Journal List > J Korean Ophthalmol Soc > v.56(9) > 1010081

TOOLS
Park, Tayler, and Chung: Association between Decreased Visual Acuity and Self-Report Depressive Disorder or Depressive Mood: KNHANES IV
Original Article

J Korean Ophthalmol Soc 2015;56(9):1377-1385.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1377

Association between Decreased Visual Acuity and Self-Report Depressive Disorder or Depressive Mood: KNHANES IV

Hye Won Park, M.D1, Hyung Taek Rim Tayler, M.D1, Eun Jee Chung, M.D, PhD2,

1Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

2Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Address reprint requests to Eun Jee Chung, MD, PhD Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0049 E-mail: eunjee95@nhimc.or.kr

∗ This study was presented as a poster at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 31 October 201421 April 2015       Accepted 10 July 2015

Copyright © 2015 Korean Ophthalmological Society

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 assess the association between decreased visual acuity (VA) and diagnosis of depressive disorder by a physician or experience of depressive mood using self-report questionnaires.

Methods

We conducted a cross-sectional analysis using nationally representative data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2012). A total of 28,919 adults who had sociodemographic and health behav-ioral risk factors available were included. An association between decreased VA and depression was identified using multi-variate logistic regression analysis after adjusting for possible confounders. Depression was defined as a depressive disorder with a diagnosis by a physician or depressive mood lasting more than 2 weeks using self-report questionnaires.

Results

The prevalence of depressive disorder and depressive mood in Koreans was 1,160 (4.0%) and 4,063 (14.1%), respectively. In univariable logistic regression, there was significant association between VA and depressive disorder or depres-sive mood. However, in multivariable logistic regression analysis, this study found no statistically significant association between VA status and the prevalence of depressive disorder or depressive mood in Koreans.

Conclusions

No association between decreased VA and a depressive disorder/depressive mood in Korean adults after adjust-ing for possible confounders was found. Therefore, further longitudinal cohort studies examining the causal relationship between decreased VA and depression in Korean adults are necessary.

Keywords: Depression, KNHANES, Low vision, Visual acuity

References

1. World Health Organization Global initiative for the elimination of avoidable blindness: action plan 2006-2011. Geneva: World Health Organization,. 2007; 1–89.
2. World Health Organization Global data on visual impairments 2010. Geneva: World Health Organization,. 2012; 1–14.
3. Rim TH, Nam JS, Choi M. . Prevalence and risk factors of vis-ual impairment and blindness in Korea: the fourth Korea National Health and Nutrition Examination Survey in 2008-2010. Acta Ophthalmol. 2014; 92:e317–25.
crossref
4. Horowitz A, Reinhardt JP, Kennedy GJ. Major and subthreshold depression among older adults seeking vision rehabilitation services. Am J Geriatr Psychiatry. 2005; 13:180–7.
crossref
5. McDonnall MC. Risk factors for depression among older adults with dual sensory loss. Aging Ment Health. 2009; 13:569–76.
crossref
6. Rees G, Tee HW, Marella M. . Vision-specific distress and de-pressive symptoms in people with vision impairment. Invest Ophthalmol Vis Sci. 2010; 51:2891–6.
crossref
7. Casten R, Rovner B. Depression in age-related macular degeneration. J Vis Impair Blind. 2008; 102:591–9.
crossref
8. Augustin A, Sahel JA, Bandello F. . Anxiety and depression prevalence rates in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2007; 48:1498–503.
crossref
9. Brody BL, Gamst AC, Williams RA. . Depression, visual acui-ty, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology. 2001; 108:1893–900.
crossref
10. Rovner BW, Casten RJ. Activity loss and depression in age-related macular degeneration. Am J Geriatr Psychiatry. 2002; 10:305–10.
crossref
11. Rovner BW, Casten RJ, Tasman WS. Effect of depression on vision function in age-related macular degeneration. Arch Ophthalmol. 2002; 120:1041–4.
crossref
12. Rovner BW, Casten RJ, Hegel MT. . Low vision depression prevention trial in age-related macular degeneration: a randomized clinical trial. Ophthalmology. 2014; 121:2204–11.
13. Rovner BW, Casten RJ, Massof RW. . Psychological and cog-nitive determinants of vision function in age-related macular degeneration. Arch Ophthalmol. 2011; 129:885–90.
crossref
14. Leung JC, Kwok TC, Chan DC. . Visual functioning and qual-ity of life among the older people in Hong Kong. Int J Geriatr Psychiatry. 2012; 27:807–15.
crossref
15. American Psychiatric Association. Diagnostic and statistical man-ual of mental disorders. 4th. Washington: American Psychiatric Association;1994. p. 317–91.
16. Kroenke K, Spitzer RL, Williams JB. The patient health ques-tionnaire-2: validity of a two-item depression screener. Med Care. 2003; 41:1284–92.
17. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. J Gen Intern Med. 1997; 12:439–45.
crossref
18. Judd LL, Paulus MP, Wells KB, Rapaport MH. Socioeconomic burden of subsyndromal depressive symptoms and major depres-sion in a sample of the general population. Am J Psychiatry. 1996; 153:1411–7.
19. Park JH, Kim KW. Subsyndromal depression. Korean J Biol Psychiatry. 2011; 18:210–6.
20. Lebowitz BD, Pearson JL, Schneider LS. . Diagnosis and treat-ment of depression in late life. Consensus statement update. JAMA. 1997; 278:1186–90.
crossref
21. Rodu B, Cole P. Smoking prevalence: a comparison of two American surveys. Public Health. 2009; 123:598–601.
crossref
22. Casten RJ, Rovner BW. Update on depression and age-related mac-ular degeneration. Curr Opin Ophthalmol. 2013; 24:239–43.
crossref
23. Rovner BW, Ganguli M. Depression and disability associated with impaired vision: the MoVies Project. J Am Geriatr Soc. 1998; 46:617–9.
crossref
24. Evans JR, Fletcher AE, Wormald RP. Depression and anxiety in visually impaired older people. Ophthalmology. 2007; 114:283–8.
crossref
25. Jones GC, Rovner BW, Crews JE, Danielson ML. Effects of de-pressive symptoms on health behavior practices among older adults with vision loss. Rehabil Psychol. 2009; 54:164–72.
crossref
26. Bandello F, Lafuma A, Berdeaux G. Public health impact of neo-vascular age-related macular degeneration treatments extrapolated from visual acuity. Invest Ophthalmol Vis Sci. 2007; 48:96–103.
crossref
27. Zhang X, Bullard KM, Cotch MF. . Association between de-pression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005-2008. JAMA Ophthalmol. 2013; 131:573–81.
crossref
28. Goldstein JE, Massof RW, Deremeik JT. . Baseline traits of low vision patients served by private outpatient clinical centers in the United States. Arch Ophthalmol. 2012; 130:1028–37.
crossref
29. Chang SM, Hahm BJ, Lee JY. . Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affect Disord. 2008; 106:159–67.
crossref
30. Hammen C. Stress and depression. Annu Rev Clin Psychol. 2005; 1:293–319.
crossref
31. Sheets ES, Craighead WE. Comparing chronic interpersonal and noninterpersonal stress domains as predictors of depression re-currence in emerging adults. Behav Res Ther. 2014; 63:36–42.
crossref

Figure 1.
Proportion of depressive disorder and depressive mood according to visual acuity. Black line and circle mean predicted value of depressive disorder/depressive mood and vertical axis mean percentage of proportion and 95% confidential interval of de-pressive disorder/depressive mood. Horizontal axis means visual acuity by Snellen scale 1.0, 0.8, 0.5-0.63, 0.25-0.4, and LP-0.2. 1.0 means a decimal unit of visual acuity respectively. (A) Depressive disorder by visual acuity. (B) Depressive mood for 2 weeks by visual acuity. LP = light perception.
jkos-56-1377f1.tif
Table 1.
Demographic characteristics of study population (n = 28,919)
Variables n Percentage (%)
Depressive disorder
 No 27,759 96.0
 Yes 1,160 4.0
Depressive mood
 No 24,856 86.0
 Yes 4,063 14.1
Visual acuity∗
1.0 17,958 62.1
0.8 9,041 31.3
0.5-0.63 1,412 4.9
0.25-0.4 375 1.3
LP-0.2 133 0.5
Age (years)
19-29 3,621 12.5
30-39 5,414 18.7
40-49 5,360 18.5
50-59 5,291 18.3
60-69 4,859 16.8
70-79 3,592 12.4
≥80 782 2.7
Sex
Male 12,333 42.7
Female 16,586 57.4
Household income
1st quintile 6,054 21.2
2nd-4th quintile 16,104 56.5
5th quintile 6,359 22.3
Education
Elementary school 7,558 26.7
Middle school 3,135 11.1
High school 9,633 34.0
University or higher 8,031 28.3
Occupation
Indoor 9,136 32.2
Outdoor 7,609 26.9
Not economically active population 11,599 40.9
Residential area
Urban 22,317 77.2
Rural 6,602 22.8
Spouse
With 25,087 86.9
Without 3,784 13.1
Lifetime smoker
 No 17,404 61.4
 Yes 10,961 38.6
Binge alcohol user
 No 19,617 68.7
 Yes 8,924 31.3
Perceived stress
Mild 4,494 15.8
Moderate 22,533 79.4
Severe 1,345 4.7

LP = light perception.

∗ Visual acuity based on Snellen chart based on better seeing eye.

Table 2.
Association between visual acuity and depression-univariate and multivariate logistic regression
Variables Unadjusted OR 95% CI p-value Adjusted OR 95% CI p-value
Visual acuity∗
1.0 1 (ref) 1 (ref)
0.8 1.38 1.17-1.63 <0.01 1.04 0.85-1.26 0.71
0.5-0.63 1.76 1.33-2.35 <0.01 1.11 0.77-1.59 0.59
0.25-0.4 1.38 0.67-2.88 0.38 0.90 0.41-1.95 0.78
LP-0.2 0.72 0.21-2.51 0.61 0.56 0.16-1.97 0.36
Age (years)
19-29 1 (ref) 1 (ref)
30-39 1.08 0.79-1.46 0.64 1.04 0.76-1.42 0.81
40-49 1.23 0.90-1.67 0.19 1.21 0.88-1.65 0.24
50-59 2.14 1.60-2.85 <0.01 1.57 1.13-2.18 <0.01
60-69 2.15 1.62-2.87 <0.01 1.23 0.85-1.78 0.28
70-79 1.79 1.32-2.42 <0.01 0.82 0.53-1.26 0.36
Over 80 1.23 0.69-2.18 0.49 0.38 0.20-0.75 <0.01
Sex
Male 1 (ref) 1 (ref)
Female 3.38 2.82-4.04 <0.01 3.44 2.55-4.64 <0.01
Household income
1st quintile 1 (ref) 1 (ref)
2nd-4th quintile 0.67 0.56-0.81 <0.01 0.96 0.77-1.20 0.73
5th quintile 0.61 0.48-0.78 <0.01 1.05 0.79-1.39 0.75
Education
Elementary school 1 (ref) 1 (ref)
Middle school 0.84 0.67-1.06 0.14 0.90 0.69-1.18 0.45
High school 0.53 0.45-0.63 <0.01 0.65 0.50-0.86 <0.01
University or higher 0.32 0.25-0.39 <0.01 0.43 0.31-0.61 <0.01
Occupation
Indoor 1 (ref) 1 (ref)
Outdoor 1.27 1.01-1.58 0.04 1.06 0.83-1.34 0.65
Not economically active population 2.46 2.03-2.97 <0.01 1.76 1.44-2.15 <0.01
Residential area
Urban 1 (ref) 1 (ref)
Rural 0.89 0.73-1.09 0.25 0.79 0.64-0.99 0.04
Spouse
With 1 (ref) 1 (ref)
Without 2.15 1.79-2.58 <0.01 1.32 1.05-1.66 0.02
Lifetime smoker
 No 1 (ref) 1 (ref)
 Yes 0.64 0.55-0.75 <0.01 1.71 1.34-2.18 <0.01
Binge alcohol user
 No 1 (ref) 1 (ref)
 Yes 0.57 0.47-0.68 <0.01 0.83 0.66-1.03 0.09
Perceived stress
Mild 1 (ref) 1 (ref)
Moderate 1.63 1.28-2.08 <0.01 1.85 1.45-2.37 <0.01
Severe 5.15 3.77-7.05 <0.01 5.15 3.75-7.09 <0.01

OR = odds ratio; CI = confidential interval; LP = light perception; ref = reference.

∗ Visual acuity based on Snellen chart based on better seeing eye.

Table 3.
Association between visual acuity and depressive mood for 2 weeks-univariate and multivariate logistic regression
Variables Unadjusted OR 95% CI p-value Adjusted OR 95% CI p-value
Visual acuity∗
1.0 1 (ref) 1 (ref)
0.8 1.31 1.20-1.44 <0.01 1.04 0.94-1.16 0.44
0.5-0.63 1.78 1.50-2.11 <0.01 1.13 0.91-1.40 0.27
0.25-0.4 1.54 1.07-2.20 0.02 1.06 0.69-1.64 0.79
LP-0.2 1.96 1.13-3.39 0.02 1.34 0.65-2.77 0.43
Age (years)
19-29 1 (ref) 1 (ref)
30-39 0.88 0.75-1.02 0.09 0.87 0.74-1.02 0.09
40-49 1.01 0.88-1.17 0.84 0.99 0.85-1.15 0.90
50-59 1.41 1.22-1.62 <0.01 1.17 0.99-1.39 0.06
60-69 1.35 1.16-1.56 <0.01 0.88 0.72-1.08 0.23
70-79 1.52 1.30-1.77 <0.01 0.84 0.67-1.05 0.13
Over 80 1.62 1.24-2.12 <0.01 0.91 0.63-1.32 0.62
Sex
Male 1 (ref) 1 (ref)
Female 2.07 1.90-2.27 <0.01 2.05 1.78-2.38 <0.01
Household income
1st quintile 1 (ref) 1 (ref)
2nd-4th quintile 0.57 0.52-0.63 <0.01 0.72 0.64-0.81 <0.01
5th quintile 0.52 0.46-0.59 <0.01 0.74 0.64-0.86 <0.01
Education
Elementary school 1 (ref) 1 (ref)
Middle school 0.77 0.67-0.88 <0.01 0.86 0.73-1.02 0.08
High school 0.56 0.50-0.62 <0.01 0.67 0.58-0.79 <0.01
University or higher 0.41 0.37-0.46 <0.01 0.54 0.45-0.65 <0.01
Occupation
Indoor 1 (ref) 1 (ref)
Outdoor 1.10 0.99-1.23 0.09 0.93 0.82-1.06 0.27
Not economically active population 1.56 1.41-1.72 <0.01 1.24 1.10-1.39 <0.01
Residential area
Urban 1 (ref) 1 (ref)
Rural 1.13 1.03-1.25 0.01 1.05 0.94-1.18 0.41
Spouse
With 1 (ref) 1 (ref)
Without 2.25 2.03-2.49 <0.01 1.62 1.42-1.84 <0.01
Lifetime smoker
 No 1 (ref) 1 (ref)
 Yes 0.76 0.70-0.83 <0.01 1.28 1.12-1.47 <0.01
Binge alcohol user
 No 1 (ref) 1 (ref)
 Yes 0.85 0.77-0.94 <0.01 1.12 0.99-1.28 0.07
Perceived stress
Mild 1 (ref) 1 (ref)
Moderate 3.44 2.88-4.12 <0.01 4.36 3.62-5.26 <0.01
Severe 21.80 17.61-26.99 <0.01 26.87 21.43-33.70 <0.01

OR = odds ratio; CI = confidential interval; LP = light perception; ref = reference.

∗ Visual acuity based on Snellen chart based on better seeing eye.

TOOLS
Similar articles