Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants (Respondents)
2.2. Questionnaires
2.3. Statistical Methods
2.4. Study Approval
3. Results
3.1. Basic Characteristics of the Participants
3.2. Correlations Between Glaucoma Stages and Anxiety (GAD-7) Correlation of Respondents’ Anxiety (GAD-7 Questionnaire) with Respondents’ Characteristics
3.3. Correlations Between Glaucoma Stages and Depression (PHQ-9) Association of Depression (PHQ-9 Questionnaire) with Characteristics of the Subjects
3.4. Correlations Between Glaucoma Stages and Psychoneurotic Disorders (CCEI)
3.5. Association of Psychoneurotic Disorders (CCEI Questionnaire) with the Age of the Subjects, the Duration of Treatment and the Stage of Glaucoma
3.6. The Influence of Glaucoma Stage and Other Characteristics of the Subjects on the Severity of Anxiety and Depression
3.7. Correlation of the Depression Subscale with the Characteristics of the Subjects
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ACG | Angle-closure glaucoma |
ATG | Antiglaucoma |
CCEI | Crown-Crisp Experiential Index |
dB | Decibel |
FFA | Free-floating anxiety |
GAD-7 | General Anxiety Disorder 7 |
GAT | Goldmann applanation tonometry |
GCL | Ganglion cell layer |
IOP | Intraocular pressure |
IQR | Interquartile range |
MD | Mean deviation |
mmHg | Millimeters of mercury |
NTG | Normal tension glaucoma |
OAG | Open-angle glaucoma |
OR | Odds ratio |
PHOA | Phobic anxiety |
PHQ-9 | Patient Health Questionnaire 9 |
POAG | Primary open-angle glaucoma |
RNFL | Retinal nerve fibre layer |
VF | Visual field |
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Instrument | Purpose/Primary Focus | Number of Items | Clinical Validation | Usability for Patients |
---|---|---|---|---|
CCEI (Crown–Crisp Experiential Index) | Assesses six domains of neurotic disorders: free-floating anxiety, phobic anxiety, obsessiveness, somatic symptoms, depression, and hysteria | 48 | Validated in multiple clinical populations; commonly used in psychoneurotic assessments [32] | Moderate—requires more time and cognitive effort |
GAD-7 (Generalized Anxiety Disorder-7) | Screens for and measures severity of generalized anxiety disorder | 7 | Widely validated and recommended for clinical use [36] | High—short, simple, and user-friendly |
PHQ-9 (Patient Health Questionnaire-9) | Screens for and evaluates severity of depressive symptoms | 9 | High clinical validity and reliability [37] | High—brief and easy to administer |
Sex [n (%)] | |
Male | 68 (34) |
Female | 132 (66) |
Age groups [n (%)] | |
Up to 55 | 22 (11.0) |
56–65 years | 92 (46.0) |
66 and over | 86 (43.0) |
OAG stage [n (%)] | |
Stage I | 68 (34.0) |
Stage II | 65 (32.5) |
Stage III | 67 (33.5) |
Earlier ophthalmological state [n (%)] | 36 (18.0) |
Subjective feeling under stress [n (%)] | 93 (46.5) |
Achieved IOP goal [n (%)] | 150 (75) |
Age (years) [Median (IQR)] | 65 (60–68) |
Length of treatment (months) [Median (IQR)] | 96 (39–156) |
Number of application of ATG therapy per day [Median (IQR)] | 2 (1–2) |
OAG stage [n (%)] | |
Stage I | 68 (34.0) |
Stage II | 65 (32.5) |
Stage III | 67 (33.5) |
GAD-7 Total Score [Median (IQR)] | 8 (4–12) |
Level of anxiety [n (%)] | |
Mild (0–4) | 55 (27.5) |
Moderate (5–9) | 64 (32.0) |
Moderately Severe (10–14) | 62 (31.0) |
Severe anxiety (15–21) | 19 (9.5) |
PHQ-9 Total Score [Median (IQR)] | 7 (3–11) |
Level of depression [n (%)] | |
Minor (0–4) | 69 (34.5) |
Mild (5–9) | 62 (31.0) |
Moderate (10–14) | 38 (19.0) |
Moderately Severe (15–19) | 28 (14.0) |
Severe depression (20–27) | 3 (1.5) |
Median (IQR) GAD-7 | Difference | 95% Confidence Interval | p | |
---|---|---|---|---|
Gender | ||||
Men | 8 (4–12) | 0 | −1–2 | 0.99 * |
Women | 8 (4–12) | |||
Age groups | ||||
Up to 55 years | 5 (3–9) | 0.06 † | ||
56–65 years | 8 (5–12) | - | - | |
66 and over | 9 (4–13) | |||
OAG stage | ||||
Stage I | 7 (5–12) | 0.91 † | ||
Stage II | 8 (4–12) | - | - | |
Stage III | 8 (4–12) | |||
Feeling stressed | ||||
No | 5 (3–9) | 5 | 3–6 | <0.001 * |
Yes | 11 (7–14) | |||
Achieved IOP target values | ||||
No | 7 (4–11) | 1 | 0–3 | 0.13 * |
Yes | 8 (4–13) |
Spearman’s Rho Correlation Coefficient (p Value) | |||
---|---|---|---|
Age of the Respondent | Length of Treatment | Glaucoma Stage | |
GAD-7 scale—all respondents | 0.133 (0.06) | 0.124 (0.08) | 0.001 (0.99) |
GAD-7 scale | |||
IOP target values not achieved | −0.157 (0.28) | 0.209 (0.15) | 0.110 (0.45) |
IOP target values achieved | 0.215 (0.008) | 0.120 (0.14) | 0.036 (0.66) |
Median (IQR) | Difference | 95% Confidence Interval | p | |
---|---|---|---|---|
Sex | ||||
Male | 7 (4–11) | 0 | −1–2 | 0.76 * |
Female | 7 (3–12) | |||
Age groups | ||||
Up to 55 | 6 (3–7) | - | - | 0.03 †§ |
56–65 years | 6 (3–11) | |||
66 and over | 8 (4–13) | |||
OAG stage | ||||
Stage I | 6 (4–11) | 0.95 † | ||
Stage II | 7 (3–11) | - | - | |
Stage III | 7 (3–12) | |||
Feeling stressed | ||||
No | 4 (3–7) | 6 | 4–7 | <0.001 * |
Yes | 11 (7–15) | |||
Achieved IOP target values | ||||
Not | 6 (3–9) | 1 | −1–2 | 0.31 * |
That | 7 (4–12) |
Spearman’s Rho Correlation Coefficient (p Value) | |||
---|---|---|---|
Age of Subjects | Length of Treatment | Degree of Glaucoma | |
PHQ-9 scale—all respondents | 0.182 (0.01) | 0.199 (0.005) | 0.020 (0.78) |
PHQ-9 scale | |||
IOP target values not achieved | −0.152 (0.29) | 0.144 (0.32) | 0.154 (0.29) |
IOP target values achieved | 0.269 (0.001) | 0.221 (0.006) | 0.035 (0.67) |
Median (IQR) | Range from Minimum to Maximum Value | |
---|---|---|
Free floating anxiety (FFA) | 5 (2–10) | 0–16 |
Phobic anxiety (PHOA) | 5 (4–7) | 0–16 |
Obsessiveness | 8 (6–10) | 0–14 |
Somatic manifestations of anxiety | 7 (4–10) | 0–16 |
Depression | 7 (4–9) | 0–14 |
Hysteria | 4 (2–5) | 0–12 |
Number (%) of Respondents in Relation to the Severity of Each Subscale | ||
Not Expressed | Expressed | |
Free floating anxiety (FFA) | 119 (59.5) | 81 (40.5) |
Phobic anxiety (PHOA) | 133 (66.5) | 67 (33.5) |
Obsessiveness | 158 (79.0) | 42 (21.0) |
Somatic manifestations of anxiety | 133 (66.5) | 67 (33.5) |
Depression | 102 (51.0) | 98 (49.0) |
Hysteria | 146 (73.0) | 54 (27.0) |
Spearman’s Correlation Coefficient Rho (p Value) | |||
---|---|---|---|
Age of the Respondent | Duration of Treatment | Glaucoma Stage | |
All respondents | |||
Free floating anxiety (FFA) | 0.068 (0.34) | 0.109 (0.12) | −0.006 (0.94) |
Phobic anxiety (PHOA) | 0.042 (0.56) | 0.051 (0.48) | 0.049 (0.49) |
Obsessiveness | 0.050 (0.48) | 0.050 (0.48) | −0.147 (0.04) |
Somatic manifestations of anxiety | 0.190 (0.01) | 0.164 (0.02) | 0.022 (0.76) |
Depression | 0.183 (0.01) | 0.082 (0.25) | 0.023 (0.75) |
Hysteria | −0.021 (0.77) | 0.051 (0.48) | −0.134 (0.06) |
Target IOP not reached | |||
Free floating anxiety (FFA) | −0.344 (0.01) | 0.022 (0.88) | −0.053 (0.71) |
Phobic anxiety (PHOA) | −0.062 (0.67) | 0.011 (0.94) | 0.154 (0.29) |
Obsessiveness | −0.057 (0.69) | 0.013 (0.93) | −0.104 (0.47) |
Somatic manifestations of anxiety | 0.034 (0.81) | 0.042 (0.77) | −0.053 (0.71) |
Depression | −0.040 (0.78) | 0.090 (0.54) | −0.084 (0.56) |
Hysteria | −0.125 (0.39) | −0.086 (0.55) | −0.323 (0.02) |
Target IOP achieved | |||
Free floating anxiety (FFA) | 0.174 (0.03) | 0.143 (0.08) | 0.043 (0.60) |
Phobic anxiety (PHOA) | 0.077 (0.35) | 0.067 (0.42) | 0.052 (0.53) |
Obsessiveness | 0.096 (0.24) | 0.068 (0.41) | −0.094 (0.26) |
Somatic manifestations of anxiety | 0.222 (0.01) | 0.197 (0.02) | 0.073 (0.37) |
Depression | 0.251 (<0.001) | 0.100 (0.23) | 0.100 (0.23) |
Hysteria | 0.016 (0.84) | 0.100 (0.22) | −0.028 (0.74) |
β | Wald | p | Odds Ratio (OR) | 95% Confidence Interval | |
---|---|---|---|---|---|
PHQ-9 | |||||
Age (66 and over) | 0.06 | 5.50 | 0.02 | 2.03 | 1.03–3.99 |
Feeling stressed | 2.27 | 39.3 | <0.001 | 9.47 | 4.75–19.59 |
Constant | −6.27 | 10.7 | 0.001 | ||
GAD-7 | |||||
Feeling stressed | 1.79 | 21.4 | <0.001 | 6.02 | 2.82–12.9 |
Constant | 0.32 | 2.68 | 0.04 | ||
FFA (CCEI) | |||||
Sex (Female) | 1.11 | 7.97 | 0.005 | 3.03 | 1.40–6.52 |
Feeling stressed | 2.04 | 28.9 | <0.001 | 7.70 | 3.66–16.21 |
Constant | −2.03 | 30.6 | <0.001 | ||
PHOA (CCEI) | |||||
Sex (Female) | 1.81 | 21.3 | <0.001 | 6.12 | 2.84–13.2 |
Age | 0.08 | 6.05 | 0.01 | 1.08 | 1.02–1.15 |
Feeling stressed | 1.20 | 9.88 | 0.002 | 3.33 | 1.57–7.05 |
Constant | −6.9 | 2.1 | 0.001 |
Median (IQR) Depression Subscales | Difference | 95% Confidence Interval | p * | |
---|---|---|---|---|
Sex | ||||
Male | 5 (4–8) | 1 | 0–2 | 0.006 |
Female | 7 (5–9) | |||
Age groups | ||||
Under 55 years | 5 (4–6) | 0.007 †§ | ||
56–65 years | 6 (4–9) | - | - | |
66 and over | 7 (4–9) | |||
Stage of OAG | ||||
Stage I | 7 (4–9) | 0.94 † | ||
Stage II | 6 (4–9) | - | - | |
Stage III | 7 (4–9) | |||
Feeling stressed | ||||
No | 5 (3–7) | 3 | 2–3 | <0.001 |
Yes | 8 (6–10) | |||
Achieved IOP target values | ||||
No | 6 (4–8) | 1 | 0–2 | 0.15 |
Yes | 7 (4–9) |
Number (%) of Respondents According to Severity of Depression | p * | |||
---|---|---|---|---|
No (n = 102) | Yes (n = 98) | Total (n = 200) | ||
Sex | ||||
Male | 37 (36.3) | 31 (31.6) | 68 (34) | 0.49 |
Female | 65 (63.7) | 67 (68.4) | 132 (66) | |
Age groups | ||||
Up to 55 years | 18 (17.6) | 4 (4.1) | 22 (11) | 0.001 |
56–65 years | 51 (50) | 41 (41.8) | 92 (46) | |
66 and over | 33 (32.4) | 53 (54.1) | 86 (43) | |
Stage of OAG | ||||
Stage I | 34 (33.3) | 34 (34.7) | 68 (34) | 0.46 |
Stage II | 37 (36.3) | 28 (28.6) | 65 (32.5) | |
Stage III | 31 (30.4) | 36 (36.7) | 67 (33.5) | |
Target IOP achieved | 73 (71.6) | 77 (78.6) | 150 (75) | 0.25 |
Feeling stressed | 34 (33.3) | 59 (60.2) | 93 (46.5) | <0.001 |
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Olujić, M.; Biuk, D.; Balog, S.; Kotromanović Šimić, I.; Kotromanović, D.; Dodig-Ćurković, K. Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage. J. Clin. Med. 2025, 14, 3954. https://doi.org/10.3390/jcm14113954
Olujić M, Biuk D, Balog S, Kotromanović Šimić I, Kotromanović D, Dodig-Ćurković K. Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage. Journal of Clinical Medicine. 2025; 14(11):3954. https://doi.org/10.3390/jcm14113954
Chicago/Turabian StyleOlujić, Marija, Dubravka Biuk, Slaven Balog, Ivana Kotromanović Šimić, Darko Kotromanović, and Katarina Dodig-Ćurković. 2025. "Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage" Journal of Clinical Medicine 14, no. 11: 3954. https://doi.org/10.3390/jcm14113954
APA StyleOlujić, M., Biuk, D., Balog, S., Kotromanović Šimić, I., Kotromanović, D., & Dodig-Ćurković, K. (2025). Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage. Journal of Clinical Medicine, 14(11), 3954. https://doi.org/10.3390/jcm14113954