Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Graefe's Archive for Clinical and Experimental Ophthalmology
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 3/2019

01-03-2019 | Xerophthalmia | Cornea

Depressive symptoms, resilience, and personality traits in dry eye disease

Authors: Tina Kaiser, Birgit Janssen, Stefan Schrader, Gerd Geerling

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 3/2019

Login to get access

Abstract

Purpose

Dry eye disease (DED) is a multifactorial disease of the ocular surface that leads to symptoms of discomfort and reduces quality of life. Several studies have shown an association with depression. We investigated the prevalence of depressive symptoms and their severity in DED patients and examined whether depressive symptoms correlate with signs, symptoms, or subtypes of DED or with psychological factors (resilience, premorbid personality, and subjective well-being).

Methods

This cross-sectional study (n = 64, mean age 56.72, 70% women) was conducted at the Dry Eye Clinic of the Department of Ophthalmology, University Hospital Düsseldorf. Psychological assessment included the Beck Depression Inventory, revised version (BDI-II); World Health Organization Well-Being Index (WHO-5); 13-item Resilience Scale (RS-13); and Munich Personality Test (MPT). DED parameters were assessed by the Ocular Surface Disease Index (OSDI), Schirmer test (ST), tear film break-up time (TBUT), and corneal fluorescein staining (CFS). As the reference for the BDI-II depression score, we used standard values from a German sample of healthy individuals (n = 582, 66% women). Multivariate logistic regression analysis was performed to investigate the effects of various parameters on depressive symptoms. Associations between variables were examined by Pearson or Spearman correlation tests.

Results

Among all participants, 61% had depressive symptoms (25% minimal, 14% mild, 17% moderate, and 5% severe). The mean BDI-II score (11.95, ± 8.46) was significantly higher than in the healthy reference group (p < .0001). It was not correlated with the severity of signs or symptoms of DED or with its subtypes, but it was significantly negatively correlated with resilience (p < .0001) and subjective well-being (p < .0001). Depressive symptoms were negatively correlated with the premorbid personality trait extraversion (p = .036) and frustration tolerance (p < .0001) and positively correlated with premorbid neuroticism (p = .001), isolation tendencies (p = .014), and esoteric tendencies (p = .001).

Conclusions

Depressive symptoms of all degrees of severity are common in DED patients, but they are not associated with the severity of signs or symptoms of DED. Subjective well-being, resilience, and premorbid personality do not correlate with the signs or symptoms of DED, but they do correlate with depressive symptoms.
Literature
1.
Craig JP, Nichols KK, Akpek EK et al (2017) TFOS DEWS II definition and classification report. Ocul Surf 15(3):276–283CrossRefPubMed
2.
Mertzanis P, Abetz L, Rajagopalan K et al (2005) The relative burden of dry eye in patients’ lives: comparisons to a U.S. normative sample. Invest Ophthalmol Vis Sci 46(1):46–50CrossRefPubMed
3.
4.
McCarty CA, Bansal AK, Livingston PM et al (1998) The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 105(6):1114–1119CrossRefPubMed
5.
Hashemi H, Khabazkhoob M, Kheirkhah A et al (2014) Prevalence of dry eye syndrome in an adult population. Clin Exp Ophthalmol 42(3):242–248CrossRefPubMed
6.
Jie Y, Xu L, Wu YY et al (2009) Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye (Lond) 23(3):688–693CrossRef
7.
Yazdani C, McLaughlin T, Smeeding JE et al (2001) Prevalence of treated dry eye disease in a managed care population. Clin Ther 23(10):1672–1682CrossRefPubMed
8.
Stapleton F, Alves M, Bunya VY et al (2017) TFOS DEWS II epidemiology report. Ocul Surf 15(3):334–365CrossRefPubMed
9.
Schiffman RM, Walt JG, Jacobsen G et al (2003) Utility assessment among patients with dry eye disease. Ophthalmology 110(7):1412–1419CrossRefPubMed
10.
Buchholz P, Steeds CS, Stern LS et al (2006) Utility assessment to measure the impact of dry eye disease. Ocul Surf 4(3):155–161CrossRefPubMed
11.
Kim KW, Han SB, Han ER et al (2011) Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci 52(11):7954–7958CrossRefPubMed
12.
Wen W, Wu Y, Chen Y et al (2012) Dry eye disease in patients with depressive and anxiety disorders in Shanghai. Cornea 31(6):686–692CrossRefPubMed
13.
Labbe A, Wang YX, Jie Y et al (2013) Dry eye disease, dry eye symptoms and depression: the Beijing Eye Study. Br J Ophthalmol 97(11):1399–1403CrossRefPubMed
14.
Galor A, Felix ER, Feuer W et al (2015) Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters. Br J Ophthalmol 99(8):1126–1129CrossRefPubMed
15.
Na K-S, Han K, Park Y-G et al (2015) Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study. Cornea 34(7):733–738CrossRefPubMed
16.
Nepp J (2016) Psychosomatic aspects of dry eye syndrome/Psychosomatische Aspekte beim trockenen Auge. Ophthalmologe 113(2):111–119CrossRefPubMed
17.
Erb C, Horn A, Günthner A et al (1996) Psychosomatic aspects of patients with primary keratoconjunctivitis sicca (Psychosomatische Aspekte bei Patienten mit primarer Keratoconjunctivitis sicca). Klin Monatsbl Augenheilkd 208(2):96–99CrossRefPubMed
18.
Li M, Gong L, Sun X et al (2011) Anxiety and depression in patients with dry eye syndrome. Curr Eye Res 36(1):1–7CrossRefPubMed
19.
Galor A, Feuer W, Lee DJ et al (2012) Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database. Am J Ophthalmol 154(2):340–346.e2CrossRefPubMed
20.
Yilmaz U, Gokler ME, Unsal A (2015) Dry eye disease and depression-anxiety-stress: a hospital-based case control study in Turkey. Pak J Med Sci 31(3):626–631PubMedPubMedCentral
21.
van der Vaart R, Weaver MA, Lefebvre C et al (2015) The association between dry eye disease and depression and anxiety in a large population-based study. Am J Ophthalmol 159(3):470–474CrossRefPubMed
22.
23.
Szakats I, Sebestyen M, Nemeth J et al (2016) The role of health anxiety and depressive symptoms in dry eye disease. Curr Eye Res 41(8):1044–1049CrossRefPubMed
24.
Liyue H, Chiang PP-C, Sung SC et al (2016) Dry eye-related visual blurring and Irritative symptoms and their association with depression and anxiety in eye clinic patients. Curr Eye Res 41(5):590–599CrossRefPubMed
25.
Hallak JA, Tibrewal S, Jain S (2015) Depressive symptoms in patients with dry eye disease: a case-control study using the Beck Depression Inventory. Cornea 34(12):1545–1550CrossRefPubMedPubMedCentral
26.
Wan KH, Chen LJ, Young AL (2016) Depression and anxiety in dry eye disease: a systematic review and meta-analysis. Eye (Lond) 30(12):1558–1567CrossRef
27.
Zheng Y, Wu X, Lin X et al (2017) The prevalence of depression and depressive symptoms among eye disease patients: a systematic review and meta-analysis. Sci Rep 7:46453CrossRefPubMedPubMedCentral
28.
Miller KL, Walt JG, Mink DR et al (2010) Minimal clinically important difference for the ocular surface disease index. Arch Ophthalmol 128(1):94–101CrossRefPubMed
29.
Hautzinger M, Keller F, Kühner C (2009) BDI-II. Beck Depressions-Inventar. Revision 2. Auflage. Pearson Assessment, Frankfurt
30.
Kühner C, Bürger C, Keller F et al (2007) Reliability and validity of the revised Beck Depression Inventory (BDI-II). Results from German samples (Reliabilitat und Validitat des revidierten Beck-Depressions-inventars (BDI-II). Befunde aus deutschsprachigen Stichproben). Nervenarzt 78(6):651–656CrossRefPubMed
31.
Alexandrowicz RW, Fritzsche S, Keller F (2014) Die Anwendbarkeit des BDI-II in klinischen und nichtklinischen Populationen aus psychometrischer Sicht. Eine vergleichende analyse mit dem Rasch-Modell (A psychometric view on the applicability of the BDI-II in non-clinical populations). Neuropsychiatr 28(2):63–73CrossRefPubMed
32.
Topp CW, Østergaard SD, Søndergaard S et al (2015) The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 84(3):167–176CrossRefPubMed
33.
Brähler E, Mühlan H, Albani C et al (2007) Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index. Diagnostica 53(2):83–96CrossRef
34.
Wagnild GM, Young HM (1993) Development and psychometric evaluation of the Resilience Scale. J Nurs Meas 1(2):165–178PubMed
35.
Leppert K, Koch B, Brähler E et al (2008) Die Resilienzskala (RS)—Überprüfung der Langform RS-25 und einer Kurzform RS-13. Klin Diagn Eval 2:226–243
36.
van Zerssen D, Petermann F (2012) MPT Münchner Persönlichkeitstest. 1. Auflage 2012. Hogrefe
37.
Costa PT, McCrae RR (1992) The five-factor model of personality and its relevance to personality disorders. J Personal Disord 6:343–359CrossRef
38.
Baudouin C, Aragona P, van Setten G et al (2014) Diagnosing the severity of dry eye: a clear and practical algorithm. Br J Ophthalmol 98(9):1168–1176CrossRefPubMedPubMedCentral
39.
World Health Organization (2017) Depression and other common mental disorders. Global Health Estimates, Geneva
40.
Tiskaoglu NS, Yazici A, Karlidere T et al (2017) Dry eye disease in patients with newly diagnosed depressive disorder. Curr Eye Res 42(5):672–676CrossRefPubMed
41.
Bartlett JD, Keith MS, Sudharshan L et al (2015) Associations between signs and symptoms of dry eye disease: a systematic review. Clin Ophthalmol 9:1719–1730CrossRefPubMedPubMedCentral
42.
Vehof J, Sillevis Smitt-Kamminga N, Nibourg SA et al (2017) Predictors of discordance between symptoms and signs in dry eye disease. Ophthalmology 124(3):280–286CrossRefPubMed
43.
Liu JC, Chang LY, Wu SY et al (2015) Resilience mediates the relationship between depression and psychological health status in patients with heart failure: a cross-sectional study. Int J Nurs Stud 52(12):1846–1853CrossRefPubMed
44.
Strauss B, Brix C, Fischer S et al (2007) The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT). J Cancer Res Clin Oncol 133(8):511–518CrossRefPubMed
45.
Cal SF, Santiago MB (2013) Resilience in systemic lupus erythematosus. Psychol Health Med 18(5):558–563CrossRefPubMed
46.
DeNisco S (2011) Exploring the relationship between resilience and diabetes outcomes in African Americans. J Am Acad Nurse Pract 23(11):602–610CrossRefPubMed
47.
Girtler N, Casari E-F, Brugnolo A et al (2010) Italian validation of the Wagnild and Young resilience scale: a perspective to rheumatic diseases. Clin Exp Rheumatol 28(5):669–678PubMed
48.
Zautra AJ, Arewasikporn A, Davis MC (2010) Resilience: promoting well-being through recovery, sustainability, and growth. Res Hum Dev 7(3):221–238CrossRef
49.
Katon W, Kleinman A, Rosen G (1982) Depression and somatization: a review. Am J Med 72(1):127–135CrossRefPubMed
50.
Kawashima M, Uchino M, Yokoi N et al (2015) Associations between subjective happiness and dry eye disease: a new perspective from the Osaka study. PLoS One 10(4):e0123299CrossRefPubMedPubMedCentral
51.
Fine PG (2011) Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med 12(7):996–1004CrossRefPubMed
52.
Mathews PM, Ramulu PY, Swenor BS et al (2017) Functional impairment of reading in patients with dry eye. Br J Ophthalmol 101(4):481–486CrossRefPubMed
53.
Arya S, Lee S, Zahner GJ et al (2018) The association of comorbid depression with mortality and amputation in veterans with peripheral artery disease. J Vasc Surg 68(2):536–545.e2CrossRefPubMedPubMedCentral
54.
Donnellan C, Hickey A, Hevey D et al (2010) Effect of mood symptoms on recovery one year after stroke. Int J Geriatr Psychiatry 25(12):1288–1295CrossRefPubMed
55.
Baumeister H, Hutter N, Bengel J (2012) Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database Syst Rev 12:CD008381PubMed
56.
DGPPN, BÄK, KBV et al. (2015) S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, 2. Auflage. Version 5
57.
DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160(14):2101–2107CrossRefPubMed
58.
Clarke DM, Currie KC (2009) Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 190(7 Suppl):S54–S60PubMedCrossRef
59.
Ghio L, Gotelli S, Cervetti A et al (2015) Duration of untreated depression influences clinical outcomes and disability. J Affect Disord 175:224–228CrossRefPubMed
60.
Ghio L, Gotelli S, Marcenaro M et al (2014) Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord 152-154:45–51CrossRefPubMed
Metadata
Title
Depressive symptoms, resilience, and personality traits in dry eye disease
Authors
Tina Kaiser
Birgit Janssen
Stefan Schrader
Gerd Geerling
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 3/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-019-04241-1

Other articles of this Issue 3/2019

Graefe's Archive for Clinical and Experimental Ophthalmology 3/2019 Go to the issue

Neuroophthalmology

Incidence and timing of recurrence of optic neuritis

Retinal Disorders

Swept source optical coherence tomography analysis of choroidal thickness in macular telangiectasia type 2: a case-control study

Editorial (by Invitation)

Requirement of age-dependent normalization of spectral-domain optical coherent tomography parameters in non-human primates for translational studies

Basic Science

An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery

Refractive Surgery

Comparison of the posterior corneal elevation and biomechanics after SMILE and LASEK for myopia: a short- and long-term observation

Retinal Disorders

Impact of segmentation density on spectral domain optical coherence tomography assessment in Stargardt disease