Depression Risk Elevated in Months Prior to Vision Impairment

The risk of depression in patients with vision impairments (VI) often climbs for approximately 3 years prior to the time of registration and finally peaks at the time of registration, according to a study published in the British Journal of Ophthalmology. The study also shows some demographic factors can put VI patients at an even higher risk.

The study recruited 131,434 participants from the Korean National Health Insurance Service database who presented between 2005 and 2013. All participants were older than 18 years and had newly registered vision impairments. A control group was selected using 1:1 propensity score matching with similar age, sex, residential area, and income. Researchers followed each participant in the 5 years following VI registration and during the 3 years prior to registration. Using conditional logistic regression modeling, they examined the risk of depression before and after a person registers with a VI. 

The “time to registration” was defined in the study using the South Korean qualifications of having persistent visual disability after treatment for longer than 6 months after the causative disease, injury, or undergoing surgery. 

Researchers found that risk of depression is the highest at the time of registration (OR, 1.925; 95% CI 1.788 to 2.073). It gradually increases during the 3 years leading up to registration (OR, 1.186; 95% CI 1.089 to 1.290) and then gradually decreases again in the 5 years following registration (OR, 1.128; 95% CI 1.046 to 1.216). Demographic factors that further increased the risk of depression include male sex (OR, 2.406, 95% CI 2.145 to 2.699 vs OR, 1.626, 95% CI 1.475 to 1.793) and being aged 18 to 21 years (OR, 10.010, 95% CI 3.046 to 32.863). Additionally, severe VI increases the risk of depression when compared with mild VI severity (OR, 3.064, 95% CI 2.736 to 3.430 vs OR, 1.751, 95% CI 1.620 to 1.892). 

This study reports that rates of depression are especially high in men compared with women ((OR, 2.406, 95% CI 2.145 to 2.699 vs OR, 1.626, 95% CI 1.475 to 1.793). They also suggest that VI can lead to higher rates of unemployment and social isolation, which can increase risk of depression. To combat this, researchers recommend physicians offer psychiatric interventions within these populations when diagnosing VI. 

Limitations in this study include the use of health codes rather than medical records to diagnose depression, the reliance on registration of VI disability which may not account for all people with VI, a lack of analysis of other possible factors influencing depression, and finally, the severity of VI was only documented at the time of registration, meaning that any changes to severity were not recorded in the five years following registration.

Reference

Seong HJ, Kim J, Yook TM, et al. Association between vision impairment anddepression: a 9-year, longitudinal, nationwide, population-based cohort study in South Korea. Br J Ophthalmol. Published online May 23, 2022. doi:10.1136/ bjophthalmol-2021-320970