Ilyung Jung; Jin Woo Kwon; Jin A Choi; Donghyun Jee

doi:10.3341/jkos.2018.59.8.745

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Jung, Kwon, Choi, and Jee: Association between Psychological Stress and Glaucoma: Korea National Health and Nutritional Examination Survey 2008–2012

Original Article

J Korean Ophthalmol Soc 2018;59(8):745-751.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.8.745

Association between Psychological Stress and Glaucoma: Korea National Health and Nutritional Examination Survey 2008–2012

Ilyung Jung, MD, Jin Woo Kwon, MD, Jin A Choi, MD, PhD, Donghyun Jee, MD, PhD, MPH

Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

Address reprint requests to Donghyun Jee, MD, PhD, MPH Department of Ophthalmology, The Catholic University of Korea, St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-249-7343, Fax: 82-31-249-6225 E-mail: doj087@mail.catholic.ac.kr

Received 15 March 2018 Revised 28 May 2018 Accepted 27 July 2018

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 evaluate the possible association between psychological stress and glaucoma, given that there are emerging issues and controversy regarding whether psychological stress is one of contributing factors of glaucoma development.

Methods

We used the medical records of 16,426 patients from the Korean National Health and Nutritional Examination Survey 2008–2011. Glaucoma was defined based on examinations including the intraocular pressure, optic disc, visual field, and retinal nerve fiber layer. Stress was evaluated using five questionnaires regarding sustained stress, depression, feelings of suicide, history of suicide attempt/s, and history of psychological counseling. We used univariable and multivariable logistic regression analyses after adjusting confounding factors for glaucoma.

Results

Univariable logistic regression analysis revealed no significant association between glaucoma and psychological stress (odds ratio [OR] = 0.84; confidence interval [CI] = 0.70–1.01), depression (OR = 1.22; CI = 0.97–1.55), suicide attempt/s (OR = 0.73, CI = 0.33–1.59), and psychological counseling (OR = 0.72, CI = 0.43–1.21). Using univariate analysis, only the feelings of suicide factor (OR = 1.28, CI = 1.02–1.60) was significantly associated with glaucoma. Using multivariable analysis after adjusting for confounding factors, no significant association was found in any psychological stress factor.

Conclusions

There was no significant association between psychological stress and glaucoma. The results of this study indicated that the pathogenesis of glaucoma is more consistent with the pathogenesis of physiological causes such as age or hypertension, rather than indirect causes such as stress.

Keywords: Glaucoma, Korea, Stress

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Figure 1.

Flow diagram presenting the selection of study participants. A total of 16,426 subjects with stress and glaucoma examination aged over 40 years were selected according to inclusion and exclusion criteria. KNHANES = Korea National Health And Nutritional Survey.

Table 1.

Demographic and clinical characteristics according to glaucoma, as reported in the Korean National Health and Nutrition Examination Survey 2008–2011

Characteristics	Non glaucoma (n = 15,641)	Glaucoma (n = 785)	Total (n = 16,426)	p-value
Male (n, %)	46.8 (0.4)	55.2 (2.1)	47.2 (0.4)	<0.001^*
Age (years)	55.6 (0.1)	60.7 (0.5)	55.8 (0.1)	<0.001^*
Obesity (n, %)	33.4 (0.4)	33.2 (2.1)	33.4 (0.4)	0.908
Hypertension (n, %)	37.4 (0.6)	54.6 (2.3)	38.2 (0.6)	<0.001^*
Smoking status (n, %)				<0.001^*
Present	27.3 (0.3)	30.3 (2.1)	27.4 (0.3)
Past	10.6 (0.2)	20.6 (1.7)	10.8 (0.2)
Never	62.1 (0.3)	49.2 (2.1)	61.9 (0.3)
Diabetes (n, %)	11.7 (0.3)	16.7 (1.8)	11.9 (0.3)	0.002^*
Mental stress (n, %)	28.7 (0.3)	25.3 (1.8)	28.6 (0.3)	0.065
Depression (n, %)	13.5 (0.3)	16.0 (1.6)	13.5 (0.3)	0.088
Suicide feeling (n, %)	14.5 (0.3)	18.5 (1.7)	15.1 (0.3)	0.028^*
Suicide trial (n, %)	5.8 (0.4)	4.3 (1.6)	5.8 (0.4)	0.431
Psychology counseling (n, %)	2.4 (0.1)	1.8 (0.5)	2.4 (0.1)	0.223
Education (n, %)				<0.001^*
Quartile 1 (lowest)	17.3 (0.4)	36.4 (2.0)	17.8 (0.4)
Quartile 2	10.1 (0.3)	13.3 (1.5)	10.2 (0.3)
Quartile 3	40.7 (0.5)	28.5 (2.0)	40.4 (0.5)
Quartile 4	31.9 (0.6)	21.7 (1.9)	31.6 (0.6)
Economic status (n, %)				<0.001^*
Quartile 1 (lowest)	14.9 (0.4)	29.7 (2.0)	15.4 (0.4)
Quartile 2	26.3 (0.6)	26.5 (2.2)	26.3 (0.5)
Quartile 3	30.0 (0.5)	21.6 (1.8)	29.7 (0.5)
Quartile 4	28.8 (0.7)	22.0 (1.8)	28.6 (0.6)
Marital status (married) (n, %)	77.3 (0.5)	90.0 (1.6)	77.7 (0.5)	<0.001^*

Data are expressed as weighted means or weighted frequency (%) with standard errors.

^* p < 0.05.

Table 2.

Crude and adjusted odds ratio of glaucoma by psychological stress

Characteristics	Univariate analysis	p-value	Multivariate analysis	p-value
Female (%)	0.73 (0.62–0.86)	<0.001^*	0.55 (0.41–0.73)	<0.001^*
Age (years)	1.05 (1.04–1.05)	<0.001^*	1.04 (1.03–1.05)	<0.001^*
Obesity (%)	0.98 (0.81–1.19)	0.908
Hypertension (%)	2.63 (2.21–3.13)	<0.001^*	1.45 (1.20–1.76)	<0.001^*
Smoking status (%)		<0.001^*		0.225
Present	1.40 (1.14–1.73)		1.26 (0.94–1.70)
Past	2.47 (1.99–3.06)		1.20 (0.90–1.60)
Never	Reference		Reference
Diabetes (%)	2.04 (1.59–2.62)	<0.001^*	1.18 (0.92–1.52)	0.182
Mental stress	0.84 (0.70–1.01)	0.065
Depression	1.22 (0.97–1.55)	0.089
Suicide feeling	1.28 (1.02–1.60)	0.029^*	1.23 (0.88–1.43)	0.351
Suicide trial	0.73 (0.33–1.59)	0.432
Psychology counseling	0.72 (0.43–1.21)	0.225
Education		<0.001^*		0.892
Quartile 1 (lowest)	Reference		Reference
Quartile 2	0.62 (0.48–0.81)		1.00 (0.72–1.38)
Quartile 3	0.33 (0.27–0.40)		1.03 (0.78–1.36)
Quartile 4	0.32 (0.25–0.40)		112 (0.81–1.54)
Economic status		<0.001^*		0.356
Quartile 1 (lowest)	Reference		Reference
Quartile 2	0.51 (0.40–0.65)		0.91 (0.67–1.22)
Quartile 3	0.36 (0.28–0.45)		0.77 (0.57–1.04)
Quartile 4	0.38 (0.30–0.48)		0.81 (0.60–1.10)
Marital status (married)	2.63 (1.87–3.69)	<0.001^*	0.81 (0.52–1.26)	0.365

Multivariate analysis was done after adjusting sex, age, hypertension, smoking status, diabetes, suicide feeling, education levels, economic status, marital status which was statistically significant in the univariable analysis.

^* p < 0.05. Prevalence was expressed as weighted estimates (%) (standard errors [%], 95% confidence intervals).

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