Increased Incidence of Mental Disorders in Children with Cataract: Findings from a Population-based Study

Moug Al-Bakri,Anne Mette Skovgaard,Daniella Bach-Holm,Dorte Ancher Larsen,Volkert Siersma,Line Kessel

doi:10.1016/j.ajo.2021.09.034

Abstract

To examine the incidence of mental disorders in children with cataract compared with children without cataract. Nationwide cohort study based on entries in comprehensive national databases. The incidence of mental disorders in children born between 2000 and 2017 diagnosed with cataract before 10 years of age (n=485) was compared with sex- and age-matched controls (n=4358). Analyses were corrected to somatic disease in the child and parental socioeconomic status and psychiatric morbidity. The study was conducted as 2 university hospitals in Denmark managing children 6 years of age our younger with cataract. The incidence of mental disorders was nearly doubled in children with cataract compared with controls (odds ratio [OR], 1.83; 95% CI, 1.28-3.63). The risk of anxiety disorders was quadrupled (OR, 4.10; 95% CI, 1.90-8.84) and the risk of developmental delay was doubled (OR, 2.66; 95% CI, 1.45-4.90). The risk of mental disorders was significantly higher in children diagnosed with cataract in the first 3 years of life compared with controls (OR, 2.36; 95% CI, 1.53-3.64), whereas those diagnosed with cataract later in childhood did not have an increased risk (OR, 1.24; 95% CI, 0.66-2.30). The risk of mental disorders, in particular anxiety and neurodevelopmental delay, is markedly increased in children with cataract and even more so in those diagnosed within the first 3 years of life. Psychiatric screening instruments may be integrated in the management of these children.

Highlights

Clinical and research evidence point to an increased risk of mental health problems and disorders in children and adolescents suffering from chronic diseases [1,2,3,4]
The incidence of any mental disorders (21.8%), neurodevelopmental disorders (15.4%) and other mental disorders (9.0%) was significantly higher in children with cataract who had somatic comorbidities compared to children with isolated cataract, see Table 2
Children with cataract were twice as likely to have a mental disorder as children without cataract, 10.5% (n = 51/485) and 5.2% (n = 225/4358), respectively, with odds ratio (OR) = 1.83, 95% confidence interval (95% CI) (1.28 – 2.63), p-value = 0.0009 in analyses adjusted for geographical birth origin, somatic disease confounders, socio-economic status and parental mental disorders

Summary

Introduction

Clinical and research evidence point to an increased risk of mental health problems and disorders in children and adolescents suffering from chronic diseases [1,2,3,4]. In children with diabetes type I, an increased risk of anxiety, mood disorders and eating disorders have been shown in the years following disease onset 7. Childhood cataract is a significant cause of visual disability in infancy and early childhood, affecting approximately 200,000 children worldwide 8. It is a chronic condition requiring intensive management 9. Most cases of childhood cataract occur in early childhood 21, which is the period of onset of several childhood mental disorders, in particular neurodevelopmental disorders 22. Children with cataract are more likely to come from a socio-economically disadvantaged background 23 which may further increase the risk of pediatric child mental disorders 24,25

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