Depression and Anxiety in Patients with Glaucoma or Glaucoma Suspect

Moon Won Hwang; Jung Lim Kim

doi:10.3341/jkos.2015.56.7.1089

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Hwang and Kim: Depression and Anxiety in Patients with Glaucoma or Glaucoma Suspect

Original Article

J Korean Ophthalmol Soc 2015;56(7):1089-1095.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1089

Depression and Anxiety in Patients with Glaucoma or Glaucoma Suspect

Moon Won Hwang, M.D, Jung Lim Kim, M.D, PhD

Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Jung Lim Kim, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329 E-mail: pcheck@hanmail.net

∗ This study was presented as a poster at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 14 November 201414 January 2015 Accepted 20 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To investigate depression and anxiety in patients with glaucoma or glaucoma suspect.

Methods:

Seventy-two patients with glaucoma, 72 patients with glaucoma suspect and 26 controls comprised the study population. Anxiety and depression was evaluated by hospital anxiety and depression scale (HADS) questionnaire. In this study, scores higher than 10 on the HADS-A and HADS-D were defined as anxiety and depression, respectively. The relationship be-tween HADS and mean deviation (MD) of visual field tests or visual acuity of the better eye was analyzed in glaucoma patients.

Results:

Three (11.5%) controls, 11 (15.3%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had anxiety. One (3.8%) control, 5 (6.9%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had depression. In glaucoma patients, the number of anxiety patients was higher in patients who had MD of less than -6 dB and the numbers of anxiety and depression patients were higher in patients who had visual acuity of lower than 20/40.

Conclusions:

The rate of depression in patients with glaucoma is higher than that of glaucoma suspect and controls. There is no significant difference between the three groups in rate of anxiety. Clinicians are advised to not only offer medical treatment but also should monitor for mood disturbances like anxiety and depression to ensure compliance and quality of life of patients.

Keywords: Anxiety, Depression, Glaucoma, Glaucoma suspect, Hospital anxiety and depression scale

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Table 1.

Basic characteristics comparison between control group, glaucoma suspect group and glaucoma group

	Controls (n = 26)	Glaucoma suspect (n = 72)	) Glaucoma (n = 72)	p-value
Age (years)	50.9 ± 9.6	49.6 ± 11.0	49.2 ± 10.6	0.768^∗
Sex
Male	10 (38.5)	27 (37.5)	35 (48.6)	0.384^†
Female	16 (61.5)	45 (62.5)	37 (51.4)
Education (years)
<10	16 (61.5)	40 (55.6)	51 (70.8)	0.168^†
≥10	10 (38.5)	32 (44.4)	21 (29.2)
Monthly income
<2.500 thousand won	16 (61.5)	51 (70.8)	49 (68.1)	0.697^†
≥2.500 thousand won	10 (38.5)	21 (29.2)	23 (31.9)
Marital state
Married/cohabiting	21 (80.8)	57 (79.1)	54 (75.0)	0.801^†
Divorce/separated/ not married	5 (19.2)	15 (20.9)	18 (25.0)
Occupation
Yes	17 (65.4)	53 (73.6)	60 (83.3)	0.134^†
No	9 (34.6)	19 (26.4)	12 (16.7)
Hypertension
Yes	2	10	16	0.392^‡
No	24	62	56
Diabetic mellitus
Yes	3	10	5	0.186^‡
No	23	62	67
Spherical equivalent	-0.87 ± 1.11	-3.10 ± 3.78	-2.53 ± 3.64	0.244^∗
log MAR BCVA of better eye	0.89 ± 0.16	0.85 ± 0.19	0.89 ± 0.26	0.402^∗

Values are presented as mean ± SD or n (%). BCVA = best-corrected visual acuity.

^∗ One-way analysis of variance (ANOVA) test;

^† Chi-square test;

^‡ Fisher exact test.

Table 2.

Hospital Anxiety and Depression Scales (HADS)-anxiety and HADS-depression comparison between control group, glau-coma suspect group and glaucoma group

	Controls	Glaucoma suspect group	Glaucoma group	p-value
HADS-anxiety average	4.8 ± 3.8	5.9 ± 3.7	6.5 ± 4.1	0.328^∗
HADS-anxiety ≥8	5/26 (19.2)	22/72 (30.6)	22/72 (30.6)	0.522^†
HADS-anxiety ≥10	3/26 (11.5)	11/72 (15.3)	15/72 (20.8)	0.535^‡
HADS-depression average	3.3 ± 3.7	4.4 ± 3.1	5.3 ± 4.1	0.172^∗
HADS-depression ≥8	4/26 (15.4)	12/72 (16.7)	19/72 (26.4)	0.282^†
HADS-depression ≥10	1/26 (3.8)	5/72 (6.9)	15/72 (20.8)	0.021^‡

Values are presented as mean ± SD or n (%).

^∗ One-way analysis of variance (ANOVA) test;

^† Chi square test;

^‡ Fisher exact test.

Table 3.

Hospital Anxiety and Depression Scales (HADS)-anxiety score and prevalence comparison according to demographic char-acteristics of the glaucoma patients (n = 72)

		Anxiety score	p-value	Anxiety prevalence	e p-value
Sex	Male	6.7 ± 4.1	0.776^∗	8/36	0.727^†
	Female	6.4 ± 4.2		7/37
Age (years)	<50	6.7 ± 4.4	0.753^∗	7/34	0.961^†
	≥50	6.4 ± 4.0		8/38
Education (years)	<10	6.9 ± 4.7	0.716^∗	3/13	1.000^‡
	≥10	6.5 ± 4.0		12/59
Economy	<2.500 thousand won	6.5 ± 4.6	0.870^∗	13/51	0.203^‡
	≥2.500 thousand won	6.7 ± 2.6		2/21
Marital status	Married/cohabiting	6.2 ± 3.6	0.246^∗	9/57	0.069^‡
	Divorce/separated/not married	8.0 ± 5.6		6/15

Values are presented as mean ± SD.

^∗ Independent t-test;

^† Chi square test;

^‡ Fisher exact test.

Table 4.

Hospital Anxiety and Depression Scales (HADS)-depression score and prevalence comparison according to demographic characteristics of the glaucoma patients (n = 72)

	Depression score	p-value	Depression prevalence	p-value
Sex	Male	5.3 ± 4.1	0.947^∗	6/36	0.418^†
	Female	5.4 ± 4.3		9/37
Age (years)	<50	5.1 ± 4.4	0.618^∗	5/34	0.226^†
	≥50	5.6 ± 4.0		10/38
Education	<10	5.4 ± 3.9	0.951^∗	2/13	0.723^‡
	≥10	5.3 ± 4.2		13/59
Monthly income	<2.500 thousand won	5.0 ± 4.2	0.411^∗	9/51	0.346^‡
	≥2.500 thousand won	6.0 ± 4.1		6/21
Marital status	Married	5.1 ± 4.1	0.292^∗	10/57	0.281^‡
	Divorce	6.3 ± 4.5		5/15

Values are presented as mean ± SD unless otherwise indicated.

^∗ Independent t-test;

^† Chi square test;

^‡ ^‡ Fisher exact test.

Table 5.

Hospital Anxiety and Depression Scales (HADS)-anxiety and HADS-depression comparison according to the mean devia-tion (MD) of the visual field in the better eye

Better MD eye	MD ≥ -6.0 dB (n = 42)	MD < -6.0 dB (n = 30)	p-value
HADS-anxiety average	5.9 ± 3.7	6.5 ± 4.1	0.093^＊
HADS-anxiety ≥8	11/42 (26.2)	11/30 (36.7)	0.438^†
HADS-anxiety ≥10	5/42 (11.9)	10/30 (33.3)	0.039^†
HADS-depression average	5.5 ± 3.8	5.1 ± 4.6	0.699^＊
HADS-depression ≥8	11/42 (26.2)	8/30 (26.7)	1.000^†
HADS-depression ≥10	8/42 (19.0)	7/30 (23.3)	0.777^†

Values are presented as mean ± SD or n (%).

^∗ Independent t-test;

^† Chi-square test.

Table 6.

Hospital Anxiety and Depression Scales (HADS)-anxiety and HADS-depression comparison according to the vision of bet-ter eye

Better eye	VA <0.5 (n = 8)	VA ≥ 0.5 (n = 64)	p-value
HADS-anxiety average	10.4 ± 4.4	6.1 ± 3.9	0.005^∗
HADS-anxiety ≥10	4 (50.0)	11 (17.2)	0.053^†
HADS-depression average	8.6 ± 4.6	4.9 ± 4.0	0.016^∗
HADS-depression ≥10	3 (37.5)	12 (18.8)	0.350^†

Values are presented as mean ± SD or n (%).

VA = visual acuity.

^∗ Independent t-test;

^† Fisher exact test.

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