IRCCS Fondazione G. B. Bietti, Rome, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
JAMA Ophthalmol. 2021 Jul 1;139(7):753-761. doi: 10.1001/jamaophthalmol.2021.1557.
Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients.
To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services.
MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched.
Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy.
Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Proportion of depression.
A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51).
The results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.
鉴于抑郁症是可以治疗的，一些导致视力丧失的眼部疾病是可以逆转的，因此早期识别和治疗视力障碍风险最高的患者可能对这些患者的健康有重要影响。
对定期到眼科诊所和低视力康复服务机构就诊的视力障碍患者中抑郁症的患病率进行荟萃分析。
检索 MEDLINE（从建库起至 2020 年 6 月 7 日）和 Embase（从建库起至 2020 年 6 月 7 日）。
确定了获取 18 岁及以上人群获得性视力障碍与抑郁之间关联数据的研究，并将其纳入本综述。排除标准包括遗传性或先天性眼病、综述研究、未发表的文章、摘要、论文、学位论文和章节。四位独立的评审员分析了检索结果，并进行了选择和数据提取，以确保准确性。
使用随机截距逻辑回归模型对患病率进行荟萃分析。本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
抑郁比例。
本综述共纳入 27 项研究，除 2 项研究外，其余研究均纳入年龄大于 65 岁的患者。在 6992 名视力障碍患者（平均[标准差]年龄 76[13.9]岁；4195 名女性[60%]）中，1687 名患者患有抑郁症，抑郁症的中位数比例为 0.30（范围，0.03-0.54）。随机效应汇总估计值为 0.25（95%置信区间，0.19-0.33），存在高度异质性（95%预测区间，0.05-0.70）。除认知障碍患者（0.33；95%置信区间，0.28-0.38 与排除该因素的 13 项研究中的 0.18；95%置信区间，0.11-0.30；P = .008）外，研究水平上的任何患者特征均未影响抑郁的患病率。在基于诊所的研究（6 项研究中，0.34；95%置信区间，0.23-0.47）和康复服务（18 项研究中，0.25；95%置信区间，0.18-0.33 与 3 项研究中的其他环境相比，0.15；95%置信区间，0.05-0.38；P = .17）中，抑郁的患病率均较高，且与视力障碍的严重程度无关（轻度视力障碍的 8 项研究中为 0.24；95%置信区间，0.14-0.38；中度视力障碍的 10 项研究中为 0.29；95%置信区间，0.21-0.39；严重视力障碍的 5 项研究中为 0.29；95%置信区间，0.12-0.56；P = .51）。
这项荟萃分析的结果表明，视力障碍患者的抑郁是一个常见问题，应引起治疗这些患者的医护人员的重视。
