title: Dry eye disease and depression-anxiety-stress: A hospital-based case control study in Turkey.
abstract: OBJECTIVE
  The aim of the present study was to investigate the association between dry eye disease (DED) and psychosomatic conditions, such as depression, stress, and anxiety, and the distribution of associated risk factors.
  
  
  METHODS
  In this case control study, the sample consisted of 121 DED subjects and 242 control subjects. Each subjects was diagnosed as having DED or not by an ophthalmologist. Ocular Surface Disease Index and Depression Anxiety Stress Scales were administered to all subjects. Data were analysed using chi-square and Mann Whitney U tests as a univariate analysis and multiple logistic regression as a multivariate analysis.
  
  
  RESULTS
  Of 1,458 consecutive outpatients, clinically diagnosed DED was present in 121 individuals (8.3%). There was a significant relationship of family history of DED (OR, 1.43; 95% CI, 0.84-2.41), chronic disease history (OR, 2.84; 95% CI, 1.66-4.87), OSDI score (OR, 1.07; 95% CI, 1.97-4.06), depression (OR, 2.06; 95% CI, 1.30-3.27), anxiety (OR, 2.66; 95% CI, 1.67-4.23), and stress (OR, 2.33; 95% CI, 1.48-3.67) with DED.
  
  
  CONCLUSIONS
  Individuals with depression, anxiety and stress are more likely to experience DED. In addition to confirming some well-known risk factors, this study has found new associations between DED and a family history of DED and the presence of stress.
authors.affiliation: Ugur Yilmaz, MD, Specialist Ophthalmologist, Nigde State Hospital Eye Clinic, Nigde, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Yilmaz
authors.affiliation: Mehmet Enes Gökler, MD, Research Assistant, Department of Public Health, Eskisehir Osmangazi University, Medical Faculty, Eskisehir, Turkey.
authors.forename: Mehmet Enes
authors.initials: ME
authors.lastname: Gokler
authors.affiliation: Alaettin Unsal, MD, Professor, Department of Public Health, Eskisehir Osmangazi University, Medical Faculty, Eskisehir, Turkey.
authors.forename: Alaettin
authors.initials: A
authors.lastname: Unsal
keywords: Anxiety; Depression; Dry eye disease; Stress; Turkey