The relationship between diabetic retinopathy and psychosocial functioning: a systematic review
Abstract
Importance Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the association remains uncertain.Objective To determine the relationship between DR/DME and psychosocial functioning, the latter an umbrella term used to capture the emotional and social aspects of functioning which may include, for example, depression; depressive disorder; anxiety; vision-specific distress; diabetes-specific distress and emotional and social well-being.Evidence review PubMed, Embase, Medline and the Cochrane Central register were systematically searched for relevant interventional and observational quantitative studies using standardised criteria. Studies with DR/DME and psychosocial functioning as exposures or outcomes were accepted. Study quality was evaluated using the modified Newcastle-Ottawa scale for observational studies, and the modified Down's and Black checklist for interventional studies.Findings Of 1827 titles initially identified, 42 were included in the systematic review. They comprised of four interventions (one RCT, three non-RCTs) and 38 observational studies (33 cross sectional, five prospective). In studies with DR/DME as the exposure (n = 28), its severity and related vision impairment were consistently associated with poor psychosocial outcomes, mostly higher incidence of depression and depressive symptoms. Baseline depression and depressive symptoms were also associated with greater DR incidence and progression of DR. Medical intervention strategies showed significant improvement in psychosocial outcomes in patients with DR, such as significant improvements in mental health domain scores of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ 25).Conclusion and relevance Severity of DR, DME and associated vision loss are significantly associated with poor psychosocial outcomes. Aspects of depression and its symptoms show a bi-directional association, with increased incidence and progression of DR significant in those with baseline depression or depressive symptoms. Based on these findings, we propose two areas that may benefit from targeted interventions: (1) Prevention of development of poor psychological outcomes by preventing and delaying progression of DR/DME; and (2) Improved detection and management of poor psychological functioning by improving screening tools and multidisciplinary care for patients. Subsequent longitudinal studies can further help establish the underlying relationship between the two measures.
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Anxiety and depression in DR patients reduce their quality of life.
“It not only threatens the physical and mental health of DR patients, but also reduces the quality of life of patients.[9–12]”
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- Authors
- Khoo, K., Man, R. E. K., Rees, G., Gupta, P., Lamoureux, E. L., & Fenwick, E. K.
- Affiliations
- National University of Singapore (SG)
- The University of Melbourne (AU)
- Singapore Eye Research Institute (SG)
- Corresponding author
- Lamoureux, Ecosse L.
- Venue
- Quality of Life Research
- Published
- 2019-03-16
- Volume
- 28
- Issue
- 8
- Pages
- 2017-2039
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- OpenAlex
- W2921403879
- Cited by
- 89
- References
- 88
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 12 · 2023: 20 · 2022: 14 · 2021: 9 · 2020: 8 · 2017: 1
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Quality of Life Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- diabetic retinopathy, diabetic macular edema, psychosocial functioning, depression, depressive symptoms, visual impairment, diabetes distress, NEI VFQ-25, mental health, disease progression
- MeSH terms
- Anxiety, Cross-Sectional Studies, Depression, Depressive Disorder, Diabetic Retinopathy, Humans, Macular Edema, Male, Mental Health, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Vision Disorders, Incidence
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