title: The association between dry eye disease and depression and anxiety in a large population-based study.
abstract: OBJECTIVE
  To investigate the association between dry eye disease and each of depression and anxiety.
  
  
  METHODS
  Retrospective, case-control study.
  
  
  METHODS
  setting: University of North Carolina outpatient clinics. study population: All patients over the age of 18 years seen between July 2008 and June 2013 were included in the analysis. observation procedure: Cases were defined according to ICD-9 diagnosis codes for dry eye disease, anxiety, and depression. outcome measure: Separate odds ratios were calculated for dry eye disease and each of anxiety and depression. Similar odds ratios were also calculated between dry eye disease and rheumatoid arthritis, a systemic disease with a known association with dry eye, as a way of validating our approach.
  
  
  RESULTS
  A total of 460 611 patients were screened; 7207 patients with dry eye were included, while 20 004 patients with anxiety and 30 100 patients with depression were included. The adjusted odds ratio for dry eye disease and anxiety was 2.8 (95% confidence interval [CI] 2.6-3.0). For dry eye disease and depression, the odds ratio was 2.9 (95% CI 2.7-3.1).
  
  
  CONCLUSIONS
  We identified a statistically significant association between dry eye disease and each of depression and anxiety. Such an association has implications for ophthalmologists in the management and treatment of dry eye disease.
authors.affiliation: Department of Ophthalmology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Robert
authors.initials: R
authors.lastname: van der Vaart
authors.affiliation: The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: Department of Ophthalmology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Lefebvre
authors.affiliation: Department of Ophthalmology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: Richard_davis@med.unc.edu.
authors.forename: Richard Marc
authors.initials: RM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000503:physiopathology*; D001172:Arthritis, Rheumatoid / Q000503:physiopathology; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000503:physiopathology*; D015352:Dry Eye Syndromes / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D055815:Young Adult