Depression and anxiety in visually impaired older people

To investigate the association between visual impairment and depression and anxiety in older people in Britain.

Population-based cross-sectional study.

Thirteen thousand nine hundred people aged 75 years and older in 49 family practices in Britain.

Vision was measured in 13 900 people aged 75 years and older in 49 family practices taking part in a randomized trial of health screening that included depression (Geriatric Depression Scale [GDS-15]) and anxiety (General Health Questionnaire [GHQ-28]). Cause of visual impairment (binocular acuity less than 6/18) was assessed from medical records. Analysis was by logistic regression (odds ratio [OR] and 95% confidence interval [CI]), taking account of potential health and social confounders.

Levels of depression and anxiety.

Visually impaired people had a higher prevalence of depression compared with people with good vision. Of visually impaired older people, 13.5% were depressed (GDS-15 score of 6 or more) compared with 4.6% of people with good vision (age- and gender-adjusted OR, 2.69; 95% CI, 2.03-3.56). Controlling for potential confounding factors, particularly activities of daily living, markedly attenuated the association between visual impairment and depression (OR, 1.26; 95% CI, 0.94-1.70). There was little evidence for any association between visual impairment and anxiety. On the GHQ-28 scale, 9.3% of visually impaired people had 2 or more symptoms of anxiety compared with 7.4% of people with good vision.

Although cause and effect cannot be established in a cross-sectional study, it is plausible that people with visual impairment are more likely to experience problems with functioning, which in turn leads to depression.