Psychological comorbidity in glaucoma: prevalence and impact of anxiety and depression

Abstract

Purpose To assess the prevalence of anxiety and depression among individuals diagnosed with glaucoma, using standardised psychometric instruments, to define factors associated with these psychological diseases, and to identify a potential healthcare gap. Methods In this cross-sectional study, 249 patients with glaucoma were assessed using the 7-item Generalised Anxiety Disorder (GAD-7) scale and the Patient Health Questionnaire (PHQ-9). Correlation analyses explored links between psychometric scores, general mental and physical health functioning, vision-related quality of life and biosocial factors. Results Among participants, 1.2% had a prior anxiety diagnosis and 11.2% a depression diagnosis, yet screening revealed higher rates: 42.2% for anxiety and 34.9% for depression, indicating significant underdiagnosis (p<0.001, respectively). PHQ-9 and GAD-7 scores correlated strongly (p<0.001). Higher PHQ-9 scores were linked to poorer mental and physical health functioning as well as lower vision-related quality of life (p<0.001, respectively), female gender, living alone (p=0.02, respectively), younger age and lower income (p=0.01, respectively). Similarly, higher GAD-7 scores were associated with worse mental health functioning and vision-related quality of life (p<0.001, respectively), female gender (p=0.003), reduced physical health functioning (p=0.03) and lower income (p=0.002). Conclusion Anxiety and depression are frequently underdiagnosed in patients with glaucoma, highlighting a significant healthcare gap. The higher prevalence of these conditions in patients with glaucoma compared with the general population underscores the need for routine psychometric screening to enhance detection and management. Bridging this gap calls for an integrated care model that incorporates psychological evaluation and support into standard protocols, enabling comprehensive, patient-centred care tailored to age, gender, vision-related and socioeconomic factors. Data are available upon reasonable request.