Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Ophthalmol. 2022 Apr 1;140(4):392-399. doi: 10.1001/jamaophthalmol.2022.0140.
Depression is more prevalent in patients with dry eye disease (DED) than in the general population; however, the association between severity of DED and depression needs further evaluation.
To investigate the association between depression and severity of DED symptoms and signs, including inflammatory markers.
DESIGN, SETTING, AND PARTICIPANTS: Secondary cross-sectional and longitudinal analysis performed in April to December 2020 of data from Dry Eye Assessment and Management (DREAM) study, a randomized clinical trial from October 2014 to July 2016 including patients with moderate to severe symptoms and signs of DED. Enrolled from 27 ophthalmology and optometry centers, both academic and private, in 17 US states, 535 patients were followed up for 1 year.
Participants screened positive for depression if they scored 42 or less on the Mental Component Summary (MCS) of the 36-Item Short Form Health Survey.
Symptoms of DED were assessed by Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI) and signs assessed by tear film breakup time, Schirmer test, corneal and conjunctival staining, tear osmolarity, and meibomian gland dysfunction at baseline, 6 months, and 12 months. A composite severity sign score was calculated from all 6 signs. Inflammatory markers (cytokines in tears and HLA-DR expression by conjunctival surface cells) were measured for some trial participants. Features of DED were compared between participants with and without depression and adjusted for age, sex, race, visits, and baseline comorbidities.
Among the 535 participants, mean (SD) age was 58 (13.2) years, 434 participants (81%) were women, and 398 (74.4%) were White. Participants who screened positive for depression had worse DED symptoms by OSDI (effect size = 0.45, P < .001) and BODI (effect size = 0.46, P < .001) and composite DED sign score (effect size = 0.21, P = .006). Lower MCS score (ie, worse depression) was correlated with higher OSDI score (ie, worse DED symptoms) at baseline (Spearman ρ = -0.09, P = .03), 6 months (ρ = -0.20, P < .001), and 12 months (ρ = -0.21, P < .001). Inflammatory markers did not differ by depression status.
Depression was associated with more severe dry eye symptoms and overall signs, suggesting that among patients with moderate to severe DED, those with depression may be likely to have more severe DED. These findings support consideration of depression as a comorbidity when managing patients with DED. Further study is needed to elucidate the relationship.
与普通人群相比，患有干眼症（DED）的患者中抑郁症更为普遍；然而，DED 的严重程度与抑郁症之间的关联仍需要进一步评估。
调查抑郁症与 DED 症状和体征严重程度之间的关联，包括炎症标志物。
设计、设置和参与者：2020 年 4 月至 12 月，对 2014 年 10 月至 2016 年 7 月的干眼评估和管理（DREAM）研究数据进行二次横断面和纵向分析，该研究为一项随机临床试验，纳入了中度至重度 DED 症状和体征的患者。该研究共纳入来自美国 17 个州的 27 个眼科和验光中心的 535 名患者，随访 1 年。
如果参与者的 36 项简短健康调查问卷的精神成分综合得分（MCS）为 42 或更低，则他们被筛查为患有抑郁症。
在基线、6 个月和 12 个月时，通过眼表面疾病指数（OSDI）和简要眼不适指数（BODI）评估 DED 症状，通过泪膜破裂时间、泪液分泌试验、角膜和结膜染色、泪液渗透压和睑板腺功能障碍评估体征。从所有 6 个体征中计算出复合严重程度体征评分。对于一些试验参与者，还测量了眼泪中的细胞因子和结膜表面细胞 HLA-DR 表达等炎症标志物。比较了有和无抑郁症的参与者的 DED 特征，并根据年龄、性别、种族、就诊次数和基线合并症进行了调整。
在 535 名参与者中，平均（SD）年龄为 58（13.2）岁，434 名（81%）参与者为女性，398 名（74.4%）为白人。筛查为抑郁症的参与者的 DED 症状通过 OSDI（效应量=0.45，P<.001）和 BODI（效应量=0.46，P<.001）以及复合 DED 体征评分（效应量=0.21，P=.006）更差。较低的 MCS 评分（即更严重的抑郁症）与基线时更高的 OSDI 评分（即更严重的 DED 症状）呈负相关（Spearman ρ=-0.09，P=.03），6 个月时（ρ=-0.20，P<.001）和 12 个月时（ρ=-0.21，P<.001）。炎症标志物与抑郁状态无关。
抑郁症与更严重的干眼症状和整体体征相关，这表明在患有中重度 DED 的患者中，患有抑郁症的患者可能更有可能出现更严重的 DED。这些发现支持在管理 DED 患者时将抑郁症作为一种合并症进行考虑。需要进一步的研究来阐明这种关系。
