Abstract
Purpose: We aimed to investigate the risk of developing depression in individuals with primary open-angle glaucoma with associated vision impairment. Methods: We conducted a nationwide, population-based cohort study using data from the Korean National Health Information Database and National Disability Registry. We assessed baseline characteristics such as age, sex, income level, lifestyle factors, anthropometric data, lab results, and Charlson Comorbidity Index scores through diagnostic codes and health screening data. Depression risk in relation to glaucoma and vision impairment was analyzed using a multivariable-adjusted Cox proportional hazard model. Results: Among 3,680,570 individuals screened through the Korean National Health Screening Program in 2009, 681,515 were newly diagnosed with depression during follow-up. Subjects with glaucoma showed a higher risk of depression than those without glaucoma, with an adjusted hazard ratio (HR) of 2.011 (95 % confidence interval [CI]: 1.946-2.078) pre-adjustment and 1.085 (95 % CI: 1.050-1.121) post-adjustment for covariates. For those with glaucoma and vision impairment, the adjusted HR increased to 1.164 (95 % CI: 1.045-1.297) and to 1.207 (95 % CI: 1.039-1.403) with severe vision impairment. The association between glaucoma and depression was more pronounced in men (P for interaction = 0.001) and those with a Charlson Comorbidity Index <3 (P for interaction = 0.008). Conclusions: Primary open-angle glaucoma increased the risk of developing depression. The risk escalated gradually with the presence and severity of concurrent vision impairment. The impact of glaucoma and vision impairment on new-onset depression was greater in men and in those with less comorbidities.