Association Between Posterior Segment Eye Diseases, Common Mental Disorders, and Depression: Cross-Sectional and Longitudinal Analyses of Brazilian Longitudinal Study of Adult Health Cohort.

Abstract

Posterior segment eye diseases, such as glaucoma and retinal diseases (such as diabetic retinopathy, age-related macular degeneration, and retinal detachment), are chronic diseases that are among the major causes of visual impairment. We investigated the prevalence of anxiety disorders, depressive disorders, and common mental disorders in these patients and also the incidence of depression. We examined baseline (2008-2010) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used the Clinical Interview Schedule-Revised (CIS-R) to perform International Classification of Diseases-10-based diagnoses of anxiety and depressive disorders. Common mental disorder was defined as a Clinical Interview Schedule-Revised >11. We used multinomial logistic regression models to investigate associations between eye diseases and mental disorders, adjusted by age, gender, educational level, self-reported ethnicity, cardiovascular conditions, and self-reported quality of vision. Out of 10,775 subjects, 249 (2.3%), 303 (2.8%), and 30 (0.3%) reported having retinal diseases, glaucoma, or both, respectively. Patients with retinal diseases and those with glaucoma and retinal diseases presented a higher prevalence of common mental disorders (relative-risk ratios of 1.7 and 3.7, respectively, P<0.001). These patients also presented a higher incidence of depression at follow-up (relative-risk ratios of 3.0 and 5.9, respectively, P<0.001). Patients with glaucoma presented neither a higher prevalence nor a higher incidence of mental disorders or depression. Retinal diseases but not glaucoma were associated with mental disorders, indicating that patients with posterior segment eye diseases require distinct management of psychiatric morbidity according to the underlying pathology.