Relationship between Diabetic Retinopathy Disease Severity, Anxiety, and Depression

Purpose: Determine the relationship between nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), anxiety, and depression. Materials and Methods: This retrospective case-control study identified patients 18 years or older seen by the University of North Carolina Ophthalmology department between July 2008-July 2018 diagnosed with anxiety, depression, NPDR, and PDR. Odds ratios (OR) were calculated separately for the severity of diabetic retinopathy (DR) and anxiety or depression. Results: Among the 47,740 study subjects, 27,893 (58%) were female, 3,239 (6.8%) had NPDR and 1,430 (3.0%) had PDR. The incidence of anxiety after DR was 1.5%, and the incidence of depression after DR was 2.4%. NPDR (0.997; 0.896-1.110; p<0.001) conveyed no change in odds, while PDR (0.869; 0.756-0.998; p<0.001) demonstrated a reduction in odds for a subsequent diagnosis of anxiety. Compared to other 18-34 year old patients with less severe or no disease, 18-34 year old patients with NPDR (2.801; 1.450-5.408; p=0.003) and PDR (2.999; 1.499-6.001; p=0.004) exhibited an increased odds for subsequent anxiety. NPDR (1.473; 1.342-1.617; p<0.001) and PDR (1.232; 1.092-1.389; p<0.001) demonstrated an increased odds for subsequent diagnosis of depression. When stratifying by age, 18-34 year old patients again had the highest increase in odds for subsequent diagnosis of depression (NPDR 3.452; 1.774-6.719; p<0.001 and PDR 4.382; 2.232-8.603; p<0.001). Conclusions: Patients with DR have an increased risk for a new diagnosis of depression, and DR severity has a positive linear relationship with the diagnosis of depression. Age likely plays a prominent role in risk stratification for a new diagnosis of anxiety in patients with DR.