Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
School of Social Work, University of Michigan, Ann Arbor.
JAMA Ophthalmol. 2019 Jul 1;137(7):793-800. doi: 10.1001/jamaophthalmol.2019.1085.
Vision impairment (VI) and mental health conditions are highly prevalent among older adults and are major causes of morbidity and health care expenditures. However, there are few nationally representative data from the United States on the longitudinal association between VI and depressive symptoms, and no such data on anxiety symptoms.
To evaluate the longitudinal association and directionality of the association between self-reported VI and clinically significant symptoms of depression and anxiety in older US adults.
DESIGN, SETTING, AND PARTICIPANTS: The National Health and Aging Trends Study, a nationally representative US survey administered annually from 2011 to 2016 to a cohort of Medicare beneficiaries 65 years and older. A total of 7584 participants with complete data on self-reported VI status at baseline were included. Data analysis was performed from February to October 2018.
Multivariable Cox proportional hazards regression models were used to evaluate the longitudinal associations between self-reported VI and depression and anxiety symptoms, adjusting for sociodemographics and medical comorbidities and accounting for the complex survey design.
There were 7584 participants included in this study. At baseline, the survey-weighted proportion of participants who were women was 56.6%; 53.0% were aged 65 to 74 years, and 8.9% (95% CI, 8.1%-9.8%) had self-reported VI. Symptoms of depression were significantly more common in participants with self-reported VI than those without self-reported VI (31.2%; 95% CI, 27.0%-35.6% vs 12.9%; 95% CI, 11.9%-14.0%; P < .001), as were symptoms of anxiety (27.2%; 95% CI, 23.7%-30.9% vs 11.1%; 95% CI,10.2%-12.0%, P < .001). Baseline self-reported vision status was significantly associated with future report of depression (hazard ratio [HR], 1.33; 95% CI, 1.15-1.55) but not anxiety (HR, 1.06; 95% CI, 0.85-1.31) symptoms. Baseline depression (HR, 1.37; 95% CI, 1.08-1.75) and anxiety (HR, 1.55; 95% CI, 1.19-2.02) symptoms were both significantly associated with future reports of self-reported VI. In a sensitivity analysis excluding data provided by proxy respondents, statistical significance was unchanged and the effect size was similar for all statistical models.
Older US adults with self-reported VI were more likely to report symptoms of depression in the future, while those who had symptoms of either depression or anxiety were more likely to report VI in the future. This investigation suggests that there is a significant bidirectional and longitudinal association between self-reported VI and mental health symptoms. Furthermore, the study suggests the need for effective strategies to screen for and address depression and anxiety among older US adults with VI.
视力障碍（VI）和心理健康状况在老年人中非常普遍，是发病率和医疗保健支出的主要原因。然而，美国关于 VI 与抑郁症状之间的纵向关联以及关于焦虑症状的此类数据很少。
评估美国老年成年人中自我报告的 VI 与抑郁和焦虑的临床显著症状之间的纵向关联和关联方向。
设计、地点和参与者：国家健康与老龄化趋势研究是一项全国性的美国调查，从 2011 年到 2016 年，每年对 65 岁及以上的医疗保险受益人进行一次调查。共有 7584 名参与者在基线时完整报告了自我报告的 VI 状态，包括在内。数据分析于 2018 年 2 月至 10 月进行。
使用多变量 Cox 比例风险回归模型评估自我报告 VI 与抑郁和焦虑症状之间的纵向关联，调整社会人口统计学和合并症，并考虑到复杂的调查设计。
本研究共纳入 7584 名参与者。在基线时，调查加权的参与者中女性比例为 56.6%；53.0%的年龄在 65 至 74 岁之间，8.9%（95%CI，8.1%-9.8%）自我报告 VI。有自我报告 VI 的参与者出现抑郁症状的比例明显高于没有自我报告 VI 的参与者（31.2%；95%CI，27.0%-35.6%比 12.9%；95%CI，11.9%-14.0%；P<0.001），焦虑症状也是如此（27.2%；95%CI，23.7%-30.9%比 11.1%；95%CI，10.2%-12.0%，P<0.001）。基线自我报告的视力状况与未来报告的抑郁（危险比[HR]，1.33；95%CI，1.15-1.55）显著相关，但与焦虑（HR，1.06；95%CI，0.85-1.31）无关。基线抑郁（HR，1.37；95%CI，1.08-1.75）和焦虑（HR，1.55；95%CI，1.19-2.02）症状均与未来自我报告的 VI 显著相关。在排除代理受访者提供的数据的敏感性分析中，所有统计模型的统计显着性均未改变，且效应大小相似。
美国老年人自我报告 VI 者在未来更有可能报告抑郁症状，而那些有抑郁或焦虑症状的人在未来更有可能报告 VI。这项研究表明，自我报告的 VI 与心理健康症状之间存在显著的双向和纵向关联。此外，该研究表明，需要采取有效的策略来筛选和解决美国有 VI 的老年人中的抑郁和焦虑问题。
