According to the American Diabetes Association, routine mental health assessments and treatments are important for ensuring good health outcomes in patients with diabetes. Photo: Jay Haynie, OD. Click image to enlarge.

Loss to follow-up is a common hurdle practices encounter with diabetic retinopathy patients. Regular treatment is key, but because of the many health and socioeconomic challenges often faced by those with the disease, attending appointments can be challenging. The depression incidence among individuals with diabetes is estimated to be up to 30%—considerably higher than that of the general population (2% to 9%). Researchers recently investigated the relationship between depression and adherence to regular dilated fundus examinations. Their findings, published in Ophthalmic Research, showed that there is an association between depression and compliance, and that this association varies by sex.

The cross-sectional study used data from the National Health and Nutrition Examination Survey database. They classified participants as having depression based on a score greater than 9 on the Patient Health Questionnaire-9. A total of 3,656 participants were included in the study.

The researchers reported that participants without depression had higher adherence rates to annual or biennial dilated fundus exam than those with depression (annual: 64.8% vs. 56.1%; biennial: 80.3% vs. 69.7%). Multivariate analyses showed that depression wasn’t independently associated with adherence; however, sex-stratified data showed that only female patients with diabetes and depression had a significantly higher likelihood of nonadherence to either exam (odds ratio: annual 1.52 and biennial 1.55).

Based on these findings, the researchers concluded in their paper that “females with depression and diabetes should receive more attention for timely interventions for diabetic retinopathy.” They wrote that further studies are needed to help identify the mechanisms underlying this sex disparity, but that it may be related to the higher prevalence of depression in women than in men.

Zhong Z, Lin Y, Zhong L, et al. Sex difference in the association between depression and adherence to recommended dilated eye examinations among patients with diabetes: findings from the National Health and Nutrition Examination Survey. Ophthalmic Res 2023. [Epub October 11, 2023].