Depression and anxiety in dry eye disease: a systematic review and meta-analysis

Abstract

AimTo evaluate the association of dry eye disease (DED) with depression and anxiety.Patients and methodsWe conducted a systematic review and meta-analysis of studies that reported the prevalence, incidence and/or severity grading of depression and/or anxiety in DED patients and healthy controls. We searched MEDLINE, EMBASE, PsycINFO, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform for relevant studies.ResultsTwenty-two eligible studies consisted of 2 980 026 patients were analyzed. DED was associated with an increased prevalence of depression (summary odds ratio (OR)=2.92, 95% CI: 2.13-4.01, P<0.00001) and anxiety (OR=2.80, 95% CI: 2.61-3.02, P<0.00001). The depression score (standardized mean difference (SMD)=0.81, 95% CI: 0.48-1.15, P<0.00001) and anxiety score (SMD=0.37, 95% CI: 0.10-0.64, P=0.007) were higher in DED patients than in controls. Subgroup analyses revealed that the prevalence and severity of depression are greatest in primary Sjogren's syndrome patients. No study reported the incidence.ConclusionDepression and anxiety are more prevalent in DED patients than in controls. Among patients with DED, those suffering from primary Sjogren's syndrome have higher prevalence and severity of depression.

Figure 1

Flow chart showing selection of studies for inclusion in this meta-analysis. * Of these 603 studies, 458 did not involve patients with dry eye disease (DED), depression, or anxiety; 67 studied DED patients, but its association with mental disorder were not its outcome; 27 studied patients with depression or anxiety, but its association with DED were not its outcome; 49 studies were case series or review articles with no control group; 2 studies were not in English.

Figure 2

(a) Association between prevalence of depression in dry eye disease (DED) patients versus control group. (b) Association between prevalence of anxiety in DED patients versus control group. CI, confidence interval; M-H, Mantel–Haenszel; SSDE, Sjogren Syndrome Dry Eye.

Figure 3

(a) Association between score of depression in dry eye disease (DED) patients versus control group. (b) Association between score of anxiety in DED patients versus control group. CI, confidence interval non-SSDE; IV, inverse variance; SSDE, Sjogren Syndrome Dry Eye; Std. Mean Difference, standardized mean difference.