Visual Impairment, Eye Disease, and the 3-year Incidence of Depressive Symptoms: The Canadian Longitudinal Study on Aging

Figures & data

Figure 1. Flow chart of participants included in the analysis

Table 4. Summary of studies that have examined cataract and depression

Report	Type	Findings
Eramudugolla et al^Citation10	Cross-sectional	The self-report of having or having had a cataract was associated with greater depressive symptoms (OR = 1.40, 95% CI 1.07, 1.81) in a community based sample (n = 662) of adults aged > 70 years after adjusting for age, sex, income source, accommodation type, the number of comorbid health conditions, and level of assistance required for activities of daily living
Wang et al^Citation9	Cross-sectional	Currently having a cataract in the eye, as measured using the Lens Opacities Classification System III scheme, was associated with depressive symptoms (OR = 1.33, 95% CI 1.08, 1.70) after adjusting for age, sex, education level, monthly income, living alone, smoking, alcohol intake, tea consumption, sleeping hours per day and presenting visual acuity in a community-based sample (n = 4,611) of Chinese adults aged > 60 years.
Chen et al^Citation16	Longitudinal	In a population-based study of patients identified through the National Health Insurance Research Database in Taiwan (n = 233,258), cataract patients were found to have an increased risk of developing a new diagnosis of depression (HR = 1.72, 95% CI 1.64–1.80) after adjusting for age, sex, income and comorbidities as compared with non-cataract individuals. The risk was elevated both in those who had surgery (HR = 1.65, 95% CI 1.54, 1.76) and in those who did not (HR = 2.14, 95% CI 2.03, 2.27) compared to those without cataract. Among cataract patients, the risk of depression was lower in individuals who underwent surgery (HR = 0.75, 95% CI 0.71–0.79) compared to those who did not.

Table 1. Descriptive statistics of those with and without incident depression

Variable	Depressed n = 1,807 Mean (SD)/Row %	Not Depressed n = 20,751 Mean (SD)/Row %
Visually Impaired
No (n = 20,810)	7.5	92.5
Yes (n = 1,476)	8.2	91.8
Cataract
No (n = 16,006)	7.1	93.0
Yes (n = 6,113)	10.2	89.8
AMD
No (n = 21,596)	7.6	92.4
Yes (n = 863)	11.1	88.9
Glaucoma
No (n = 21,413)	7.6	92.4
Yes (n = 1,059)	9.8	90.2
Age Group, Years	60.0 (10.8)	59.1 (9.6)
45–55 (n = 5,772)	7.6	92.4
55–65 (n = 7,593)	6.9	93.1
65–75 (n = 5,581)	7.1	92.9
75–85 (n = 3,612)	11.4	88.6
Sex
Female (n = 11,065)	9.5	90.5
Male (n = 11,493)	5.9	94.1
Education
More than Bachelor’s (n = 5,311)	5.9	94.1
Bachelor’s (n = 5,604)	6.2	93.8
Less than Bachelor’s (n = 11,602)	9.3	90.7
Annual Household Income
≥ $150,000(n = 8,590)	5.7	94.3
$50,000 -$100,000 (n = 7,673)	7.7	92.3
$20,000 – $50,000 (n = 4,217)	11.1	88.9
<$20,000 (n = 782)	18.6	81.4
Refused/Don’t know (n = 1,296)	10.0	90.0
Smoking
Current (n = 1,591)	13.2	86.8
Former (n = 9,874)	7.6	92.4
Never (n = 11,023)	6.9	93.1
Marital Status
Partnered (n = 16,304)	6.8	93.2
Not Partnered (n = 6,247)	11.1	88.9
Comorbidity Score (n = 21,804)	1.2 (1.1)	0.8 (0.9)
Hearing Loss No (n = 20,243) Yes (n = 2,300)	7.4 10.1	92.6 89.9

Table 2. Vision/eye disease variables and incident depression during the 3-year follow up from four separate Poisson regression models

Model #	Vision/Eye Disease Variable	Incident Depressive Symptoms Adjusted RR*	95% CI	P-value
1	No Visual Impairment Visual Impairment	Reference 0.94	0.75, 1.17	0.568
2	No Cataract Cataract	Reference 1.20	1.05, 1.37	0.008
3	No AMD AMD	Reference 1.22	0.97, 1.53	0.092
4	No Glaucoma Glaucoma	Reference 1.10	0.90, 1.36	0.350

*Adjusted for age, sex, household income, education, marital status, smoking status, comorbidity score, hearing loss, province, and the complex survey design.

Table 3. Age and sex-stratified analysis for cataract

Strata	Cataract Presence	Incident Depressive Symptoms Adjusted RR*	95% CI	P-value
Men	No Cataract Cataract	Reference 1.26	1.01, 1.56	0.041
Women	No Cataract Cataract	Reference 1.18	1.00, 1.40	0.048
Age<65	No Cataract Cataract	Reference 1.24	1.01, 1.52	0.043
Age≥65	No Cataract Cataract	Reference 1.17	1.00, 1.37	0.050

Eramudugolla R, Wood J, Anstey KJ. Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults. Front Aging Neurosci. 2013;5:56. doi:10.3389/fnagi.2013.00056.

 PubMed Web of Science ®Google Scholar

Wang H, Sun HP, Wang P, Xu Y, Pan CW. Cataract and Depressive Symptoms among Older Chinese Adults. Optom Vis Sci. 2016;93(12):1479–1484. doi:10.1097/OPX.0000000000000960.

 PubMed Web of Science ®Google Scholar

Chen PW, Liu PP, Lin SM, Wang JH, Huang HK, Loh CH. Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study. Sci Rep. 2020;10(1):13421. doi:10.1038/s41598-020-70285-7.

 PubMed Web of Science ®Google Scholar

Data availability

Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data.