Associations between refractive errors and mental health: A cohort study of UK Biobank participants

Although vision impairment has been shown to negatively impact the quality of daily life, no large-scale studies have reported the effect of refractive errors (REs) on mental health. Therefore, this study aimed to investigate the influence of different types and severities of REs on mental health disorders.

UK Biobank participants who underwent ophthalmologic examinations were analyzed in this population-based cohort study. A Cox proportional hazards regression model was established using REs as exposure factors to determine the associations between REs and the risk of mental health disorders. A multiple linear regression model was used to explore the relationships between REs and the outcomes of a 12-item mental health questionnaire. The primary and secondary outcomes were risk of mental health disorders and the 12-item mental health questionnaire results, respectively.

A cohort of 106,004 participants, initially free of mental disorders, was followed up for a median duration of 12.5 years, during which 15,608 (14.72 %) were diagnosed with mental health disorders. Participants with REs have a significantly higher risk of mental health disorders than those with emmetropia (hazard ratio [HR]: 1.07, 95 % CI: 1.01-1.13). Individuals with astigmatism (HR: 1.13, 95 % CI: 1.02-1.25), hyperopia (HR: 1.20, 95 % CI: 1.12-1.28), and hyperopia with astigmatism (HR: 1.28, 95 % CI: 1.13-1.44) had a higher risk of mental health disorders than those with emmetropia. The dose-response curve indicated that the risk of mental health disorders increased as corrected visual acuity decreased. Participants with REs had significantly lower life satisfaction and subjective well-being (both P < 0.01) and higher scores for neuroticism, depressive symptoms, and anxiety symptoms (all P < 0.01) than those with emmetropia, particularly among individuals with hyperopia and astigmatism (neuroticism: β = 1.16, 95 % CI: 0.87-1.45; depressive symptoms: β = 0.81, 95 % CI: 0.49-1.14; anxiety symptoms: β = 0.64, 95 % CI: 0.33-0.95).

Our study showed that participants with hyperopia, astigmatism, and reduced corrected visual acuity had a higher risk of mental health disorders than those with emmetropia or myopia. Furthermore, individuals with moderate-to-high myopia exhibited an increase in depressive or anxiety symptoms.