A Comparative Analysis of Anxiety and Depression among Glaucoma and Cataractous Patients in Southwest Nigeria

Background: Glaucoma is the leading cause of irreversible blindness worldwide. An appreciable proportion of glaucoma patients have been found to have hidden psychiatric disorders that often go undetected. Anxiety and depression have been found to be major contributors to these psychological issues. This present study aims to compare the prevalence of anxiety and depression amongst glaucoma and cataract patients and to identify risk factors for anxiety and depression amongst these patients. Materials and Methods: A comparative crossectional study was carried out among 197 Primary Open Angle Glaucoma (POAG) patients and 197 controls (non-POAG patients that have no ocular disorder other than cataract) attending Deseret Community Vision Institute, Ijebu Imushin, Ogun state from 1st of April to 31st May 2014. POAG was defined as patients with open anterior chamber angles based on gonioscopy, pale and cupped discs (Cup: Disc ratio ≥ 0.4), and corresponding visual field defects with or without an elevated intraocular pressure. Cataract was defined as patients with opacification of the crystalline lens in either or both eyes. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression among the participants. Data were analyzed using SPSS Version 20 using Chi-square, Independent student T-test and Logistic regression. Results: The mean age of glaucoma subjects was 62.24 years and the cataract subjects was 64.2 years. There was a male preponderance with a male: female ratio of 1.5:1. Anxiety as defined by the HADS was seen in 35.5% of glaucoma patients and 21.8% of the cataract patients but there was no statistically significant difference after controlling for sociodermographic and clinical characteristics on logistic regression. The risk factors for anxiety among the glaucoma participants were those younger than 60 (OR 2.9, 95% CI: 1.3 - 6.5 p = 0.009) and those with severe glaucoma (OR 9.5, 95% CI: 1.7 - 54.4 p = 0.011). The risk factors for anxiety among cataract patients were sociodermographic factors. Those employed (OR 6.4. 95% CI: 2.1 - 20.0 p = 0.001) and those separated and divorced (OR 10.3, 95% CI: 1.4 - 78.4 p = 0.002). Visual status was not a risk factor amongst the cataract participants. Depression as defined by HADS was seen in 24.4% of glaucoma participants and 3.6% of cataract participants. Glaucoma participants were four times more likely to be depressed than the cataract participants after controlling for clinical and sociodermographic variables (OR 4.0, 95% CI: 1.5 - 10.8 p = 0.007). The risk factors for depression among the glaucoma participants were those younger than 60 (OR 4.7, 95% CI: 1.7 - 13.5 p = 0.004), those with primary (OR 6.6, 95% CI: 1.5 - 28.4) p = 0.010) and secondary education (OR 8.0, 95% CI: 2.1 - 29.9 p = 0.002) as compared to those with tertiary education, those unemployed (OR 2.0, 95% CI: 1.0 - 7.2 p = 0.042) as compared to those employed. Those blind (OR 10.8. 95% CI: 2.8 - 42.4 p = 0.001) as compared to those without visual impairment and those that had had surgery (OR 3.7, 95% CI: 1.4 - 10.0 p = 0.011). Conclusion: Anxiety and Depression were found in 35.5% and 24.4% of glaucoma patients as compared to 21.8% and 3.6% of cataract patients respectively. Glaucoma patients were 4 times more likely to be depressed than patients with cataracts. There was no significant difference in anxiety between the two groups but glaucoma patients had a four times higher risk of being depressed as compared to cataract patients. There is a need to address these psychological issues at the community level in order to improve the quality of life of these patients. It is also important to identify those at risk in order to curb this growing trend/concern.