Influence of visual acuity on anxiety, panic and depression disorders among young and middle age adults in the United States

Abstract

Background

Previous research, albeit limited, has demonstrated an association of visual acuity with depression and anxiety. However, these studies are limited in that they have focused on older adults, used a convenient sample, and/or used a subjective assessment of visual function. As a result, the purpose of this study was to examine the association of objectively-measured visual acuity with depression and anxiety (and panic disorder) among a national sample of young- and middle-age U.S. adults (20–39 years).

Methods

Using data from the 2003–2004 NHANES (n=602), the presence of anxiety, depression, and panic disorders was assessed from a diagnostic interview. Visual acuity was assessed from a vision exam using the Nidek Auto Lensmeter Model (LM-990A) and expressed as LogMAR units.

Results

After adjusting for age, gender, race-ethnicity, body mass index, mean arterial pressure, cotinine, diabetes, and physical activity, visual acuity was not associated with panic disorder (p=0.71) or depression disorder (p=0.20), but for every 0.1 LogMAR unit change in vision, participants had a 14% (OR=1.14; p=0.04) higher odds of having an anxiety disorder.

Limitations

The main limitation of this study was the cross-sectional design.

Conclusion

Young- and middle-age U.S. adults with worse visual function are at increased odds of having an anxiety disorder. Strategies to prevent and treat anxiety among those with worse visual function are needed.

Introduction

While vision loss is typically thought of as an affliction of old age, it does not escape all younger adults. Estimates among Americans in 2006 indicate that approximately 14 million individuals aged 12 years and older have visual impairment (Vitale et al., 2006). Even those not classified as elderly experience physical and psychological challenges associated with vision loss (Crewe et al., 2011). Various physical challenges such as loss of balance and relearning how to traverse and function in the world pose massive hurdles to those who experience any form of vision loss (Grue et al., 2009). Further, vision loss is also associated with psychological well-being (Karlson, 1998). For example, studies have shown that loss of vision increases an individual׳s likelihood of developing disorders related to depression and anxiety (Bernabei et al., 2011). Despite these noted associations between vision and psychological well-being, most of these studies were conducted among the elderly population (Bernabei et al., 2011, Kempen et al., 2012), individuals with pre-existing conditions (Robertson et al., 2006, Kulaksizoglu, 2007), or in narrow geographic population samples (Bernabei et al., 2011). Further, most research on this topic did not employ an objective measure of vision impairment but rather used self-report methodology (Karlson, 1998) or recruited pre-diagnosed individuals seeking vision rehabilitation (Kempen et al., 2012).

To address these gaps in the literature, the purpose of this brief study was to examine the association between objectively-measured visual function and various affect-related parameters, including depression, anxiety, and panic disorder. Further, given that most of the studies to date on this topic have utilized elderly samples, here we examine these associations among young- and middle-age adults. Lastly, to increase generalizability of our findings, we utilize data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES); in the 2003–2004 NHANES only adults 20–39 years were eligible for both the diagnostic interview (to assess anxiety, panic, and depression disorders) and objective assessment of vision.