Prevalence of Mental Health Illness among Patients with Adult-Onset Strabismus

Abstract

Background Children diagnosed with some forms of strabismus were recently found to have an increased risk of developing mental illness by early adulthood. The purpose of this case-controlled study was to determine if adults with non-paralytic forms of strabismus are similarly at an elevated risk for developing mental illness. Methods The medical records of all patients diagnosed as adults (≥ 19 years of age) with convergence insufficiency (CI, n=118), divergence insufficiency (DI, n=80), and small angle hypertropia (HT, n=99) from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Each case was compared with a sex- and birthdate-matched non-strabismic control. The medical records were reviewed for mental health diagnoses, including inpatient and outpatient encounters, psychiatric ER visits, and medication use. Results Mental health disorders were diagnosed in 65 (55.1%) patients with CI compared to 54 (45.8%) controls (p=0.15), in 51 (63.8%) patients with DI compared to 42 (52.5%) controls (p=0.15), and in 63 (63.6%) patients with HT compared to 57 (57.6%) controls (p=0.38). CI patients were not more likely to have mental health disorders than their controls (p=0.15). Mental health hospitalizations (p=0.02), psychiatric medication use (p=0.04), and unspecified anxiety disorders (p=0.03) were higher in DI patients compared to controls. HT patients were found to have more generalized anxiety disorders (p=0.003) than controls. Conclusions Adults with some forms of strabismus (DI and HT) appear to have an increased risk of mental illness and its comorbidities, compared to age- and gender-matched non-strabismic controls.

Association of Strabismus With Mood Disorders, Schizophrenia, and Anxiety Disorders Among Children

“…There is prior evidence that patients with esotropia, exotropia, or hypertropia have increased risk of developing mental illness. 23,24 However, it is unclear whether the type of strabismus has an association with the magnitude of mental illness risk. In 1 study, children with exotropia (intermittent exotropia and convergence insufficiency) were more likely to develop mental illness than those without strabismus, whereas children with esotropia (congenital, accommodative, and nonaccommodative) were not more likely to develop mental illness compared with controls.…”

Self-reported health and smoking status, and body mass index: a case-control comparison based on GEN SCRIP (GENetics of SChizophRenia In Pakistan) data

“…There are studies to suggest that visual problems are positively associated with schizophrenia. 54 56 The eye problems associated with schizophrenia include eye movement disorder, 60 strabismus 61–64 and visual impairment. 65 66 Certain systemic infections can have eye manifestations and can lead to schizophrenia.…”

High Risk for Attention-Deficit Hyperactive Disorder in Children with Strabismus: A Nationwide Cohort Study from the National Health Insurance Research Database

“…In the past decade, strabismus has been found to be related to mental health problems in both children and adults [11,[22][23][24][25]. In a Western study, patients with exotropiaespecially intermittent type-in particular were more prone to develop mental health problems than non-strabismus controls, and the top five mental health disorders related to strabismus were depression, ADHD, adjustment disorder, illegal drug use, and alcoholism [11].…”