Alcohol use and positive screening results for depression and anxiety are highly prevalent among Chinese children with strabismus.
OBJECTIVE
To study associations between strabismus and alcohol use, anxiety, and depression among 10- to 17-year-old children in Guangdong, southern China.


METHODS
Cross-sectional, population-based study.


METHODS
Among 7537 children aged 6-17 years from 9 randomly selected primary and middle schools, ocular alignment was assessed with the Hirschberg light reflex, cover-uncover testing, and alternate cover testing at distance (6 m) and near (40 cm). Additionally, 4000 children (53.1%) aged 10+ years received self-administered questionnaires containing screening questions on alcohol use, anxiety, and depression.


RESULTS
Examinations were completed on 7464 of 7537 subjects (99.0%), including 3928 boys (52.6%), with a mean age of 11.1 ± 1.8 years. The prevalence of any strabismus, including exotropia (2.7%), esotropia (0.2%), and intermittent exotropia (3.9%), was 6.8%. Strabismus was more prevalent in urban students (7.3%) and female subjects (7.4%) compared to rural students (6.0%) and male subjects (6.2%) (all P < .05). In multivariate regression models, any strabismus was associated with older age and rural vs urban residence. Among 3903 children (97.6%) answering questionnaires, history of alcohol use (62.3% vs 36.3%) and positive screening responses for depression (26.0% vs 11.6%) and anxiety (10.3% vs 4.9%) were significantly (P < .01 for all) more common among children with strabismus.


CONCLUSIONS
These Chinese children with strabismus had a significantly higher prevalence of alcohol use and possible markers of emotional problems than children without strabismus. Further research should focus on the appropriateness of classifying surgical treatment for strabismus as "cosmetic" (ineligible for reimbursement) under China's rural health insurance.
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China.
Shibin
S
Lin
Zhongshan Ophthalmic Centre, Sun Yat Sen University, State Key Laboratory and Division of Preventive of Ophthalmology, Guangzhou, China; ORBIS International, New York, USA.
Nathan
N
Congdon
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China.
Jason C S
JC
Yam
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China.
Yuqiang
Y
Huang
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China.
Kunliang
K
Qiu
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China.
Di
D
Ma
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China.
Bin
B
Chen
Medical College of Shantou University, Shantou, China.
Liping
L
Li
Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China. Electronic address: bob239@163.com.
Mingzhi
M
Zhang
D000293:Adolescent; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D013285:Strabismus / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data