Depressive symptoms and age-related macular degeneration in older people: the cardiovascular health study

Evaluating the Impact of the Prime Time Sister Circles® Intervention on Reducing Depressive Symptoms Among African American Women with Uncontrolled Hypertension

BACKGROUND

The Prime Time Sister Circles®, a randomized controlled trial (PTSC-RCT), assessed the impact of a community-based peer support program on hypertension management among African American women 40-75 years of age. While the PTSC-RCT was designed to evaluate changes in blood pressure control, subsequent sub-analyses revealed a high proportion of self-reported depressive symptoms in our sample. Accordingly, we conducted an ancillary investigation of the PTSC intervention on depression to ascertain its impact on reduced depressive symptoms in the study population.

METHOD

Depressive symptoms were measured using an adapted version of the Center for Epidemiologic Studies Depression Scale Revised (CES-D-10). We used unadjusted and adjusted fixed effect models. Data for this study came from the PTSC-RCT. We collected data between 2017 and 2018 in Washington, DC. We used a balanced analytical sample of 172 African American, English-speaking women between 40 to 75 years old with uncontrolled hypertension.

INTERVENTION

The intervention group participated in a 2-h, peer-based support group once a week for 13 weeks. A trained PTSC facilitator facilitated sessions with experts who delivered content on various topics, including psychosocial wellness (e.g., stress, depressive symptoms, anxiety management, and self-esteem), physical health (e.g., hypertension, inflammation, and heart disease), physical activity, and healthy nutrition.

RESULTS

Results from the fixed-effects models indicated that participants in the PTSC program exhibited a greater reduction in CES-D-10 score at three months (Coeff: -1.99, 95% CI: -3.49, -0.49) and at 15 months (Coeff: -2.38, 95% CI: -3.94, -0.83), as compared to those in the control group.

CONCLUSIONS

Evidence suggests that the Prime Time Sister Circles® intervention reduced depressive symptoms among African American women with low socioeconomic status and hypertension.

TRIAL REGISTRATION

NCT04371614.

Impact of Age-Related Macular Degeneration and Related Visual Disability on the Risk of Depression: A Nationwide Cohort Study

PURPOSE

To evaluate the prospective association of age-related macular degeneration (AMD) and related visual disability (VD) with the risk of depression.

DESIGN

This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service.

PARTICIPANTS

A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009.

METHODS

Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model.

MAIN OUTCOME MEASURES

Hazard ratios and 95% confidence intervals (CIs) for depression development according to the presence of AMD and VD.

RESULTS

During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13-1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16-1.30).

CONCLUSIONS

Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Association of Mood Disorders, Substance Abuse, and Anxiety Disorders in Children and Teens With Serious Structural Eye Diseases

PURPOSE

We sought to evaluate the association between 5 eye diseases (including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision) and mental illness in a pediatric population.

DESIGN

Cross-sectional study.

METHODS

A de-identified commercial insurance claims database, OptumLabs Data Warehouse, between January 1, 2007, and December 31, 2018, was used. Children and teens less than 19 years of age at the time of eye diagnosis were included. Demographics and mental illness claims were compared, looking at the association of mental illness and eye disease claims.

RESULTS

A total of 11,832,850 children and teens were included in this study with mean age of 8.04 ± 5.94 years at the first claim. Of the patients with at least 1 of the 5 eye diseases (n = 180,297), 30.5% had glaucoma (n = 54,954), 9.5% had cataract (n = 17,214), 21.4% had congenital optic nerve disease (n = 38,555), 26.9% had congenital retinal disease (n = 48,562), and 25.9% had blindness or low vision (n = 46,778). There was a statistically significant association, after adjusting for confounding variables, between at least 1 of the 5 eye diseases and schizophrenia disorder (OR = 1.54, 95% CI = 1.48-1.61, P < .001), anxiety disorder (OR = 1.45, 95% CI = 1.43-1.48, P < .001), depressive disorder (OR = 1.27, 95% CI = 1.25-1.29, P < .001), and bipolar disorder (OR = 1.27, 95% CI = 1.21-1.31, P < .001), but a reversed association with substance use disorder (OR = 0.88, 95% CI = 0.86-0.90, P < .001).

CONCLUSIONS

We found associations between eye disease in children and teens and mental illness. Understanding these relationships may improve mental illness screening and treatment in the pediatric population.

Prevalence and new onset of depression and anxiety among participants with AMD in a European cohort

To investigate the prevalence and new onset of depression and anxiety among subjects with age-related macular degeneration (AMD) and its association with AMD in a large European cohort with relatively good visual acuity. 11,834 participants enrolled in the German population-based Gutenberg Health Study were studied. AMD was diagnosed by grading of fundus photographs. Depression and anxiety were assessed with the Patient Health Questionnaire and the Generalized Anxiety Disorder-2 Scale, respectively. Logistic regression analyses were performed and adjusted for several parameters. 1,089 (9.2%) participants were diagnosed having AMD. Prevalence of depression in AMD and non-AMD participants was 7.2% and 8.0%, respectively and prevalence of anxiety was 4.2% and 7.0%, respectively. New onset of depression and anxiety at 5-year follow-up in AMD subjects was 2.6% and 3.6%, respectively. AMD was not associated with depression (OR 0.93; CI 95% 0.70-1.20; p = 0.62). AMD was associated with less anxiety (OR 0.67; CI 95% 0.47-0.93; p = 0.02). This is the first study analyzing both prevalence and new onset of depression and anxiety in AMD subjects. AMD- and non-AMD participants had a similar prevalence and new onset of depression in our population-based sample. Participants without AMD had a higher prevalence of anxiety. AMD was not associated with depression.

Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study

BACKGROUND

Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD.

DESIGN AND SETTING

Cross-sectional study in a state university.

METHODS

We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D).

RESULTS

The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items).

CONCLUSION

The e-AMD patients had higher depression and anxiety scores and lower QoL scores.

Towards the application of precision medicine in Age-Related Macular Degeneration

The review essentially describes genetic and non-genetic variables contributing to the onset and progression of exudative Age-related Macular Degeneration (AMD) in Italian population. In particular, AMD susceptibility within Italian population is contributed to by genetic variants, accounting for 23% of disease and non-genetic variants, accounting for 10% of AMD. Our data highlighted prominent differences concerning genetic and non-genetic contributors to AMD in our cohort with respect to worldwide populations. Among genetic variables, SNPs of CFH, ARMS2, IL-8, TIMP3, SLC16A8, RAD51B, VEGFA and COL8A1 were significantly associated with the risk of AMD in the Italian cohort. Surprisingly, other susceptibility variants described in European, American and Asiatic populations, did not reach the significance threshold in our cohort. As expected, advanced age, smoking and dietary habits were associated with the disease. In addition, we also describe a number of gene-gene and gene-phenotype interactions. In fact, AMD-associated genes may be involved in the alteration of Bruch's membrane and induction of angiogenesis, contributing to exacerbate the damage caused by aging and environmental factors. Our review provides an overview of genetic and non-genetic factors characterizing AMD susceptibility in Italian population, outlining the differences with respect to the worldwide populations. Altogether, these data reflect historical, geographic, demographic and lifestyle peculiarities of Italian population. The role of epigenetics, pharmacogenetics, comorbities and genetic counseling in the management of AMD patients have been described, in the perspective of the application of a "population-specific precision medicine" approach addressed to prevent AMD onset and improve patients' quality of life.

The Prevalence of Depression and Depressive Symptoms among Eye Disease Patients: A Systematic Review and Meta-analysis

The prevalence of depression among different eye disease patients varies across studies and has not been systematically reviewed. This study is to provide a summary of the prevalence of depression among eye disease patients. PubMed, Medline, Embase and Cochrane Library were searched from January, 1990 to December, 2015 to identify studies with information on the prevalence of depression among ophthalmic patients. A random/fixed-effects meta-analysis was used to estimate the pooled prevalence of depression among eye disease patients. Heterogeneity was assessed with the I² test. 28 studies were selected from 3162 references. The overall pooled prevalence of depression or depressive symptoms with eye disease was 25% (1502/6589 individuals, 95% CI, 0.20–0.30) ranging from 5.4% to 57.0%. Regarding different disease categories, the highest prevalence was revealed for dry eye disease (DED) with 29%, followed by 25% for glaucoma patients, 24% for age-related macular degeneration (AMD) patients, 23% for cataract patients. The increased pooled prevalence of depression was identified in those with eye diseases compared with healthy controls (OR, 1.59; 95% CI, 1.40–1.81; I² = 68.5%). Substantial heterogeneity was identified across most estimates (I² > 75%). Further research is needed to identify effective strategies for preventing and treating depression among eye disease patients.

Prevalence of depression, anxiety, adjustment disorders, and somatoform disorders in patients with age-related macular degeneration in Germany

Aims: The purpose of this study was to analyze the prevalence of depression, anxiety, adjustment disorders, and somatoform disorders in patients diagnosed with age-related macular degeneration (AMD) in Germany.

Methods: This study included 7,580 patients between the ages of 40 and 90 diagnosed with AMD between January 2011 and December 2014 in 1,072 primary care practices (index date). The last follow-up was in July 2016. We also included 7,580 controls without AMD, which were matched (1:1) to the AMD cases by age, sex, type of health insurance (private or statutory), physician, and Charlson comorbidity score as a generic marker of comorbidity. The outcome of the study was the prevalence of depression, anxiety, adjustment disorders, and somatoform disorders recorded in the database between the index date and the end of follow-up.

Results: The mean age among subjects was 75.7 years (SD=10.1 years), 34.0% were men, and 7.8% had private health insurance coverage. The Charlson comorbidity index was 2.0 (SD=1.8). Depression was the most frequent disease (33.7% in AMD patients versus 27.3% in controls), followed by somatoform disorders (19.6% and 16.7%), adjustment disorders (14.8% and 10.5%), and anxiety disorders (11.7% and 8.2%). Depression (OR=1.37, 95% CI: 1.27–1.47), anxiety (OR=1.50, 95% CI: 1.35–1.67), adjustment disorders (OR=1.50, 95% CI: 1.36–1.65), and somatoform disorders (OR=1.22, 95% CI: 1.12–1.32) were all positively associated with AMD.

Conclusion: Overall, a significant association was found between AMD and depression, anxiety, adjustment disorders, and somatoform disorders.

How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review

OBJECTIVES

To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature.

DESIGN

Systematic review.

METHODS

A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT).

RESULTS

From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%.

CONCLUSIONS

There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.

The prevalence of anxiety and depression in people with age-related macular degeneration: a systematic review of observational study data

BACKGROUND

Comorbid mental health problems have been shown to have an adverse effect on the quality of life of people with common eye disorders. This study aims to assess whether symptoms of anxiety and/or depression are more prevalent in people with age-related macular degeneration (AMD) than in people without this condition.

METHODS

A systematic search of electronic databases (Medline, CINAHL, EMBASE, PsycINFO) from inception to February 2012 was conducted to identify studies of AMD populations which measured symptoms of anxiety and/or depression. Reference checking of relevant articles was also performed. Data on the study setting, prevalence and how anxiety and depression were measured were extracted from the papers. Critical appraisal was performed using the Critical Appraisal Skills Programme (CASP) tools.

RESULTS

A total of 16 papers were included in the review, from an original search result of 597. The prevalence estimates, taken from nine cross-sectional and cohort studies, ranged from 15.7%-44% for depressive symptoms and 9.6%-30.1% for anxiety symptoms in people with AMD. The seven case-control studies found that people with AMD were more likely to experience symptoms of depression compared with those without AMD, but not more likely to experience symptoms of anxiety.

CONCLUSIONS

Overall, the evidence suggests that symptoms of depression are more prevalent amongst AMD populations than anxiety symptoms. The heterogeneity of the studies included in this review means that it is difficult to draw strong conclusions as to the true estimates of depression and anxiety symptoms in AMD populations and prevented formal meta-analysis. Further research which specifies clinical anxiety and gives clear definitions as to the type of AMD being investigated is required.

Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults

This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment.

Education and risk for late life depression: a meta-analysis of published literature

OBJECTIVE

Less education is commonly viewed as an important risk factor for late life depression. However, this has still not been confirmed. The goal of this study was to determine the relationship between education and risk for depression among the old.

METHOD

MEDLINE, EMBASE, and The Cochrane Library database were used to identify potential studies. The studies were divided into cross-sectional and longitudinal subsets. The qualitative meta-analysis of cross-sectional studies and that of longitudinal studies were preformed, respectively. For prevalence and incidence rates of depression, odds risk (OR) and relative risk (RR) were calculated, respectively.

RESULTS

Twenty-four cross-sectional and 12 prospective longitudinal studies were included in this review. In this meta-analysis, in the more and less education groups, there were 22,964 and 28,024 subjects and 3032 and 6462 cases of depression, respectively. The qualitative meta-analysis showed that, compared with old people with more education, those with less education had higher risk for depression (odds risk (OR): 1.58, 95% confidence intervals (95% CI): 1.38-1.82; Relative risk (RR): 1.49, 95% CI: 1.16-1.91).

CONCLUSIONS

Despite the methodological limitations of this meta-analysis, less education is associated with increase risk of late life depression.

Chronic diseases and risk for depression in old age: a meta-analysis of published literature

OBJECTIVE

We assessed the relationship between chronic diseases and risk for depression in old age.

METHOD

MEDLINE, EMBASE, The Cochrane Library database were used to identify potential studies. All of the clinical studies that obtained data on the association between chronic diseases and risk of depression among individuals aged 55 years or older were identified and included in this review. The studies were classified into cross-sectional and longitudinal subsets. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were preformed, respectively. For prevalence and incidence rates of depression, odds risk (OR) and relative risk (RR) were calculated, respectively.

RESULTS

Since all but one study found in the search was for individuals 60 years of age or over, we assessed and report on results for this larger group only. 24 cross-sectional and 7 prospective longitudinal studies were included in this review. The quantitative meta-analysis showed that, among chronic diseases, stroke, loss of hearing, loss of vision, cardiac disease or chronic lung disease had both a significant OR and RR for increased depression in old age; arthritis, hypertension or diabetes had a significant OR but an un-significant RR for increased depression in old age; and gastrointestinal disease had neither a significant OR nor a significant RR for increased depression in old age.

CONCLUSIONS

We concluded here that in old age, the associations of depression with some chronic diseases were definite; among these chronic diseases, stroke, loss of hearing, loss of vision, cardiac disease and chronic lung disease were risk factors for increased depression, but it should be further investigated whether arthritis, hypertension and diabetes were risk factors for increased depression or not.

Age-related macular degeneration and risk of coronary heart disease and stroke: the Cardiovascular Health Study

PURPOSE

To examine the associations of age-related macular degeneration (AMD) with incident coronary heart disease (CHD) and stroke in the Cardiovascular Health Study.

DESIGN

Population-based prospective cohort study.

PARTICIPANTS

A total of 1786 white and African-American participants free of CHD or 2228 participants free of stroke, aged 69 to 97 years.

METHODS

AMD was evaluated from photographs taken in 1997 and 1998.

MAIN OUTCOME MEASURES

Incident CHD and stroke ascertained using standardized methods.

RESULTS

Of the 1786 persons free of CHD, 303 developed incident CHD over 7 years. Participants with early AMD (n = 277) had a higher cumulative incidence of CHD than participants without early AMD (25.8% vs. 18.9%, P = 0.001). By adjusting for age, gender, race, systolic and diastolic blood pressure, hypertension status, fasting glucose, triglyceride, low-density lipoprotein cholesterol, cigarette smoking, pack years of smoking, and C-reactive protein, the presence of early AMD was associated with an increased risk of incident CHD (hazard ratio 1.57; 95% confidence interval, 1.17-2.22). Late AMD (n = 25) was not associated with incident CHD (hazard ratio 0.78; 95% confidence interval, 0.25-2.48). Among 2228 persons at risk, 198 developed incident stroke; neither early nor late AMD was associated with incident stroke.

CONCLUSIONS

This study suggests persons with early AMD have a higher risk of CHD but not stroke in a population aged 69 to 97 years. This provides further support that AMD is associated with underlying systemic vascular disease.