A large population-based study found glaucoma patients are prone to depression, and those who are female, low income or live alone may be especially at risk.

Researchers used data from the Taiwan National Health Insurance Research Database for an 11-year follow up period (2001 through 2011). Enrollment included 8,777 glaucoma patients and 35,108 age- and gender-matched unaffected controls. Investigators generated Kaplan-Meier curves to compare the cumulative hazard of subsequent depression between the groups, performed regression analysis to estimate ratios for depression, and investigated risk factors leading to depression among the glaucoma patients.

The study found glaucoma patients had a significantly higher cumulative hazard of depression compared to the control group, and the regression model indicated the glaucoma group had a significantly higher risk of depression.

For the glaucoma group, significant risk factors for depression included being female, of older age, low income, having substance abuse issues and living alone. However, the investigators reported use of β-blocker eye drops and the number of glaucoma medications were not significant risk factors for depression.

The majority of prior studies linking glaucoma and depression used various self-report questionnaires to assess depression symptoms rather than clinical diagnosis, which limited comparisons between the studies, the investigators noted in their report. In this current study, board-certified doctors diagnosed glaucoma, depression and systemic comorbidities, increasing the validity of the results, they added.

“The findings from our study have clinical and public health implications,” they wrote. Doctors treating glaucoma should “focus not only on the medical aspects of glaucoma, but must also provide psychological support to their patients. Glaucoma patients at a high risk for depression, such as older patients, female patients and patients with low income, should be referred to a psychiatrist if early signs of depression become apparent.”

From a public health perspective, policy makers are encouraged to enforce screening for depression risk in patients with glaucoma and to provide more substantial integrated care, they concluded.