Psychological states in diabetic retinopathy: Social support correlates and risk factors

Table 1 Hamilton Anxiety Scale-based anxiety classification in diabetic retinopathy subjects

Categories	Score range (points)	Results
No anxiety	0-6	30 (24.00)
Possible anxiety	7-13	53 (42.40)
Definite anxiety	14-20	37 (29.60)
Significant anxiety	21-28	5 (4.00)
Severe anxiety	≥ 29	0 (0.00)
Total	0-56	11.1 ± 5.22

Table 2 Hamilton Depression Scale evaluation findings in diabetic retinopathy patients

Categories	Score range (points)	Results
No depression	0-6	31 (24.80)
Possible depression	7-16	63 (50.40)
Definite depression	17-23	29 (23.20)
Severe depression	≥ 24	2 (1.60)
Total	0-56	10.83 ± 5.75

Table 3 Psychological states in diabetic retinopathy cases, n (%)

Categories	Criteria	Results
Anxiety rate	HAMA ≥ 14 points	42 (33.60)
Depression rate	HAMD ≥ 17 points	31 (24.80)
Anxiety or depression rate	HAMA ≥ 14 points or HAMD ≥ 17 points	62 (49.60)
Anxiety-depression comorbidity rate	HAMA ≥ 14 points and HAMD ≥ 17 points	11 (8.80)

HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Table 4 Assessment of social support among diabetic retinopathy cases

Categories	Score range (points)	Results
Subjective support	8-32	20.85 ± 6.59
Objective support	1-22	6.89 ± 5.92
Utilization of support	3-12	6.63 ± 2.70
Total	12-66	34.37 ± 7.69
Minimal support	12-22	7 (5.60)
Intermediate support	23-44	106 (84.80)
Robust support	45-66	12 (9.60)

Table 5 Relationship between anxiety/depression and social support in diabetic retinopathy patients

Categories	SSRS (points)
	r	P value
HAMA (points)	-0.396	< 0.001
HAMD (points)	-0.481	< 0.001
NPDR cases (n = 99)
HAMA (points)	-0.435	< 0.001
HAMD (points)	-0.463	< 0.001
PDR cases (n = 26)
HAMA (points)	-0.372	0.061
HAMD (points)	-0.374	0.060

SSRS: Social Support Rating Scale; HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale; NPDR: Non-proliferative diabetic retinopathy; PDR: Proliferative diabetic retinopathy.

Table 6 Univariable evaluation of contributors to psychological distress states in diabetic retinopathy cases, n (%)

Variable	Psychological distress group (n = 62)	Non-psychological distress group (n = 63)	χ2	P value
Age (years)			0.961	0.327
< 55 (n = 70)	32 (51.61)	38 (60.32)
≥ 55 (n = 55)	30 (48.39)	25 (39.68)
Sex			0.986	0.321
Male (n = 67)	36 (58.06)	31 (49.21)
Female (n = 58)	26 (41.94)	32 (50.79)
DM course (years)			13.873	< 0.001
< 8 (n = 75)	27 (43.55)	48 (76.19)
≥ 8 (n = 50)	35 (56.45)	15 (23.81)
Disease stage			1.872	0.171
NPDR (n = 99)	46 (74.19)	53 (84.13)
PDR (n = 26)	16 (25.81)	10 (15.87)
Per capita monthly household income (CNY)			5.793	0.016
< 5000 (n = 93)	52 (83.87)	41 (65.08)
≥ 5000 (n = 32)	10 (16.13)	22 (34.92)
Visual disturbance comorbidity			8.193	0.004
No (n = 25)	6 (9.68)	19 (30.16)
Yes (n = 100)	56 (90.32)	44 (69.84)
Coexisting hypertension			10.899	< 0.001
No (n = 84)	33 (53.23)	51 (80.95)
Yes (n = 41)	29 (46.77)	12 (19.05)
Familial DM history			8.894	0.003
No (n = 95)	40 (64.52)	55 (87.30)
Yes (n = 30)	22 (35.48)	8 (12.70)
SSRS (points)			8.827	0.003
< 35 (n = 68)	42 (67.74)	26 (41.27)
≥ 35 (n = 57)	20 (32.26)	37 (58.73)

NPDR: Non-proliferative diabetic retinopathy; PDR: Proliferative diabetic retinopathy; DM: Diabetes mellitus; SSRS: Social Support Rating Scale; CNY: Chinese yuan.

Table 7 Multivariable evaluation of determinants affecting psychological distress in diabetic retinopathy individuals

Variable	B	SE	Wald	P value	OR	95%CI
Course of DM (years)	1.097	0.460	5.684	0.017	2.995	1.215-7.378
Per capita monthly household income (CNY)	-1.007	0.533	3.563	0.059	0.365	0.129-1.039
Visual disturbance comorbidity	1.715	0.612	7.848	0.005	5.559	1.674-18.460
Coexisting hypertension	1.348	0.494	7.456	0.006	3.851	1.463-10.137
Familial DM history	1.458	0.573	6.483	0.011	4.299	1.399-13.211
SSRS (points)	-1.072	0.450	5.679	0.017	0.342	0.142-0.827

OR: Odds ratio; CI: Confidence interval; DM: Diabetes mellitus; SSRS: Social Support Rating Scale; CNY: Chinese yuan.