Factors associated with depressive and anxiety symptoms among anophthalmic patients wearing ocular prostheses
![](https://article.accscience.com/imageFile/by.png)
This study aimed to investigate the prevalence of anxiety and depression among individuals with ocular prostheses and to identify factors associated with these psychological symptoms. A sample of patients who underwent monocular enucleation and socket implantation participated in the study, responding to digital questionnaires covering demographics, psychosocial factors, and aspects related to their ocular prostheses. Depressive and anxiety symptoms were evaluated using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Optimal scale regression analysis was employed to explore factors linked to psychological symptoms in ocular prosthesis users. Results from 100 valid participants revealed a 51% prevalence of depressive symptoms and a 45% prevalence of anxiety symptoms. The mean PHQ-9 score was 4.91 ± 1.98, and the mean GAD-7 score was 4.99 ± 2.15. Factors such as undergoing right eye enucleation, longer duration of ocular prosthesis use, comfort with prosthesis wearing, and greater satisfaction correlated with milder depressive symptoms. In terms of anxiety, those who used ocular prostheses due to trauma or tumors were affected by more severe symptoms, while individuals who were comfortable with their prosthesis or using alumina-based prostheses reported fewer anxiety symptoms. In conclusion, ocular prosthesis users wrestle with significant challenges of depressive and anxiety symptoms. Factors including age, household registration, economic status, enucleation side, cause of anophthalmos, prosthetic material, and satisfaction and duration of prosthesis use were associated with depressive or anxiety symptoms. Long-term comprehensive care targeting these vulnerable individuals is imperative to alleviate depression and anxiety.
- McBain HB, Ezra DG, Rose GE, Newman SP, Appearance Research Collaboration (ARC). The psychosocial impact of living with an ocular prosthesis. Orbit. 2014;33(1):39-44. doi: 10.3109/01676830.2013.851251
- Chen FS, Minson JA, Schone M, Heinrichs M. In the eye of the beholder: Eye contact increases resistance to persuasion. Psychol Sci. 2013;24(11):2254-2261. doi: 10.1177/0956797613491968
- Ye J, Lou L, Jin K, et al. Vision-related quality of life and appearance concerns are associated with anxiety and depression after eye enucleation: A cross-sectional study. PLoS One. 2015;10(8):e0136460. doi: 10.1371/journal.pone.0136460
- Pine K, Sloan B, Stewart J, Jacobs RJ. Concerns of anophthalmic patients wearing artificial eyes. Clin Exp Ophthalmol. 2011;39(1):47-52. doi: 10.1111/j.1442-9071.2010.02381.x
- Rokohl AC, Koch KR, Adler W, et al. Concerns of anophthalmic patients-a comparison between cryolite glass and polymethyl methacrylate prosthetic eye wearers. Graefes Arch Clin Exp Ophthalmol. 2018;256(6):1203-1208. doi: 10.1007/s00417-018-3942-8
- Rokohl AC, Koch KR, Trester M, Trester W, Pine KR, Heindl LM. Concerns of anophthalmic patients wearing cryolite glass prosthetic eyes. Ophthalmic Plast Reconstr Surg. 2018;34(4):369-374. doi: 10.1097/iop.0000000000001021
- Song JS, Oh J, Baek SH. A survey of satisfaction in anophthalmic patients wearing ocular prosthesis. Graefes Arch Clin Exp Ophthalmol. 2006;244(3):330-335. doi: 10.1007/s00417-005-0037-0
- Clarke A, Rumsey N, Collin JR, Wyn-Williams M. Psychosocial distress associated with disfiguring eye conditions. Eye (Lond). 2003;17(1):35-40. doi: 10.1038/sj.eye.6700234
- Kondo T, Tillman WT, Schwartz TL, Linberg JV, Odom JV. Health-related quality of life after surgical removal of an eye. Ophthalmic Plast Reconstr Surg. 2013;29(1):51-56. doi: 10.1097/IOP.0b013e318275b754
- McCullagh D, Puls N, Beaconsfield M, Dempster M, Jackson J, Williams M. Psychological aspects of living with an artificial eye. Orbit. 2022;41(6):745-750. doi: 10.1080/01676830.2021.2013505
- Pine NS, Pine KR. Depression, anxiety and stress indicators for prosthetic eye wearers. Clin Ophthalmol. 2020;14:1715-1723. doi: 10.2147/opth.S254910
- He XY, Li C, Qian J, Cui HS, Wu WY. Reliability and validity of a generalized anxiety scale in general hospital outpatients. Shanghai Arch Psychiatry. 2010;22:200-203. doi: 10.3969/j.issn.1002-0829.2010.04.002
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi: 10.1046/j.1525-1497.2001.016009606.x
- Loewe B, Decker O, Mueller S, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46(3):266-274. doi: 10.1097/MLR.0b013e318160d093
- Wang W, Bian Q, Zhao Y, et al. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36(5):539-544. doi: 10.1016/j.genhosppsych.2014.05.021
- Sun XY, Li YX, Yu CQ, Li LM. Reliability and validity of depression scales of Chinese version: A systematic review. Zhonghua Liu Xing Bing Xue Za Zhi. 2017;38(1):110-116. doi: 10.3760/cma.j.issn.0254-6450.2017.01.021
- Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic meta-analysis. Gen Hosp Psychiatry. 2016;39:24-31. doi: 10.1016/j.genhosppsych.2015.11.005
- Sasaki Y, Shobugawa Y, Nozaki I, et al. Rural-urban differences in the factors affecting depressive symptoms among older adults of two regions in Myanmar. Int J Environ Res Public Health. 2021;18(6):2818. doi: 10.3390/ijerph18062818
- Zhang Y. 345 cases of normal vision young dominant eye survey. Chinese J Pract Ophthalmol. 1992;5:66.
- Jorm AF. Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychol Med. 2000;30(1):11-22. doi: 10.1017/s0033291799001452
- Heindl LM, Trester M, Guo Y, et al. Anxiety and depression in patients wearing prosthetic eyes. Graefes Arch Clin Exp Ophthalmol. 2021;259:495-503. doi: 10.1007/s00417-020-04908-0
- Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003;54(3):216-226. doi: 10.1016/s0006-3223(03)00273-7
- Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: A systematic review and meta-analysis. J Affect Disord. 2017;221:36-46. doi: 10.1016/j.jad.2017.06.009
- Baino F, Vitale-Brovarone C. Bioceramics in ophthalmology. Acta Biomater. 2014;10(8):3372-3397. doi: 10.1016/j.actbio.2014.05.017
- Bailey MD, Mitchell GL, Dhaliwal DK, Boxer Wachler BS, Zadnik K. Patient satisfaction and visual symptoms after laser in situ keratomileusis. Ophthalmologie. 2003; 110(7):1371-1378. doi: 10.1016/S0161-6420(03)00455-X