Purchase this article with an account.
Jing Xie, Gwyneth Rees, Eva K Fenwick, Bonnie A Sturrock, Ecosse Luc Lamoureux; The impact of diabetic retinopathy and diabetic macular edema on symptoms of anxiety and depression in adults with diabetes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4578.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Whilst the presence of diabetic complications has been associated with heightened distress, few studies have examined this relationship in detail. This study explored the association of the severity of diabetic retinopathy (DR) and diabetic macular edema (DME) with depression and anxiety in adults with diabetes.
A prospective study of patients with diabetes was conducted in a tertiary eye hospital in Melbourne, Australia. Patients underwent a comprehensive eye examination and completed standardized interview-administered questionnaires. Blood samples were assessed for HbA1c; fasting blood glucose; and serum lipids. Dilated fundus photographs (disc- and macula-centred) were obtained and graded for the severity of DR (no DR, mild non-proliferative DR (NPDR), moderate NPDR severe NPDR, and PDR) and DME (no DME, mild DME, moderate DME and severe DME). Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). These two main traits were Rasch-transformed, and analysed as continuous variables. Multiple linear regression models were used to determine the associations between depression and anxiety scores and the severity of DR and DME.
Patients with diabetes (n=554) were evaluated [371(67%) male]. The median duration of diabetes was 13.0 (0-67) yrs. Of the study patients, 80 (15.7%) met the criteria for clinically significant depressive symptoms and 118 (23.0%) for anxiety. Severe non-proliferative and proliferative DR (PDR) were independently associated with the greater depressive symptoms (β= 0.48, 95% confidence interval [95% CI]: 0.02, 0.93) after controlling for sociodemographic factors, health risk behaviours and clinical characteristics, but not the anxiety symptoms (β= -0.14, [95% CI]: -0.48, 0.21). Severe non-proliferative and PDR contributed to 27.8% of the total explained variance in the depression symptoms. The severity of DME was neither associated with symptoms of depression nor anxiety.
There was a differential association of DR and DME with depression symptomatology. Only severe non-proliferative and PDR were independently associated with depressive symptoms but not with anxiety. Our findings suggest that psychological support is needed to assist patients in late stage DR.
This PDF is available to Subscribers Only