Publication: Evaluation of anxiety and depression using hospital anxiety and depression scale in patients with primary angle closure glaucoma
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Date
2022
Authors
Ting, Ooi Say
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Abstract
INTRODUCTION Primary angle closure glaucoma (PACG) is the second most common primary glaucoma after primary open angle glaucoma (POAG). It is a chronic disease and requires life-long treatment. Chronicity of the disease often affects mental health of patients with glaucoma. However, prevention and detection of mental health issue in patients with PACG are often neglected. PACG is associated with high rate of anxiety and depression. To optimise patients’ compliance and prognosis, every chronic illness, including PACG, should be managed holistically. OBJECTIVE The objectives of this study were to assess anxiety and depression using Malay version Hospital anxiety and depression scale (HADS) in PACG patients and to determine its association factors. METHOD A cross sectional study was conducted involving PACG patients from Hospital Universiti Sains Malaysia (HUSM), Hospital Raja Perempuan Zainab II (HRPZ II) and Hospital Kuala Krai from May 2020 till January 2022. A total of 150 patients were recruited. Ocular examination and Humphrey visual field (HVF) were performed. PACG severity was scored based on Advanced Glaucoma Intervention Study (AGIS) on the Humphrey visual field (HVF) of the worse eye. HADS was used to screen patients' symptoms of anxiety and depression. HADS is divided into screening for anxiety (HADS-A) and depression (HADS-D). If the score ≥ 9 is considered anxiety and depression based on respective questionnaire. The mean HADS score for anxiety (HADS-A) and depression (HADS-D) were determined. The associated factors of anxiety and depression were evaluated. RESULTS Out of 150 patients with PACG recruited in this study, 65.3% were female, 88.7% were Malay. The mean age of PACG was 65.3(8.8) years old. Percentage of PACG patients with anxiety and depression were 10% and 11.3% respectively. On multivariate analysis, a significant negative linear association was identified between age at recruitment with HADS-A (adjusted b=-0.20; 95% CI=-0.10, -0.02; p=0.004). There was positive linear association between number of acute angle closure (AAC) attack (adjusted b=0.17; 95% CI=0.09, 0.83; p=0.015) and severity of PACG (adjusted b=0.42, 95% CI=0.13, 0.25; P<0.001) with HADS-A. Multivariate analysis also showed positive linear association between number of AAC attack (adjusted b=0.17; 95% CI=0.11, 0.93; p=0.014) and severity of PACG (adjusted b=0.51; 95% CI=0.19, 0.33; p<0.001) with HADS-D. CONCLUSION The percentage of anxiety and depression in PACG patients were 10.0% and 11.3% respectively. Patients with PACG are susceptible to develop anxiety and depression especially among younger patients with multiple AAC attack and more severe visual field defect. A comprehensive approach to the management of PACG patients should include evaluation of their mental health status and early referral for mental health care, which may aid in optimising patients’ care and disease outcome.
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