Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jan 18;14(1):e075141.
doi: 10.1136/bmjopen-2023-075141.

Use of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for clinical decision-making and psychological referral in ophthalmic care: a multicentre observational study

Stefania Fortini  1   2 , Eliana Costanzo  3 , Emanuela Rellini  1   2 , Filippo Amore  1   4 , Silvio Paolo Mariotti  5 , Monica Varano  6 , Mariacristina Parravano  6 , Gianni Virgili  6   7 , Francesco Bandello  8 , Stanislao Rizzo  4 , Simona Turco  1   4
Affiliations
Observational Study

Use of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for clinical decision-making and psychological referral in ophthalmic care: a multicentre observational study

Stefania Fortini et al. BMJ Open. .

Abstract

Objectives: The aim of this study was to evaluate the influence of anxiety and depression on clinician decision-making in patients suffering from chronic eye disease in ophthalmological clinical practice.

Design and setting: This multicentre observational study, in collaboration with the WHO, included ophthalmologists and their patients affected by chronic eye disease. States of anxiety and depression were screened with specific questionnaires, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), self-administered by patients before the visit. In the present analysis, we report data from three major eye care centres in Italy between 2021 and 2022.

Primary and secondary outcomes: To assess self-reported changes in ophthalmologists' clinical approach (communication style and their clinical-therapeutic strategies) and decisions after knowing questionnaire scores (primary aim), and to analyse the PHQ-9 and GAD-7 scores in patients with chronic eye diseases (secondary aim).

Results: 41 ophthalmologists and 359 patients were included. The results from PHQ-9 and GAD-7 scores showed critical depression and anxiety status scores (PHQ-9 ≥5 and GAD-7 ≥10) in 258 patients. In 74% of cases, no actions were taken by the ophthalmologists based on these scores; in 26% of cases, they changed their clinical approach; and in 14% of cases, they referred the patients for psychological/psychiatric evaluation.

Conclusions: States of anxiety and depression affect many patients with chronic eye conditions and need to be detected and managed early to improve patients' well-being. Providing ophthalmologists with knowledge of their patients' psychological conditions can change the clinical management and attitude towards referral for a psychological evaluation. Further studies are needed to expand our knowledge of how to raise awareness among ophthalmologists regarding multimorbidity of patients suffering from chronic eye diseases in order to achieve better clinical outcomes.

Keywords: Anxiety disorders; Medical ophthalmology; Medical retina.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MV reports personal fees from Bayer, Novartis and Biogen, outside the submitted work. MP reports personal fees from Novartis, Bayer, La-Roche and Zeiss, outside the submitted work. FB reports personal fees from AbbVie, Alimera, Bayer, Boehringer-Ingelheim, Fidia-Sooft, Hofmann La-Roche, Novartis, NTC Pharma, Oxurion NV and Sifi, outside the submitted work. SF, EC, ER, FA, SPM, SR, ST and GV have nothing to disclose.

Figures

Figure 1
Figure 1
Variation in referral between different ophthalmologists via random-effects logistic regression. Each vertical bar refers to each ophthalmologist and its width is proportional to the number of patients seen. No patient was referred by 40% of the ophthalmologists.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Stevens GA, White RA, Flaxman SR, et al. . Global prevalence of vision impairment and blindness: magnitude and temporal trends, 1990-2010. Ophthalmology 2013;120:2377–84. 10.1016/j.ophtha.2013.05.025 - DOI - PubMed
    1. Nagda D, Mitchell W, Zebardast N. The functional burden of diabetic retinopathy in the United States. Graefes Arch Clin Exp Ophthalmol 2021;259:2977–86. 10.1007/s00417-021-05210-3 - DOI - PubMed
    1. Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child 2017;102:853–7. 10.1136/archdischild-2016-310532 - DOI - PubMed
    1. Bertelsen M, Jensen H, Bregnhøj JF, et al. . Prevalence of generalized retinal dystrophy in Denmark. Ophthalmic Epidemiol 2014;21:217–23. 10.3109/09286586.2014.929710 - DOI - PubMed
    1. Senra H, Hernandez-Moreno L, Moreno N, et al. . Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients. Sci Rep 2022;12:2313. 10.1038/s41598-022-06252-1 - DOI - PMC - PubMed

Publication types