HADS-Assessed Anxiety/Depression Status and Ocular Outcomes in Vision-Threatening Diabetic Retinopathy: A Multicenter Retrospective Cohort Study.
- 1Department of Ophthalmology The Fourth Affiliated Hospital of Soochow University No. 9 Chongwen Road, Suzhou Industrial Park Suzhou 215123 Jiangsu Province China.
- 2Department of Ophthalmology Shanghai General Hospital National Clinical Research Center for Eye Diseases Shanghai Jiao Tong University School of Medicine No.100 Haining Road, Hongkou District Shanghai 200080 China shsmu.edu.cn.
- 3Department of Ophthalmology Ninth People's Hospital Shanghai Jiao Tong University School of Medicine No. 639 Zhizaoju Road, Huangpu District Shanghai 200011 China shsmu.edu.cn.
Abstract
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.
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BibTeX
@article{li2026hadsassessed,
title = {{HADS-Assessed Anxiety/Depression Status and Ocular Outcomes in Vision-Threatening Diabetic Retinopathy: A Multicenter Retrospective Cohort Study.}},
author = {Bo Li and Yujin Jiang and Chenxin Li and Yikeng Huang and Shuzhi Zhao and Chuandi Zhou and Zhi Zheng and Xiaofeng Zhang},
journal = {Depression and anxiety},
year = {2026},
month = oct,
doi = {10.1155/da/6998782},
url = {https://europepmc.org/article/MED/42928730},
note = {CC BY},
}
RIS
TY - JOUR
TI - HADS-Assessed Anxiety/Depression Status and Ocular Outcomes in Vision-Threatening Diabetic Retinopathy: A Multicenter Retrospective Cohort Study.
AU - Bo Li
AU - Yujin Jiang
AU - Chenxin Li
AU - Yikeng Huang
AU - Shuzhi Zhao
AU - Chuandi Zhou
AU - Zhi Zheng
AU - Xiaofeng Zhang
PY - 2026
DA - 2026/10/25
JO - Depression and anxiety
DO - 10.1155/da/6998782
UR - https://europepmc.org/article/MED/42928730
AB - 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.
SN - 1091-4269
SN - 1520-6394
ER -