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L. Ahmadian, M. Moradi, J. A. Lopez, M. Mayers, D. J. Reich; From Retinal Microaneurysm to Neovascularization: Similar Depression and Anxiety Level in Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1366.
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97 diabetic patients had baseline evaluations that included the Hospital Depression and Anxiety Scale(HDAS), a detailed ophthalmologic examination, retinal photograph, and measurement of hemoglobin A1C (HbA1c). Diabetic retinopathy(DR) was graded with the International Clinical Classification for DR. Depression and anxiety were measured with the 14-item HDAS for fit to the Rasch model that constructed a hierarchy of the patients, ordered in a linear scale. Differential item functioning (DIF) was performed to examine the confounding effects of demographic variables, severity of retinal vascular changes , and HbA1c level on measurement of depression and anxiety. Regression analysis was performed to determine: 1) correlation between depression or anxiety levels and the presence and severity of retinopathy, 2) whether HbA1C level differed between groups with varying severity of DR.
The study included 97 diabetics(mean age of 61, SD 1.1)of whom 50 (52%) were women. The mean depression and anxiety raw scores were 7.2(SD .4) and 8.1(SD .4) respectively. Twenty six (27%) patients classified as no-retinopathy and 31(32%) as non-proliferative (NPDR) and 40(41%) with proliferative (PDR) retinopathy. The average HgbA1C level was 8.1. Regression analysis revealed a small correlation between HbA1C level and varying severity of retinopathy (P=.03); the multiple R value was .06. Analysis of variance did not reveal a statistically significant difference in mean HbA1C when comparing diabetic groups (P=.11).The t-test revealed a statistical difference in mean HbA1C between groups with and without DR (P=.03).Rasch analysis showed a better person separation for depression(.85)than anxiety (0.80) with the mean depression and anxiety measures of -.63(logit) and -.66(logit),respectively. After Banforeni adjustment, no item had a significant DIF for gender, education, ethnicity, and DR stage or macular edema. Regression analysis did not show a significant correlation between the depression or anxiety measures and severity of retinopathy (P>.5) or HbA1c level (P=.9).
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