title: Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study.
abstract: OBJECTIVE
  To investigate the association of demographic, clinical and psychosocial variables with levels of anxiety and depression in participants wearing an ocular prosthesis after eye enucleation.
  
  
  METHODS
  This cross-sectional study included 195 participants with an enucleated eye who were attending an ophthalmic clinic for prosthetic rehabilitation between July and November 2014. Demographic and clinical data, and self-reported feelings of shame, sadness and anger were collected. Participants also completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and the Hospital Anxiety and Depression Scale. Regression models were used to identify the factors associated with anxiety and depression.
  
  
  RESULTS
  The proportion of participants with clinical anxiety was 11.8% and clinical depression 13.8%. More anxiety and depression were associated with poorer vision-related quality of life and greater levels of appearance concerns. Younger age was related to greater levels of anxiety. Less educated participants and those feeling more angry about losing an eye are more prone to experience depression. Clinical variables were unrelated to anxiety or depression.
  
  
  CONCLUSIONS
  Anxiety and depression are more prevalent in eye-enucleated patients than the general population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal studies need to be conducted to further elucidate the direction of causality before interventions to improve mood states are developed.
authors: Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Juan
authors: J
authors: Ye
authors: Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Lixia
authors: L
authors: Lou
authors: Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Kai
authors: K
authors: Jin
authors: Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Yufeng
authors: Y
authors: Xu
authors: Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Xin
authors: X
authors: Ye
authors: Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, United Kingdom.
authors: Timothy
authors: T
authors: Moss
authors: School of Health Sciences, City University London, London, United Kingdom.
authors: Hayley
authors: H
authors: McBain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D015353:Eye Enucleation / Q000523:psychology* / Q000534:rehabilitation; D005137:Eye, Artificial / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014785:Vision, Ocular