Association Between Depression and Functional Vision Loss in Persons 20 Years of Age or Older in the United States, NHANES 2005-2008 Depression and Functional Vision Loss

Zhang X, Bullard K, Cotch M, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

This study provides further evidence from a national sample to generalize the relationship between depression and vision loss to adults across the age spectrum. Better recognition of depression among people reporting reduced ability to perform routine activities of daily living due to vision loss is warranted.

Objectives

To estimate, in a national survey of US adults 20 years of age or older, the prevalence of depression among adults reporting visual function loss and among those with visual acuity impairment. The relationship between depression and vision loss has not been reported in a nationally representative sample of US adults. Previous studies have been limited to specific cohorts and predominantly focused on the older population.

Design

The National Health and Nutrition Examination Survey (NHANES) 2005-2008.

Setting

A cross-sectional, nationally representative sample of adults, with prevalence estimates weighted to represent the civilian, noninstitutionalized US population.

Participants

A total of 10 480 US adults 20 years of age or older.

Main Outcome Measures

Depression, as measured by the 9-item Patient Health Questionnaire depression scale, and vision loss, as measured by visual function using a questionnaire and by visual acuity at examination.

Results

In 2005-2008, the estimated crude prevalence of depression (9-item Patient Health Questionnaire score of ≥10) was 11.3% (95% CI, 9.7%-13.2%) among adults with self-reported visual function loss and 4.8% (95% CI, 4.0%-5.7%) among adults without. The estimated prevalence of depression was 10.7% (95% CI, 8.0%-14.3%) among adults with presenting visual acuity impairment (visual acuity worse than 20/40 in the better-seeing eye) compared with 6.8% (95% CI, 5.8%-7.8%) among adults with normal visual acuity. After controlling for age, sex, race/ethnicity, marital status, living alone or not, education, income, employment status, health insurance, body mass index, smoking, binge drinking, general health status, eyesight worry, and major chronic conditions, self-reported visual function loss remained significantly associated with depression (overall odds ratio, 1.9 [95% CI, 1.6-2.3]), whereas the association between presenting visual acuity impairment and depression was no longer statistically significant.

Conclusions and Relevance

Self-reported visual function loss, rather than loss of visual acuity, is significantly associated with depression. Health professionals should be aware of the risk of depression among persons reporting visual function loss.

Vision Function, Functional Vision, and Depression Vision Function, Functional Vision, and Depression

Morse AR. — Wed, 01 May 2013 00:00:00 GMT

Vision loss and depression have long been linked but their relationship has not been well understood. Each condition by itself can be life altering but, when combined, their deleterious effects may be compounded. In this issue of JAMA Ophthalmology, Zhang et al address the relationship between vision loss and depression, and they provide evidence that loss of functional vision (ie, actual task-related visual performance) is linked to depression. This finding underscores the importance of addressing not only the causes of vision loss but their consequences in everyday life. Their analysis of data from the National Health and Nutrition Examination Survey, which used a population-based probability sample, found an overall prevalence of depression of 4.8% in the general US population without vision loss but 11.3% among US adults with self-reported vision loss, which reflects a decline in vision that interferes with an individual's normal or desired functioning. Depression in the National Health and Nutrition Examination Survey sample was assessed using the 9-Item Patient Health Questionnaire, a brief, easily administered tool that identifies and grades the severity of depression. Among those with visual acuity of less than 20/40 in the better eye with correction, the prevalence of depression was 10.7% compared with 6.8% among adults with better visual acuity. Importantly, self-reported vision loss, an individual's perception about how their vision loss affects their performance in everyday activities, was significantly related to depression while acuity was not.

JAMA Ophthalmology: Depression and Dysthymia Topic Collection

Association Between Depression and Functional Vision Loss in Persons 20 Years of Age or Older in the United States, NHANES 2005-2008 Depression and Functional Vision Loss

Vision Function, Functional Vision, and Depression Vision Function, Functional Vision, and Depression