Coping with Advanced Diabetic Retinopathy Leads to Depression

August 17, 2016

Authors of a new study note that a simple self-report question about mental health history in patients with ADR may lead to important intervention.

[[{"type":"media","view_mode":"media_crop","fid":"51113","attributes":{"alt":"","class":"media-image media-image-right","height":"263","id":"media_crop_5951485114726","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6289","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"©Ultra Violet/Shutterstock.com ","typeof":"foaf:Image","width":"260"}}]]Patients with moderate to severe diabetic retinopathy (DR) may be at high risk for depression, according to a new study.

“The findings presented here highlight that the severity of DR heightens the risk of depressive symptoms independent [of] the presence or degree of vision impairment and duration of diabetes. This association likely reflects the long-term burden of managing and coping with DR in its advanced stages,” stated the researchers, led by Gwyneth Rees, PhD, of the Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.

DR is characterized by an asymptomatic non-proliferative stage (NPDR) and symptomatic proliferative stage (PDR). PDR, together with diabetic macular edema (DME), which can develop at any stage, are the primary causes of vision loss among those with diabetes.

The researchers conducted a cross-sectional study to examine the association between severity of DR and DME with symptoms of depression and anxiety in 519 adults, mean age 65 years, with diabetes of median 13 years duration.

The patients underwent a comprehensive eye examination in which images were obtained and graded for the presence and severity of DR and DME. Visual acuity was also assessed. Patients were screened for symptoms of depression and anxiety.

Eighty individuals (15%) screened positive for depressive symptoms and 118 persons (23%) screened positive for symptoms of anxiety. Severe NPDR/PDR was independently associated with greater depressive symptoms after controlling for various factors.

A history of depression or anxiety accounted for 61% of the unique variance in depressive symptoms, and severe NPDR or PDR contributed to 19% of the total explained variance of depressive symptoms.

DME was not associated with depressive symptoms. No association between DR and symptoms of anxiety was identified.

“The findings of our study demonstrate that severe NPDR or PDR and moderate or severe vision impairment, but not DME, were independent risk factors for depressive symptoms in people with diabetes,” the researchers stated. “The severity and progression of DR may be a useful indicator to prompt assessment of psychological well-being, particularly in individuals with other risk factors.”

They added that “our findings highlight that a simple self-report question about mental health history, which is feasible to implement in clinical practice, with records of vision and DR status can be used to identify individuals with diabetes who are at risk for poor mental health.”

They also noted that “the association between depressive symptoms, diabetes, and DR is likely to be bidirectional; the impairment and burden of diabetes and its complications can precipitate depression and vice versa, and depression can impair diabetes control through various biological and behavioral pathways."

In an accompanying editorial, Peter Rabins, MD, of the University of Maryland in Catonsville, MD, suggested that “clinicians treating individuals with chronic disabling eye disease should be alert and sensitive to potential indicators of depression such as sad mood, poor sleep and appetite, impaired concentration, and diminished self-esteem. Patients reporting any of these symptoms should be asked if they have been feeling more depressed, and if so, whether they would like a referral to a counselor, social worker, psychiatrist, or psychologist.”

Source: Rees G, Jing Xie J, Fenwick EK, et al. Association between diabetes-related eye complications and symptoms of anxiety and depression. JAMA Ophthalmol. Published online July 07, 2016. doi:10.1001/jamaophthalmol.2016.2213