Relationship Between Dry Eye Disease and Emotional Disorder: The Mediating Effect of Health Anxiety.

Qing He,Ruihua Wei,Caiyuan Xie,Zhuo Chen,Lin Liu,Haibo Yang

doi:10.3389/fpubh.2022.771554

Abstract

ObjectiveThis study aims to investigate the relationship between dry eye disease (DED) and anxiety, as well as DED and depression. Additionally, the influence of health anxiety (HA) on this relationship was determined.MethodsA total of 206 patients with DED were recruited from Tianjin Medical University Eye Hospital clinic and surveyed using demographic questionnaires, the Ocular Surface Disease Index (OSDI), Hospital Anxiety and Depression Scale (HADS), and Short Health Anxiety Inventory (SHAI). Additionally, they were examined using Keratograph 5M and assessed for DED by corneal fluorescein staining. Regression analysis and the bootstrap method were used to investigate the influence of HA on the relationship between DED and emotional disorders.ResultsAmong the 206 patients with DED, 52 (25.24%) and 56 (27.18%) patients showed depression and anxiety, respectively. The OSDI score and HA were positively correlated with depression and anxiety (P < 0.01). The direct effects of OSDI on depression and anxiety were significant (95% confidence interval [CI]: 0.017–0.069; 0.008–0.060). Additionally, the bootstrap test showed significant mediating effects of HA (95% CI: 0.001–0.016; 0.003–0.021). The results suggested that the severity of DED symptoms, as measured by the OSDI score, affected anxiety and depression by a direct and an indirect pathway mediated by HA.ConclusionsWe found a significant correlation between DED and anxiety and depression. Moreover, HA was a mediator of the relationship between DED symptoms and anxiety and depression.

Highlights

Dry eye disease (DED) is a common ocular surface disease with a prevalence ranging from 5.3 to 50.1% and 7.99 to 29.9% in community and hospital-based studies, respectively [1–4]
We found that rural residents were more likely to have anxiety and depression compared to urban residents (P < 0.05)
We found that 146 (75.73%) patients with DED were categorized as severe according to the Ocular Surface Disease Index (OSDI) scoring

Summary

Introduction

Dry eye disease (DED) is a common ocular surface disease with a prevalence ranging from 5.3 to 50.1% and 7.99 to 29.9% in community and hospital-based studies, respectively [1–4]. Patients complain of discomfort including dryness, foreign body sensation, burning sensation, photophobia, and eye pain; they exhibit less severe ocular signs. Several studies have shown a relationship between symptoms of DED and emotional disorder, but there is no correlation between changes in ocular surface parameters of DED and emotional disorder [6–8]. Several studies have reported a correlation between DED and mental illness, including depression and anxiety. As compared with other ophthalmic diseases, patients with DED are more likely to experience depression [11]. These studies mostly show that the symptoms of DED are associated with anxiety and depression [8, 10, 12]. The prevention and treatment of emotional disorders in patients with DED are not well-studied. The investigation of factors affecting the development of anxiety and depression in patients with DED is necessary to develop effective and comprehensive treatments

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Discussion

Conclusion