in 4597 adults. Refraction was determined by auto-refraction followed by subjective refraction. Myopia was defined as spherical equivalent (SE) < -0.50 diopters (D) and high myopia as SE < -6.00 D.

Results

After adjusting for age, gender, education, lifestyle-related exposures, presenting visual acuity and age-related cataract, myopic adults were more likely to have any depressive symptoms compared with non-myopic ones (odds ratio = 1.39; 95% confidence interval 1.04, 1.92). There were no significant differences in the risk of having any depressive symptoms between those with and without high myopia. Myopia or high myopia was not associated with having moderate depressive symptoms. The impact of myopia on depressive symptoms was stronger in adults with no formal education compared with those with formal education.

Conclusions

Myopia was related with the presence of depressive symptoms among older adults.

Experimentally increasing sedentary behavior results in increased anxiety in an active young adult population

INTRODUCTION

Knowledge regarding the effects of sedentary behavior on anxiety has resulted mainly from observational studies. The purpose of this study was to examine the effects of a free-living, sedentary behavior-inducing randomized controlled intervention on anxiety symptoms.

METHODS

Participants confirmed to be active (i.e., acquiring 150min/week of physical activity) via self-report and accelerometry were randomly assigned into a sedentary behavior intervention group (n=26) or a control group (n=13). For one week, the intervention group eliminated exercise and minimized steps to ≤5000 steps/day whereas the control group continued their normal physical activity levels. Both groups completed the Overall Anxiety Severity Impairment Scale (OASIS) pre- and post-intervention, with higher OASIS scores indicating worse overall anxiety. The intervention group resumed normal physical activity levels for one week post-intervention and then completed the survey once more.

RESULTS

A significant group x time interaction effect was observed (F(1,37)=11.13; P=.002), with post-hoc contrast tests indicating increased OASIS scores in the intervention group in Visit 2 compared with Visit 1. That is, we observed an increase in anxiety levels when participants increased their sedentary behavior. OASIS scores significantly decreased from Visit 2 to Visit 3 (P=.001) in the intervention group.

CONCLUSION

A one-week sedentary behavior-inducing intervention has deleterious effects on anxiety in an active, young adult population. To prevent elevated anxiety levels among active individuals, consistent regular physical activity may be necessary. Clinicians treating inactive patients who have anxiety may recommend a physical activity program in addition to any other prescribed treatment.