Mental Health Conditions Associated With Nasolacrimal Duct Obstruction in the NIH All of Us Research Program

Nasolacrimal duct obstruction (NLDO) is a common cause of chronic epiphora and visual disturbance. This project aims to evaluate the association between NLDO and a spectrum of mental health conditions in a racially and socioeconomically diverse national cohort.

A retrospective cohort study with cross-sectional and time-to-event analyses was conducted with data from January 1, 2007, to January 1, 2022. The population-based cohort was derived from the National Institutes of Health All of Us Research Program, a multicenter national research initiative in the United States that compiles deidentified patient health record data. Adults with a coded diagnosis of NLDO (n = 420) were identified and compared with 1,260 adults without NLDO selected through 1:3 propensity score matching on age, sex, race, ethnicity, income, education, and insurance status. Psychiatric diagnoses, including depression, anxiety, and bipolar disorder, were ascertained from Systematized Nomenclature of Medicine diagnostic codes extracted from linked electronic health records available within the All of Us Research Program platform. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression, and hazard ratios (HRs) for incident psychiatric diagnoses were estimated using Cox proportional hazards models.

NLDO was associated with higher prevalences of anxiety (32.1% vs. 12.5%), depression (34.3% vs. 11.2%), and bipolar disorder (4.8% vs. 1.7%). After adjustment, NLDO remained significantly associated with anxiety (OR 3.60), depression (OR 4.79), and bipolar disorder (OR 3.37) (all p < 0.01). In time-to-event analyses, NLDO was linked to increased hazards of depression (HR 3.98), anxiety (HR 8.30), and bipolar disorder (HR 6.97).

In this large, ethnically diverse national cohort, NLDO was associated with significantly increased prevalence and risk of mood and anxiety disorders. These findings suggest that NLDO carries a meaningful psychosocial burden and support consideration of mental health screening and integrated care in affected patients.