Elsevier

Ophthalmology

Volume 114, Issue 2, February 2007, Pages 283-288
Ophthalmology

Original Article
Depression and Anxiety in Visually Impaired Older People

https://doi.org/10.1016/j.ophtha.2006.10.006Get rights and content

Purpose

To investigate the association between visual impairment and depression and anxiety in older people in Britain.

Design

Population-based cross-sectional study.

Participants

Thirteen thousand nine hundred people aged 75 years and older in 49 family practices in Britain.

Methods

Vision was measured in 13 900 people aged 75 years and older in 49 family practices taking part in a randomized trial of health screening that included depression (Geriatric Depression Scale [GDS-15]) and anxiety (General Health Questionnaire [GHQ-28]). Cause of visual impairment (binocular acuity less than 6/18) was assessed from medical records. Analysis was by logistic regression (odds ratio [OR] and 95% confidence interval [CI]), taking account of potential health and social confounders.

Main Outcome Measures

Levels of depression and anxiety.

Results

Visually impaired people had a higher prevalence of depression compared with people with good vision. Of visually impaired older people, 13.5% were depressed (GDS-15 score of 6 or more) compared with 4.6% of people with good vision (age- and gender-adjusted OR, 2.69; 95% CI, 2.03–3.56). Controlling for potential confounding factors, particularly activities of daily living, markedly attenuated the association between visual impairment and depression (OR, 1.26; 95% CI, 0.94–1.70). There was little evidence for any association between visual impairment and anxiety. On the GHQ-28 scale, 9.3% of visually impaired people had 2 or more symptoms of anxiety compared with 7.4% of people with good vision.

Conclusions

Although cause and effect cannot be established in a cross-sectional study, it is plausible that people with visual impairment are more likely to experience problems with functioning, which in turn leads to depression.

Section snippets

Patients and Methods

The Medical Research Council trial of the assessment and management of older people in the community was a large-cluster randomized trial in 106 general practices from the Medical Research Council General Practice Research Framework.17 The practices in the study were selected to be representative of the mortality (standardized mortality ratio) and Jarman scores of general practices in Britain (England, Wales, and Scotland). The aim of the trial was to evaluate the benefit of different methods

Results

Figure 1 shows a profile of the study. There were 43 219 eligible people in the 106 practices enrolled in the study. In the universal arm of the study, there were 21 762 eligible people in 53 general practices. Of these, 15 735 (72%) underwent a detailed assessment. People taking part were slightly younger (mean age, 81.2 years; standard deviation [SD], 4.8 years) than those not taking part (mean age, 82.0 years; SD, 5.2 years; P<0.001, Student’s t test comparing these 2 mean ages). There was an

Discussion

We found that 13.5% (95% CI, 11.5%–15.4%) of people aged 75 years and older with binocular visual impairment were depressed, that is, scored 6 or more on the GDS. This is lower than in previous studies (Table 5). However, this study reports the prevalence of depression in a large community-based sample of visually impaired people. Previous studies in general identified participants from people attending for health care, and this may account for the fact that higher rates of depression were

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    Manuscript no. 2005-1094.

    The Medical Research Council Trial of the Assessment and Management of Older People in the Community was funded by the Medical Research Council, London, United Kingdom; Department of Health, London, United Kingdom; and Scottish Office, Edinburgh, United Kingdom. Collection of data on causes of visual impairment and additional analyses was funded by the Thomas Pocklington Trust, London, United Kingdom.

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