Associations between Dry Eye Disease and Mental Health Conditions in the All of Us Research Program

Purpose: To determine the association between dry eye disease (DED) and mental health conditions in a sociodemographically diverse nationwide population of Americans.

Design: Cross-sectional study.

Methods: We used the National Institute of Health's All of Us Research Program database to identify 18257 participants with DED who were propensity score matched in a 1:3 ratio to participants without DED. Univariate and multivariable logistic regression models were used to assess associations between DED and mental health conditions (i.e., depressive disorders, anxiety, bipolar disorder, and schizophrenic spectrum disorder).

Results: Participants with DED had a significantly higher prevalence of depressive disorders (31.6% vs. 10.7%; P<0.001), anxiety disorders (34.8% vs. 14.7%; P<0.001), bipolar disorder (5.5% vs. 2.3%; P<0.001), and schizophrenia spectrum disorders (2.3% vs. 0.9%; P<0.001) than controls. Adjusted for medical comorbidities (i.e., hypothyroidism, Sjögren's syndrome, systemic lupus erythematosus), participants with DED had higher odds than controls in having a depressive disorder (odds ratio (OR): 3.47; 95% CI: 3.32-3.62), anxiety (OR: 2.74; 95% CI: 2.63-2.85), bipolar disorder (OR: 2.23; 95% CI: 2.04-2.44), and schizophrenia spectrum disorder (OR: 2.48; 95% CI: 2.17-2.84). The association between DED and mental health conditions was stronger in Black participants than White participants (OR: 3.68 vs. 3.09, P<0.001).

Conclusions: Participants with DED were significantly more likely to have mental health conditions than matched participants without DED; this association was stronger in Black participants than White participants. Greater efforts should be undertaken to screen DED patients for mental health conditions, particularly in historically medically underserved populations.