title: The Role of Health Anxiety and Depressive Symptoms in Dry Eye Disease.
abstract: To investigate the associations between health anxiety, depressive and anxiety symptoms, and the severity of the subjective and objective symptoms of dry eye disease (DED).
  
  
  
  Participants completed the following psychological questionnaires: Shortened Health Anxiety Inventory, Shortened Beck Depression Inventory, and Beck Anxiety Inventory. Dry eye symptoms were evaluated using the ocular surface disease index (OSDI). Bilateral tear osmolarity measurement, tear film break-up time (TBUT), ocular surface staining, Schirmer 1 test, and meibomian gland dysfunction assessment were performed.
  
  
  
  Based on the OSDI score, 56 of the 84 participants enrolled were symptomatic and 28 asymptomatic. According to the objective parameters, 48/56 (85.7%) in the symptomatic group and 23/28 (82.1%) in the asymptomatic group were diagnosed with DED. In terms of the objective parameters, except for TBUT, there were no statistically significant differences between the symptomatic and asymptomatic group (p > 0.108), or between the subgroups with objectively proven dry eye (p > 0.233). The results of the psychological questionnaires were significantly worse in the symptomatic group (p < 0.01) and the symptomatic subgroup with objective dry eye (p < 0.05), than in the asymptomatic groups. In the overall study population the scores of the psychological questionnaires demonstrated significant positive correlations with the OSDI scores (r > 0.306, p < 0.01).
  
  
  
  These results support the role of health anxiety and of depressive and anxiety symptoms in DED, and may serve as an explanation for the lack of correlation between subjective symptoms and objective signs of the disease.
authors.affiliation: a Department of Ophthalmology , St. Pantaleon Hospital , Dunaújváros , Hungary.
authors.forename: Ildikó
authors.initials: I
authors.lastname: Szakáts
authors.affiliation: a Department of Ophthalmology , St. Pantaleon Hospital , Dunaújváros , Hungary.
authors.forename: Margit
authors.initials: M
authors.lastname: Sebestyén
authors.affiliation: b Department of Ophthalmology , Semmelweis University , Budapest , Hungary.
authors.forename: János
authors.initials: J
authors.lastname: Németh
authors.affiliation: c Institute of Behavioural Sciences , Semmelweis University , Budapest , Hungary.
authors.forename: Emma
authors.initials: E
authors.lastname: Birkás
authors.affiliation: c Institute of Behavioural Sciences , Semmelweis University , Budapest , Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Purebl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D003863:Depression / Q000209:etiology* / Q000523:psychology; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism*; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism*
keywords: Anxiety symptoms; depressive symptoms; dry eye disease; health anxiety