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. 2025 Jun 10;11(1):94-98.
doi: 10.1159/000546894. eCollection 2025 Jan-Dec.

Association of Ptosis with Mental Health Conditions in Adults from a Large United States Research Database

Jaffer Shah  1 , Matthew Lin  1 , Gabriella Schmuter  1 , Kyle D Kovacs  1 , Kyle J Godfrey  1   2
Affiliations

Association of Ptosis with Mental Health Conditions in Adults from a Large United States Research Database

Jaffer Shah et al. Complex Psychiatry. .

Abstract

Introduction: The aim of this study was to evaluate the association between blepharoptosis (ptosis) and the prevalence of mental health disorders in adults, including anxiety, depression, bipolar disorder, schizophrenia spectrum disorders, and substance use/addictive disorders.

Methods: Cross-sectional study using data from the National Institutes of Health's All of Us Research Program. The study included 4,411 adults diagnosed with ptosis and 4,411 propensity score-matched controls, matched by age, sex, race, education, and income. A 1:1 propensity score-matched analysis was performed, comparing adults with ptosis to matched controls. Logistic regression was used to adjust for potential confounders, including body mass index, elevated blood pressure, and blood glucose levels. Prevalence rates of anxiety, depression, bipolar disorder, schizophrenia spectrum disorders, and substance use/addictive disorders. The primary outcome was the association between ptosis and any mental health disorder.

Results: Adults with ptosis exhibited significantly higher rates of mental health disorders compared to controls, including anxiety (46.8% vs. 28.9%), depression (44.9% vs. 27.8%), bipolar disorder (5.8% vs. 3.6%), schizophrenia spectrum disorders (1.8% vs. 1.1%), and substance use/addictive disorders (23.4% vs. 17.0%). The prevalence of any mental health disorder was significantly higher in the ptosis group (63.4% vs. 44.8%, p < 0.001). After adjustment, ptosis was associated with increased odds of any mental health disorder (aOR: 1.92, 95% CI, 1.76-2.10) and each specific mental health disorder.

Conclusion: Ptosis is associated with a significantly higher prevalence of mental health disorders, suggesting it may be an independent risk factor. Mental health screenings and psychosocial support should be considered for patients with ptosis. Further research is needed to explore causal mechanisms and stratify risk based on ptosis etiology and severity. This study may be subject to Berkson's bias, wherein individuals with ptosis may have more frequent health care encounters, increasing the likelihood of being diagnosed with psychiatric conditions.

Keywords: Anxiety; Blepharoptosis; Depression; Mental health disorders; Ptosis; Substance use disorders.

Plain language summary

This study examines the relationship between ptosis, a condition where the upper eyelid droops, and mental health issues in adults. Ptosis can affect vision and appearance, which may impact quality of life. Researchers used data from a large US health database, comparing 4,411 adults with ptosis to a similar group without the condition. They found that people with ptosis had notably higher rates of mental health disorders, including anxiety, depression, bipolar disorder, and substance use disorders, even after adjusting for age, gender, and other health factors. The study suggests that ptosis might be an independent risk factor for mental health problems. While ptosis itself does not cause mental health disorders, the social and personal impacts, like self-consciousness about appearance, may contribute to stress and emotional distress. The authors recommend that mental health screenings could benefit people with ptosis. Further research is needed to understand the specific causes of this link and how factors like the severity of ptosis might affect mental health outcomes.

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Conflict of interest statement

The authors have no financial disclosures to report. The authors have no conflicts of interest to declare.

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