Depressive symptoms are independently associated with worse ocular prognoses in VTDR patients, so systematic psychological screening and intervention is essential to mitigate vision deterioration risk in this population.
Key Findings
Results
In 782 patients with vision-threatening diabetic retinopathy followed for a median of 24.8 months, depressive symptoms (HADS-D ≥8) were associated with higher rates of poor final visual acuity and neovascular glaucoma.
Final BCVA <0.3 occurred in 67.8% of patients with depressive symptoms vs. 57.2% without (p = 0.033).
NVG occurred in 13.6% vs. 6.9% (p = 0.020).
The retrospective cohort was drawn from three ophthalmological centers (2018-2021).
Anxiety and depression were assessed with the hospital anxiety and depression scale (HADS).
Results
Recurrent vitreous hemorrhage was more frequent in patients with anxiety or depression.
Recurrent VH occurred in 21.0% of anxious vs. 10.6% of non-anxious patients (p = 0.031).
Recurrent VH occurred in 20.3% of depressed vs. 10.7% of non-depressed patients (p = 0.045).
Results
In multivariable logistic regression, each 1-point increase in HADS-D score was independently associated with higher adjusted odds of four adverse ocular outcomes.
TRD involving the fovea: aOR = 1.06 (95% CI: 1.01-1.11).
BCVA <0.3: aOR = 1.07 (95% CI: 1.02-1.11).
Recurrent VH: aOR = 1.09 (95% CI: 1.02-1.17).
NVG: aOR = 1.10 (95% CI: 1.03-1.17); all p < 0.05.
Results
A consistent positive gradient was observed between HADS severity and adverse ocular outcomes.
Higher HADS severity corresponded to more adverse outcomes across the outcomes examined.
Analyses used univariable and multivariable logistic regression to evaluate associations between HADS scores and ocular outcomes.
Conclusions
The authors conclude that depressive symptoms are independently associated with worse ocular prognosis in VTDR and recommend systematic psychological screening and intervention.
Primary outcomes were foveal-involving TRD, NVG, final BCVA <0.3, and recurrent VH.
DR severity was graded using ETDRS criteria.
The design is retrospective, so the associations do not establish causation.
What This Means
This study looked at 782 people with severe, sight-threatening diabetic eye disease across three eye hospitals, following them for about two years. Researchers used a questionnaire (HADS) to measure anxiety and depression and then compared how patients' eyes fared. People with symptoms of depression were more likely to end up with poor vision (67.8% vs. 57.2%) and to develop neovascular glaucoma, a serious complication (13.6% vs. 6.9%). Recurrent bleeding inside the eye was also more common in people with anxiety or depression, roughly double the rate seen in those without.
Even after statistical adjustment for other factors, each 1-point rise in depression score was linked to modestly higher odds of retinal detachment involving the central retina, poor vision, repeated bleeding, and glaucoma. Worse anxiety/depression scores tracked with worse outcomes in a graded way.
This research suggests that mental health and eye outcomes may be connected in people with advanced diabetic retinopathy, and the authors argue for routine psychological screening and support in this group. Because the study looked back at existing records, it shows an association rather than proving that depression causes worse eye outcomes, and it cannot show whether treating depression would improve vision.
Li B, Jiang Y, Li C, Huang Y, Zhao S, Zhou C, et al.. (2026). HADS-Assessed Anxiety/Depression Status and Ocular Outcomes in Vision-Threatening Diabetic Retinopathy: A Multicenter Retrospective Cohort Study.. Depression and anxiety. https://doi.org/10.1155/da/6998782