Depression and Associated Factors Among Diabetic Patients Undergoing Diabetic Retinopathy Assessments at a Tertiary Care Center: A Cross-Sectional Study.

Abstract

Purpose: To explore the prevalence of depression and its associated factors among diabetic patients attending the retina unit at Chiang Mai University Hospital for diabetic retinopathy (DR) or diabetic macular edema (DME) screening and/or treatment.

Patients and methods: This cross-sectional study recruited consecutive diabetic patients scheduled for ophthalmic evaluations between July 1, 2022, and January 31, 2023. Participants completed in-person interviews to provide demographic information, medical history, and mental health status. Depression severity was assessed using the Outcome Inventory-21, while vision-related quality of life (VRQoL) was measured with the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25). Ocular characteristics were extracted from medical records. The primary outcomes included the prevalence of depression and its association with VRQoL, anxiety, visual acuity, and DR/DME severity.

Results: A total of 304 diabetic patients participated, with 55.6% (n = 169) being male. The mean (standard deviation, SD) age was 56.3 (11.4) years, and the mean (SD) visual acuity (VA) in the better-seeing eye was 0.4 (0.3) LogMAR. Bilateral proliferative DR and bilateral center-involved DME were observed in 50.6% and 18.4% of participants, respectively. The mean (SD) composite score for the NEI VFQ-25 was 79.3 (18.1), with the color vision subscale showing the highest score at 93.3 (18.3). Depression was identified in 11 patients (3.6%, 95% confidence interval: 2.0 to 6.4%). Multivariable linear regression revealed that lower VRQoL and higher anxiety levels were significantly associated with depressive symptoms, while no significant correlation was found with VA or DR/DME severity.

Conclusion: VRQoL and anxiety levels are key factors associated with depression in diabetic patients with DR/DME, with VRQoL exhibiting a stronger association than VA. Incorporating patient-reported outcome measures into clinical care may enhance mental health assessment and overall healthcare quality, enabling earlier detection of depression risk among diabetic patients and supporting timely intervention.