Association between depression, anxiety, and treatment adherence in patients with diabetic macular edema

doi:10.5498/wjp.v16.i4.114081

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Apr 19, 2026 (publication date) through Mar 30, 2026

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World Journal of Psychiatry

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Apr 19, 2026; 16(4): 114081
Published online Apr 19, 2026. doi: 10.5498/wjp.v16.i4.114081

Association between depression, anxiety, and treatment adherence in patients with diabetic macular edema

Yan-Ling Jin, Shi-Wei Li, Ya-Min Wang, Bin Lu, Xiang-Ning Wang, Da Long

Yan-Ling Jin, Shi-Wei Li, Ya-Min Wang, Bin Lu, Xiang-Ning Wang, Da Long, Department of Ophthalmology, Shanghai Jiao Tong University Sixth People’s Hospital, Shanghai 200233, China

Co-first authors: Yan-Ling Jin and Shi-Wei Li.

Author contributions: Jin YL was responsible for the study conception and design, participant recruitment, data analysis, and drafting of the manuscript; Li SW, as a co-first author, contributed to data collection, follow-up coordination, and statistical analysis, as well as interpretation of results; Jin YL and Li SW jointly performed psychological and academic performance evaluations; Wang YM and Lu B assisted with data acquisition and contributed to data interpretation; Wang XN provided support in literature review and manuscript preparation; Long D, as the corresponding author, supervised the overall direction of the study, provided critical guidance, and contributed to data interpretation and substantive revision of the manuscript; Jin YL and Li SW are co-first authors and contributed equally to this work. All authors critically reviewed the manuscript, approved the final version, and agree to be accountable for all aspects of the work.

Supported by Shanghai Sixth People’s Hospital Retrospective Clinical Research Project (Lingang Special Project), No. ynhglg202522; Shanghai Sixth People’s Hospital Hospital-Level Clinical Research Project, No. ynhglg202523; and Shanghai Sixth People’s Hospital Hospital-Level Scientific Research Fund, No. ynts 202213.

Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, No. 2025-KY-305 (K).

Informed consent statement: Due to the retrospective nature of the study, informed consent was waived.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: There is no additional data available.

Corresponding author: Da Long, MD, Department of Ophthalmology, Shanghai Jiao Tong University Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, China. sldyyk66@sina.com

Received: October 10, 2025
Revised: November 29, 2025
Accepted: January 14, 2026
Published online: April 19, 2026
Processing time: 170 Days and 20.2 Hours

Abstract

BACKGROUND

Diabetic macular edema (DME) is a major cause of vision impairment among working-age adults with diabetes. Treatment adherence remains a considerable challenge, with psychological factors potentially playing a crucial role.

AIM

To investigate the relationship between depression, anxiety, and treatment adherence among patients with DME.

METHODS

A retrospective cohort study was conducted at our hospital January 2021 and August 2025, including 130 patients with DME. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. Treatment adherence was evaluated using the Medication Adherence Report Scale-5 and appointment attendance rates. Visual function and quality of life were measured using the National Eye Institute Visual Function Questionnaire-25.

RESULTS

Among 130 patients, 44.6% (n = 58) demonstrated depression symptoms (PHQ-9 ≥ 5), and 37.7% (n = 49) showed anxiety symptoms (GAD-7 ≥ 5). Poor medication adherence (Medication Adherence Report Scale-5 < 17) was observed in 43.1% (n = 56) of patients. Depression severity was significantly associated with low medication adherence (r = -0.42, P < 0.001) and reduced appointment attendance (r = -0.38, P < 0.001). Similarly, anxiety was inversely correlated with medication adherence (r = -0.35, P < 0.001). In multivariate analysis, moderate-to-severe depression (PHQ-9 ≥ 10) (odds ratio = 3.42, 95% confidence interval: 1.68-6.95, P = 0.001) and moderate-to-severe anxiety (GAD-7 ≥ 10) (odds ratio = 2.86, 95% confidence interval: 1.35-6.04, P = 0.006) were independent predictors of poor medication adherence. Patients with depression had significantly lower National Eye Institute Visual Function Questionnaire-25 composite scores than those without depression (58.3 ± 14.2 vs 72.6 ± 12.8, P < 0.001). Treatment adherence partially mediated the relationship between depression and visual outcomes, accounting for 28.6% of the total effect.

CONCLUSION

Depression and anxiety significantly impact treatment adherence in DME patients. Integrated care approaches addressing both psychological and ophthalmological aspects are essential for optimizing treatment outcomes.

Keywords: Diabetic macular edema; Depression; Anxiety; Treatment adherence; Visual function; Quality of life

Core Tip: Depression and anxiety are frequent psychiatric comorbidities in patients with diabetic macular edema and play a crucial role in treatment adherence. This retrospective study found that both disorders were strongly associated with poor medication compliance and reduced appointment attendance, ultimately leading to impaired visual outcomes and lower quality of life. Treatment adherence partially mediated the link between depression and vision loss. These findings underscore the need for integrated management strategies that combine psychiatric care with ophthalmological treatment to optimize adherence and improve clinical prognosis in diabetic macular edema.