Investigating Factors Associated with Depression of Type 2 Diabetic Retinopathy Patients in China

Depression in Individuals With Diabetic Retinopathy in the US National Health and Nutrition Examination Survey, 2005-2008

PURPOSE

To examine the relationship between diabetic retinopathy (DR) and depression in the United States.

DESIGN

Retrospective, cross-sectional study.

METHODS

National Health and Nutrition Examination Survey (NHANES) participants between 2005 and 2008 (ages 40-85 years) were included. Prevalence of major depression among DR stages as determined by retinal imaging was estimated. Multivariable models assessed associations between depression and DR.

RESULTS

Depression was more common in those with moderate to severe DR (16%) than in those with no DR (7%), mild nonproliferative diabetic retinopathy (NPDR, 6%), or proliferative DR (5%). In a model with DR stages that adjusted for demographic factors, there was an association between moderate to severe DR and depression (odds ratio [OR], 2.46, 95% CI, 1.03-5.85).

CONCLUSIONS

Depression was more prevalent in those with moderate to severe NPDR than in those with no DR, mild NPDR, or proliferative DR. This relationship is statistically significant after adjustment for demographic factors.

Prevalence and Risk Factors of Major Depression in Patients with Diabetic Retinopathy in a Nationally Representative Survey

PURPOSE

Evaluate the prevalence and risk factors of depression in diabetic retinopathy (DR). Compare subjective and objective measures of visual function predictivity of depression.

METHODS

National Health and Nutrition Examination Survey 2005-2008 participants aged ≥40 who underwent fundus photography, Patient Health Questionnaire (PHQ)-9, and Visual Function Questionnaire (VFQ-25) were included in the study. Multivariable logistic regression was used to evaluate whether DR was a significant risk factor for depression and to evaluate the risk factors for depression in those with DR.

RESULTS

A total of 5704 participants, 47% male, and mean age 56.5 years were included in this study. Persons with moderate, severe non-proliferative diabetic retinopathy (NPDR), or proliferative retinopathy (PDR) had higher prevalence of depression than participants with mild retinopathy or no retinopathy (14.3%, 6.9%, 7.0%). Moderate-to-severe NPDR or PDR (OR: 2.36, p = .04) was associated with depression. Among persons with DR, best-corrected visual acuity and HbA1c were not associated with depression. However, self-reported measures of vision were associated with depression: some of the time spent worrying about eyesight (OR: 4.59, p = .010), vision limit activities some of the time (OR: 8.52, p < .001), vision limits activities most/all of the time (OR: 6.99, p < .001).

CONCLUSIONS

A significant proportion of patients with DR in the NHANES population had co-morbid major depression. Best corrected visual acuity was not associated with depression in those with DR, while subjective, self-reported measures were associated with depression, suggesting subjective measures are a better determinant of poor mood and low functional status.

Prevalence and associated factors of depression and anxiety among Chinese diabetic retinopathy patients: A cross-sectional study

The purposes of this study were to evaluate the mental health among patients with diabetic retinopathy (DR) and to explore its' influencing factors. A cross-sectional survey was conducted in Liaoning Province, China. A total of 200 patients volunteered to participate in the survey. Psycho-social variables included stress, self-efficacy, resilience, and social support. logistic regression analysis was used to explore the effect of psycho-social factors on depression and anxiety in DR patients. The prevalence of depression and anxiety was 25% and 13.5% among DR patients. Regression analysis showed that social support had a significant protective effect on depression (95%CI 0.931-0.997) and anxiety (95%CI 0.900-0.995). Stress had a significant acceleration of depression (95%CI 1.055-1.253) and anxiety (95%CI 1.120-1.457). Family history of diabetes (95%CI 1.856-18.057) and other chronic diseases (95%CI 1.485-12.508) were risk factors for anxiety. The high prevalence of depression (25.0%) and anxiety (13.5%) among DR patients should receive more attention in Chinese medical settings. Stress, social support, family history of diabetes and other chronic diseases seemed to be crucial in relation to depressive symptoms. Efficient interventions such as improving social support and decreasing stress with patients should be considered by health administrators aiming at alleviating depressive and anxiety among Chinese DR patients.

Evaluation of an Artificial Intelligence System for the Detection of Diabetic Retinopathy in Chinese Community Healthcare Centers

Objective

To evaluate the sensitivity and specificity of a Comprehensive Artificial Intelligence Retinal Expert (CARE) system for detecting diabetic retinopathy (DR) in a Chinese community population.

Methods

This was a cross-sectional, diagnostic study. Participants with a previous diagnosis of diabetes from three Chinese community healthcare centers were enrolled in the study. Single-field color fundus photography was obtained and analyzed by the AI system and two ophthalmologists. Primary outcome measures included the sensitivity, specificity, positive predictive value, and negative predictive value with their 95% confidence intervals (CIs) of the AI system in detecting DR and diabetic macular edema (DME).

Results

In this study, 443 subjects (848 eyes) were enrolled, and 283 (63.88%) were men. The mean age was 52.09 (11.51) years (range 18–82 years); 266 eyes were diagnosed with any DR, 233 with more-than-mild diabetic retinopathy (mtmDR), 112 with vision-threatening diabetic retinopathy (vtDR), and 57 with DME. The image ability of the AI system was as high as 99.06%, whereas its sensitivity and specificity varied significantly in detecting DR with different severities. The sensitivity/specificity to detect any DR was 75.19% (95%CI 69.47–80.17)/93.99% (95%CI 91.65–95.71), mtmDR 78.97% (95%CI 73.06–83.90)/92.52% (95%CI 90.07–94.41), vtDR 33.93% (95%CI 25.41–43.56)/97.69% (95%CI 96.25–98.61), and DME 47.37% (95%CI 34.18–60.91)/93.99% (95%CI 91.65–95.71).

Conclusions

This multicenter cross-sectional diagnostic study noted the safety and reliability of the CARE system for DR (especially mtmDR) detection in Chinese community healthcare centers. The system may effectively solve the dilemma faced by Chinese community healthcare centers: due to the lack of ophthalmic expertise of primary physicians, DR diagnosis and referral are not timely.

The effect of psychotherapy on anxiety, depression, and quality of life in patients with diabetic retinopathy: A protocol for systematic review and network meta-analysis

BACKGROUND

Diabetic retinopathy (DR) is one of the common microvascular complications in diabetic patients, which is characterized by progressive development and often leads to irreversible visual impairment. More seriously, DR patients suffer great psychological stress due to impaired visual function and reduced self-care ability such as anxiety and depression, which seriously affect the quality of life of patients. In recent years, various psychological therapies have been applied to alleviate anxiety, depression, and quality of life in DR patients, which have achieved positive results. However, the effectiveness and safety of different psychological therapies are unclear. This study aims to assess the effects of psychotherapy on anxiety, depression, and quality of life in DR patients through a network meta-analysis.

METHODS

All randomized controlled trials (RCTs) on the effects of psychotherapy on anxiety, depression, and quality of life in patients with DR published before 30 November 30, 2021, will be searched in the PubMed, EMBASE, Cochrane Register of Controlled Trials, Web of Science, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, and China Biomedical Literature Database. There will have no restrictions on publication status and language. Two researchers will be independently responsible for RCT screening, data extraction, and quality evaluation. All statistical analyses will be performed using Stata 14.0 and R 4.1.2.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide comprehensive and reliable evidence-based references for elucidating the efficacy of psychotherapy on anxiety, depression, and quality of life in DR patients.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/K8T27.

Therapeutic of Candesartan and Music Therapy in Diabetic Retinopathy with Depression in Rats

This study aimed to investigate the therapeutic effects of candesartan combined with music therapy on diabetic retinopathy with depression and to assess the molecular mechanisms. Associated animal model of diabetes mellitus and depression was established in rats. Pathological changes in the hippocampus were detected by haematoxylin eosin (H&E) staining. Terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) was used to detect retinal cell apoptosis. Angiotensin II (Ang II) in peripheral blood and neurotransmitters, including serotonin (5-HT), dopamine (DA), and norepinephrine (NE) in the hippocampus, was measured by enzyme linked immunosorbent assay (ELISA). Fluorescence quantitative PCR and western blotting were used to detect the expression of brain-derived neurotrophic factor (BDNF) and c-fos in the hippocampus. Our data showed that chromatin aggregation and cytoplasmic vacuolation were observable in the hippocampal cells of the rats in the model group, while candesartan and music therapy could reduce morphological changes in the hippocampus of diabetic rats with depression. Compared with the control group, the apoptosis of retinal cells was significantly higher, the contents of 5-HT, DA, and NE in the hippocampus were significantly lower, Ang II level in peripheral blood was significantly higher, and the expression of BDNF and c-fos in the hippocampus decreased significantly in the model group. By contrast, candesartan or candesartan + music therapy ameliorated the changes in retina cell apoptosis, reduction of neurotransmitters, increase in AII, and the expression of c-fos and BDNF. Especially, music therapy further improved the effects of candesartan on retina cell apoptosis and neurotransmitter release in diabetic retinopathy rats with depression. In conclusion, candesartan and music therapy have an additive effect in DM with both visual impairment and depression, which might serve a potential alternative treatment for this complex disease.

Ansiedad y depresión en pacientes hospitalizados con diabetes mellitus tipo 2

Introducción: estudios han reportado altos niveles de incertidumbre, ansiedad, depresión y desesperanza en pacientes diabéticos, afectando el control glucémico y la adherencia al tratamiento, favoreciendo las complicaciones micro y macro vasculares. Especialmente en los episodios de hospitalización, donde se alteran los procesos familiares, sociales y laborales, afectando la recuperación y el desenlace de la enfermedad, reflejado en mayores días de estancia hospitalaria, y por tanto elevando los costos asociados a la hospitalización. Objetivo: asociar la ansiedad y depresión en pacientes diabéticos hospitalizados según variables clínicas y sociodemográficas. Método: estudio cuantitativo, descriptivo con componente analítico, de corte transversal. Mediante un muestreo no probabilístico por conveniencia se seleccionaron 82pacientes diabéticos tipo 2, ambos sexos, en un hospital de la ciudad de Montería, Colombia. Se aplicó un cuestionario de caracterización del paciente y la Escala Hospitalaria de Ansiedad y Depresión. El análisis de los datos se realizó a través de SPSS 25. Resultados: predominó el sexo femenino (60%), la procedencia rural (51%) y la baja escolaridad (72%). Se evidencia ausencia de trastorno para ansiedad (54%) y depresión (65%). Se observó mediante la prueba χ2 asociación entre ansiedad y depresión con las variables edad, pareja estable (p = 0,002; 0,013), años de estudio (p = 0; 0,010) complicaciones (p = 0,008; 0,006) y días de hospitalización (p = 0,005; 0,004). Conclusión: se evidenció bajos niveles de ansiedad y depresión en los pacientes diabéticos hospitalizados. Así mismo se identificó que existe asociación de ambos trastornos con la edad, años de estudio y los días de hospitalización.

The mediating and interacting role of physical activity and sedentary behavior between diabetes and depression in people with obesity in United States

AIMS

Sufficient physical activity (PA) and less sedentary behavior (SB) have antidepressant effects, however the amount of PA varies according to weight status in adults with diabetes. Given that depression is a common complication of diabetes, we aimed to quantify to what extent the effects of diabetes on the risk of depression were explained by SB or insufficient PA in adults with and without obesity.

METHODS

Data were collected from the 2007-2016 National Health and Nutrition Examination Survey (NHANES), which included 22,304 participants aged 20 years or older. The mediation and interaction were evaluated by the four-way effect decomposition method.

RESULTS

In individuals suffering from obesity, diabetes, SB, and insufficient moderate and vigorous intensity recreational activity were associated with an increased risk of depression. The increased relative risk of diabetes on depression could be decomposed into a reference interaction (96.78%), a mediated interaction (5.07%), and a pure indirect effect (2.48%), with insufficient moderate-intensity recreational activity as a potential mediator. SB attributed a proportion of 89.21% for the controlled direct effect and 3.64% for pure indirect effect.

CONCLUSION

Adults with obesity and diabetes are encouraged to increase moderate-intensity recreational activity and reduce SB, which can greatly prevent the occurrence of depression.

Pars plana vitrectomy relieves the depression in patients with symptomatic vitreous floaters

AIM

To investigate the depressive state among the patients with symptomatic vitreous floaters (SVF), as well as its change after SVF removal via vitrectomy surgery.

METHODS

Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV).

RESULTS

The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (r _s=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P<0.001) and proportion of depressive state (18.5% vs 53.6%, P=0.005) were significantly decreased.

CONCLUSION

This study suggests that symptoms of vitreous floaters have an apparently negative impact on patients' psychological state. The PPV can effectively relieve the depressive state for patients with SVF.

The relationship between diabetic retinopathy and psychosocial functioning: a systematic review

IMPORTANCE

Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the association remains uncertain.

OBJECTIVE

To determine the relationship between DR/DME and psychosocial functioning, the latter an umbrella term used to capture the emotional and social aspects of functioning which may include, for example, depression; depressive disorder; anxiety; vision-specific distress; diabetes-specific distress and emotional and social well-being.

EVIDENCE REVIEW

PubMed, Embase, Medline and the Cochrane Central register were systematically searched for relevant interventional and observational quantitative studies using standardised criteria. Studies with DR/DME and psychosocial functioning as exposures or outcomes were accepted. Study quality was evaluated using the modified Newcastle-Ottawa scale for observational studies, and the modified Down's and Black checklist for interventional studies.

FINDINGS

Of 1827 titles initially identified, 42 were included in the systematic review. They comprised of four interventions (one RCT, three non-RCTs) and 38 observational studies (33 cross sectional, five prospective). In studies with DR/DME as the exposure (n = 28), its severity and related vision impairment were consistently associated with poor psychosocial outcomes, mostly higher incidence of depression and depressive symptoms. Baseline depression and depressive symptoms were also associated with greater DR incidence and progression of DR. Medical intervention strategies showed significant improvement in psychosocial outcomes in patients with DR, such as significant improvements in mental health domain scores of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ 25).

CONCLUSION AND RELEVANCE

Severity of DR, DME and associated vision loss are significantly associated with poor psychosocial outcomes. Aspects of depression and its symptoms show a bi-directional association, with increased incidence and progression of DR significant in those with baseline depression or depressive symptoms. Based on these findings, we propose two areas that may benefit from targeted interventions: (1) Prevention of development of poor psychological outcomes by preventing and delaying progression of DR/DME; and (2) Improved detection and management of poor psychological functioning by improving screening tools and multidisciplinary care for patients. Subsequent longitudinal studies can further help establish the underlying relationship between the two measures.

Depression in Diabetic Retinopathy: A Review and Recommendation for Psychiatric Management

BACKGROUND

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the main causes of irreversible vision impairment in the working-age population. Multiple studies have demonstrated the significantly high prevalence of depression in patients with DR in recent years. The progression of DR could lead to depression, whereas depressive symptoms often worsen the condition of DR. Therefore, DR is one of the causes of psychosomatic diseases, the treatment for which should combine traditional DR therapy with depression interventions.

METHODS

We reviewed existing articles that investigated the association between DR and depression in the context of prevalence, risk factors, biological mechanisms, and treatment indications.

RESULTS

The literature review in this article includes a brief introduction to current studies of depression and DR, followed by a focus on the epidemiology of depression in DR that help doctors better identify potential or existing depression patients upon first diagnosis. The underlying biologic mechanisms between the 2 diseases are briefly reviewed, and potential treatments are addressed.

CONCLUSIONS

Depression in patients with DR is not uncommon and has a negative effect on the condition of DR. To achieve optimal prognosis in patients with DR and depression, more attention to combined psychiatric therapies for depression is recommended.

Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients

PURPOSE

Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery.

METHODS

In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer's I test, SIT) were evaluated.

RESULTS

In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively).

CONCLUSIONS

Diabetic patients undergoing cataract surgery are prone to DES. Ocular symptoms and tear film stability are transiently worsened in diabetic patients and are restored more slowly than those in nondiabetic patients.