HADS-Assessed Anxiety/Depression Status and Ocular Outcomes in Vision-Threatening Diabetic Retinopathy: A Multicenter Retrospective Cohort Study

Purpose

Vision-threatening diabetic retinopathy (VTDR) poses significant blindness risks and the study aimed to identify the impact of psychological factors on its ocular outcomes.

Methods

This retrospective cohort study enrolled 782 VTDR patients from three ophthalmological centers (2018–2021). DR severity was graded using ETDRS criteria. Primary outcomes included tractional retinal detachment (TRD) involving the fovea, neovascular glaucoma (NVG), final best-corrected visual acuity (BCVA) <0.3, and recurrent vitreous hemorrhage (VH). Anxiety and depression were assessed via the hospital anxiety and depression scale (HADS). Univariable and multivariable logistic regression evaluated the associations between HADS scores and ocular outcomes.

Results

After a median follow-up of 24.8 months, depressive symptoms (HADS-D ≥8) were associated with higher rates of BCVA <0.3 (67.8% vs. 57.2%, p = 0.033) and NVG (13.6% vs. 6.9%, p = 0.020). Recurrent VH was more frequent in patients with anxiety (21.0% vs. 10.6%, p = 0.031) or depression (20.3% vs. 10.7%, p = 0.045). Multivariable logistic analysis revealed that each 1-point increase in HADS-D score significantly increased adjusted odds of TRD (aOR = 1.06, 95% CI: 1.01−1.11), BCVA <0.3 (aOR = 1.07, 95% CI: 1.02−1.11), recurrent VH (aOR = 1.09, 95% CI: 1.02−1.17), and NVG (aOR = 1.10, 95% CI: 1.03−1.17; all p < 0.05). There was a consistent positive gradient between HADS severity and adverse outcomes.

Conclusion

Depressive symptoms are independently associated with worse ocular prognoses in VTDR patients. Systematic psychological screening and intervention is essential to mitigate vision deterioration risk in this population.