Anxiety and depression in patients wearing prosthetic eyes
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OCULOPLASTICS AND ORBIT
Anxiety and depression in patients wearing prosthetic eyes Ludwig M. Heindl 1,2 & Marc Trester 3 & Yongwei Guo 1 & Florian Zwiener 1 & Narges Sadat 1 & Nicola S. Pine 4 & Keith R. Pine 5 & Andreas Traweger 6,7 & Alexander C. Rokohl 1 Received: 4 May 2020 / Revised: 12 August 2020 / Accepted: 19 August 2020 # The Author(s) 2020
Abstract Purpose To investigate anxiety and depression levels in prosthetic eye–wearing patients using standardized psychometric instruments, to define factors associated with these psychological diseases, and to identify a potential healthcare gap. Methods A total of 295 prosthetic eye wearers were screened using the 7-item generalized anxiety disorder scale (GAD-7) and the 9-item patient health questionnaire (PHQ-9). Scores of GAD-7 and PHQ-9 were correlated with scores of general physical and mental health functioning, vision-related quality of life, appearance-related distress, appearance-related social function, and further biosocial factors. Results Five patients (2%) had a pre-diagnosed anxiety disorder, and 20 patients (7%) had a pre-diagnosed depression. However, our screening revealed 26 patients (9%) with anxiety symptoms, 31 patients (11%) with depression symptoms, and 40 patients (14%) suffering from both anxiety and depression symptoms. This underdiagnosing for both anxiety and depression disorders was significant (p < 0.001, respectively). Higher GAD-7 scores were significantly associated with higher PHQ-9 scores, lower appearance-related social function, lower mental health functioning, and female gender (p ≤ 0.021, respectively). Higher PHQ-9 scores were significantly associated with lower physical and mental health functioning, higher educational degree, and nontraumatic eye loss (p ≤ 0.038, respectively). Conclusions Anxiety and depression disorders seem to be underdiagnosed in prosthetic eye wearers and to have higher incidence compared with the general population. Therefore, a psychometric screening should be routinely implemented in the clinical care. For a successful long-term rehabilitation, integrated care by a multidisciplinary team including ophthalmic plastic surgeons, ophthalmologists, ocularists, general practitioners, and psychologists is essential. Keywords Anxiety . Depression . Anophthalmia . Ocular prostheses . Cryolite glass prosthetic eyes . Integrated care
* Ludwig M. Heindl [email protected] 1
Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
2
Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
3
Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
4
Auckland District Health Board, Auckland, New Zealand
5
School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
6
Institute for Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria
7
Austri
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