Unveiling the psychological dimensions of myopia progression: Anxiety and perceived parental rearing styles in children and adolescents.

Abstract

Purpose: This study aimed to investigate the associations among axial length elongation, anxiety, and perceived parental rearing styles across different refractive error groups in children and adolescents.

Methods: This hospital-based retrospective study included 193 children and adolescents aged 8-16 years, with one year of follow-up. Ocular examinations included axial length measurements and noncycloplegic subjective refraction. The Screen for Child Anxiety Related Emotional Disorders and the modified version of the Egna Minnen Beträffande Uppfostran for Children were used to evaluate anxiety and perceived parental rearing styles, respectively.

Results: Participants with mild to moderate myopia exhibited a higher proportion of anxiety status than those with emmetropia or hyperopia. Among myopic participants, correlation analysis indicated that anxiety scores were positively associated with axial length elongation, parental rejection, and parental overprotection, while negatively correlated with parental emotional warmth. Multivariate regression analysis revealed that greater axial length elongation and parental rejection increased the risk of higher anxiety scores after adjustment. Mediation analysis showed that parental rejection partially mediated the effect of axial length elongation on anxiety scores, accounting for 29% of the total effect. The association between axial length elongation and anxiety was not identified among participants with emmetropia or hyperopia.

Conclusions: Among children and adolescents with mild to moderate myopia, greater axial length elongation was significantly associated with higher anxiety scores, with parental rejection mediating 29% of this relationship. These findings underscore the importance of addressing the psychological health and parenting styles of myopic children and adolescents with rapid progression, though prospective studies are needed to confirm these results.