NEW YORK (Reuters Health) – Strabismus in children is associated with anxiety disorder, schizophrenia, bipolar and depressive disorders, a cross-sectional study suggests.
“We were surprised by the high association between strabismus and anxiety disorders, even after adjusting for many comorbidities,” Dr. Stacy Pineles of the University of California, Los Angeles told Reuters Health by email. “We hypothesized that there would be an association but did not expect it to be 2x. We were also surprised that exotropia had higher associations with the mental illness conditions than esotropia.”
As reported in JAMA Ophthalmology, Dr. Pineles and colleagues analyzed claims data from more than 12,000,000 youngsters (mean age, 8 years; about half, female; about half, white).
A total of 352,636 children (about 3%) had strabismus; the rest served as controls.
Overall, children with strabismus had a higher prevalence of the five mental illnesses evaluated: anxiety disorder, depressive disorder, substance use or addictive disorder, “bipolar disorder” (bipolar and related disorders), and “schizophrenia” (schizophrenia spectrum and other psychotic disorders).
Adjusted odds ratios for the association of these illnesses with strabismus were 2.01 for anxiety disorder; 1.83 for schizophrenia; 1.64 for bipolar disorder; 1.61 for depressive disorder, and 0.99 for substance use disorder.
There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 for esotropia and bipolar disorder to 2.70 for exotropia and anxiety disorder.
The authors note that it is unclear whether the type of strabismus is associated with the magnitude of mental illness risk. Because of its cross-sectional design and use of claims data, the study cannot establish causality between strabismus and mental illness.
Dr. Pineles added, “it is important that pediatricians and pediatric ophthalmologists are aware of this association. Furthermore, parents should be alerted as well. Physicians and parents will need to be more vigilant in children with strabismus to observe for signs of any mental illness, but especially anxiety, depression and schizophrenia.”
Dr. Nathan Congdon of Queen’s University in Belfast, coauthor of a related editorial, commented by email, “Longitudinal interventional studies have encouragingly shown that operations to treat strabismus can reduce anxiety and depression.”
“We should be aware of the need to refer kids with strabismus for timely mental health evaluation, or at least raise the potential for these issues with parents in a sensitive fashion,” he said.
Further, he added, “Existing evidence suggests that health insurance should cover appropriate treatment for strabismus, rather than disallow coverage for this treatment as ‘cosmetic’ care.”
SOURCE: https://bit.ly/3MKTf1P and https://bit.ly/3KJ9BGd JAMA Ophthalmology, online March 10, 2022.
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