Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.
Qual Life Res. 2019 Aug;28(8):2017-2039. doi: 10.1007/s11136-019-02165-1. Epub 2019 Mar 16.
Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the association remains uncertain.
To determine the relationship between DR/DME and psychosocial functioning, the latter an umbrella term used to capture the emotional and social aspects of functioning which may include, for example, depression; depressive disorder; anxiety; vision-specific distress; diabetes-specific distress and emotional and social well-being.
PubMed, Embase, Medline and the Cochrane Central register were systematically searched for relevant interventional and observational quantitative studies using standardised criteria. Studies with DR/DME and psychosocial functioning as exposures or outcomes were accepted. Study quality was evaluated using the modified Newcastle-Ottawa scale for observational studies, and the modified Down's and Black checklist for interventional studies.
Of 1827 titles initially identified, 42 were included in the systematic review. They comprised of four interventions (one RCT, three non-RCTs) and 38 observational studies (33 cross sectional, five prospective). In studies with DR/DME as the exposure (n = 28), its severity and related vision impairment were consistently associated with poor psychosocial outcomes, mostly higher incidence of depression and depressive symptoms. Baseline depression and depressive symptoms were also associated with greater DR incidence and progression of DR. Medical intervention strategies showed significant improvement in psychosocial outcomes in patients with DR, such as significant improvements in mental health domain scores of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ 25).
Severity of DR, DME and associated vision loss are significantly associated with poor psychosocial outcomes. Aspects of depression and its symptoms show a bi-directional association, with increased incidence and progression of DR significant in those with baseline depression or depressive symptoms. Based on these findings, we propose two areas that may benefit from targeted interventions: (1) Prevention of development of poor psychological outcomes by preventing and delaying progression of DR/DME; and (2) Improved detection and management of poor psychological functioning by improving screening tools and multidisciplinary care for patients. Subsequent longitudinal studies can further help establish the underlying relationship between the two measures.
先前的研究报告了糖尿病视网膜病变/糖尿病黄斑水肿（DR/DME）与心理社会功能之间存在关联，尽管关联的程度和方向仍不确定。
确定 DR/DME 与心理社会功能之间的关系，后者是一个伞式术语，用于捕捉功能的情感和社会方面，例如，抑郁；抑郁障碍；焦虑；视力特异性困扰；糖尿病特异性困扰和情感和社会福祉。
使用标准化标准，系统地在 PubMed、Embase、Medline 和 Cochrane 中央注册处搜索了相关的干预性和观察性定量研究。接受了以 DR/DME 和心理社会功能为暴露或结局的研究。使用改良的 Newcastle-Ottawa 量表对观察性研究进行了研究质量评估，并使用改良的 Down 和 Black 清单对干预性研究进行了评估。
在最初确定的 1827 个标题中，有 42 个被纳入系统审查。它们包括四项干预措施（一项 RCT，三项非 RCT）和 38 项观察性研究（33 项横断面研究，五项前瞻性研究）。在以 DR/DME 为暴露的研究中（n=28），其严重程度和相关视力损害与较差的心理社会结局一致，主要是更高的抑郁发生率和抑郁症状。基线抑郁和抑郁症状也与 DR 发生率和 DR 进展相关。在患有 DR 的患者中，医疗干预策略显著改善了心理社会结局，例如，国家眼科研究所视觉功能问卷-25（NEI VFQ 25）的心理健康领域评分显著提高。
DR 的严重程度、DME 和相关视力丧失与较差的心理社会结局显著相关。抑郁及其症状的各个方面显示出双向关联，在基线时患有抑郁或抑郁症状的患者中，DR 的发生率和进展更为显著。基于这些发现，我们提出了两个可能受益于针对性干预的领域：（1）通过预防和延缓 DR/DME 的发展来预防不良心理结局的发生；（2）通过改进筛查工具和多学科护理来改善对不良心理功能的检测和管理。随后的纵向研究可以进一步帮助确定这两个指标之间的潜在关系。
