Effect of visual impairment on depression and anxiety during the COVID-19 pandemic in the United States

OBJECTIVE: To evaluate associations between visual impairment, anxiety, and depression during the COVID-19 pandemic in the United States. DESIGN: Retrospective cross-sectional design. METHODS: This study included a cohort of U.S. adults enrolled in the National Institutes of Health All of Us Research Program. Individuals who were blind/visually impaired (BVI) were identified via Systematized Nomenclature of Medicine (SNOMED) codes and compared with a control cohort. Prevalences of baseline, new, and worsened depression and anxiety, as defined by SNOMED codes and medication use, were compared between the 2 groups. Anxiety and depression during the COVID-19 pandemic were evaluated using the Generalized Anxiety Disorder 7 and the Patient Health Questionnaire 9 surveys, respectively. RESULTS: A total of 324,915 participants (7526 BVI individuals and 317,389 control individuals) were included. BVI individuals had higher prevalences of baseline anxiety and depression (50.4% vs 28.7%; p < 0.001), new anxiety and depression (0.98% vs 0.66%; p < 0.001), and worsened anxiety and depression throughout the COVID-19 pandemic (0.19% vs 0.07%; p < 0.001) compared with control individuals. Being BVI was significantly associated with baseline and worsened anxiety and depression after controlling for age, sex, race, ethnicity, and comorbidity (adjusted odds ratio [aOR] = 1.61; 95% CI, 1.46–1.78 and aOR = 2.07; 95% CI, 1.03–4.13). Similarly, being BVI was associated with a 2.07 point increase on the Generalized Anxiety Disorder 7 survey (adjusted β = 2.07; 95% CI, 1.32–3.27) and a 2.96 point increase on the Patient Health Questionnaire 9 survey (adjusted β = 2.96; 95% CI, 1.64–5.36). CONCLUSIONS: These findings indicate that BVI individuals were disproportionately affected by anxiety and depression at baseline and throughout the pandemic, highlighting an important need to promote access to mental health services among this population.