Charles R Frank1, Xiaoling Xiang2, Brian C Stagg1,3,4, Joshua R Ehrlich1,5. 1. Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor. 2. School of Social Work, University of Michigan, Ann Arbor. 3. National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor. 4. Duke Eye Center, Duke University, Durham, North Carolina. 5. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
Abstract
Importance: Vision impairment (VI) and mental health conditions are highly prevalent among older adults and are major causes of morbidity and health care expenditures. However, there are few nationally representative data from the United States on the longitudinal association between VI and depressive symptoms, and no such data on anxiety symptoms. Objective: To evaluate the longitudinal association and directionality of the association between self-reported VI and clinically significant symptoms of depression and anxiety in older US adults. Design, Setting, and Participants: The National Health and Aging Trends Study, a nationally representative US survey administered annually from 2011 to 2016 to a cohort of Medicare beneficiaries 65 years and older. A total of 7584 participants with complete data on self-reported VI status at baseline were included. Data analysis was performed from February to October 2018. Main Outcomes and Measures: Multivariable Cox proportional hazards regression models were used to evaluate the longitudinal associations between self-reported VI and depression and anxiety symptoms, adjusting for sociodemographics and medical comorbidities and accounting for the complex survey design. Results: There were 7584 participants included in this study. At baseline, the survey-weighted proportion of participants who were women was 56.6%; 53.0% were aged 65 to 74 years, and 8.9% (95% CI, 8.1%-9.8%) had self-reported VI. Symptoms of depression were significantly more common in participants with self-reported VI than those without self-reported VI (31.2%; 95% CI, 27.0%-35.6% vs 12.9%; 95% CI, 11.9%-14.0%; P < .001), as were symptoms of anxiety (27.2%; 95% CI, 23.7%-30.9% vs 11.1%; 95% CI,10.2%-12.0%, P < .001). Baseline self-reported vision status was significantly associated with future report of depression (hazard ratio [HR], 1.33; 95% CI, 1.15-1.55) but not anxiety (HR, 1.06; 95% CI, 0.85-1.31) symptoms. Baseline depression (HR, 1.37; 95% CI, 1.08-1.75) and anxiety (HR, 1.55; 95% CI, 1.19-2.02) symptoms were both significantly associated with future reports of self-reported VI. In a sensitivity analysis excluding data provided by proxy respondents, statistical significance was unchanged and the effect size was similar for all statistical models. Conclusions and Relevance: Older US adults with self-reported VI were more likely to report symptoms of depression in the future, while those who had symptoms of either depression or anxiety were more likely to report VI in the future. This investigation suggests that there is a significant bidirectional and longitudinal association between self-reported VI and mental health symptoms. Furthermore, the study suggests the need for effective strategies to screen for and address depression and anxiety among older US adults with VI.
Importance: Vision impairment (VI) and mental health conditions are highly prevalent among older adults and are major causes of morbidity and health care expenditures. However, there are few nationally representative data from the United States on the longitudinal association between VI and depressive symptoms, and no such data on anxiety symptoms. Objective: To evaluate the longitudinal association and directionality of the association between self-reported VI and clinically significant symptoms of depression and anxiety in older US adults. Design, Setting, and Participants: The National Health and Aging Trends Study, a nationally representative US survey administered annually from 2011 to 2016 to a cohort of Medicare beneficiaries 65 years and older. A total of 7584 participants with complete data on self-reported VI status at baseline were included. Data analysis was performed from February to October 2018. Main Outcomes and Measures: Multivariable Cox proportional hazards regression models were used to evaluate the longitudinal associations between self-reported VI and depression and anxiety symptoms, adjusting for sociodemographics and medical comorbidities and accounting for the complex survey design. Results: There were 7584 participants included in this study. At baseline, the survey-weighted proportion of participants who were women was 56.6%; 53.0% were aged 65 to 74 years, and 8.9% (95% CI, 8.1%-9.8%) had self-reported VI. Symptoms of depression were significantly more common in participants with self-reported VI than those without self-reported VI (31.2%; 95% CI, 27.0%-35.6% vs 12.9%; 95% CI, 11.9%-14.0%; P < .001), as were symptoms of anxiety (27.2%; 95% CI, 23.7%-30.9% vs 11.1%; 95% CI,10.2%-12.0%, P < .001). Baseline self-reported vision status was significantly associated with future report of depression (hazard ratio [HR], 1.33; 95% CI, 1.15-1.55) but not anxiety (HR, 1.06; 95% CI, 0.85-1.31) symptoms. Baseline depression (HR, 1.37; 95% CI, 1.08-1.75) and anxiety (HR, 1.55; 95% CI, 1.19-2.02) symptoms were both significantly associated with future reports of self-reported VI. In a sensitivity analysis excluding data provided by proxy respondents, statistical significance was unchanged and the effect size was similar for all statistical models. Conclusions and Relevance: Older US adults with self-reported VI were more likely to report symptoms of depression in the future, while those who had symptoms of either depression or anxiety were more likely to report VI in the future. This investigation suggests that there is a significant bidirectional and longitudinal association between self-reported VI and mental health symptoms. Furthermore, the study suggests the need for effective strategies to screen for and address depression and anxiety among older US adults with VI.
Authors: Ajay Kolli; Kristian Seiler; Neil Kamdar; Lindsey B De Lott; Mark D Peterson; Michelle A Meade; Joshua R Ehrlich Journal: Am J Ophthalmol Date: 2021-09-20 Impact factor: 5.258
Authors: Ahmed F Shakarchi; Lama Assi; Abhishek Gami; Christina Kohn; Joshua R Ehrlich; Bonnielin K Swenor; Nicholas S Reed Journal: Semin Hear Date: 2021-04-15
Authors: Jacob J Abou-Hanna; Amanda N Leggett; Chris A Andrews; Joshua R Ehrlich Journal: Int J Geriatr Psychiatry Date: 2020-09-01 Impact factor: 3.485
Authors: Ajay Kolli; Michelle M Hood; Carrie Karvonen-Gutierrez; Sayoko E Moroi; Joshua R Ehrlich; Brenda W Gillespie; Sarah Dougherty Wood; David C Musch Journal: J Gerontol A Biol Sci Med Sci Date: 2021-11-15 Impact factor: 6.591
Authors: I M Maaswinkel; H P A van der Aa; G H M B van Rens; A T F Beekman; J W R Twisk; R M A van Nispen Journal: BMC Psychiatry Date: 2020-09-24 Impact factor: 3.630