Impact of Dry Eye on Psychosomatic Symptoms and Quality of Life in a Healthy Youthful Clinical Sample

Objective: To determine the impact of dry eye on quality of life, depression, anxiety, and stress in a healthy youthful clinical sample. Methods: This was a clinic-based cross-sectional study. Subjects were patients visiting the University of Cape Coast Eye Clinic for comprehensive eye examination. The age range for recruitment into the study was 16 to 35 years. Eligible participants completed three questionnaires namely the Ocular Surface Disease Index (OSDI), short version of the depression, anxiety, and stress scale (DASS-21), dry eye quality of life score (DEQS) questionnaire. All eligible participants underwent clinical assessment including meibomian gland expressibility, corneal staining, tear breakup time, and Schirmer 1 test. The Spearman correlation coefficient was used to determine the relationship between variables. Univariate and multivariate analyses of variance were used to determine the impact of the OSDI score on DASS-21 subscales scores and the dry eye quality of life scores. Results: All 211 subjects who met the inclusion criteria were included in the analysis. The mean age for the entire sample was 21.6 +/- 3.0 years with a range of (17-31) years. Spearman correlation coefficient showed a statistically significant association between OSDI scores and DEQSs (P<0.001), anxiety scores (P<0.001), depression scores (P<0.001), and stress scores (P<0.001). Spearman correlation coefficient showed no statistically significant association between clinical test results and quality of life scores (P>0.05), DASS-21 subscales scores (P>0.05), except anxiety subscale and meibomian gland expressibility score (P=0.026). There were no statistically significant association between clinical test results and OSDI scores (P>0.05) except for the tear breakup time (P=0.018). Using Pillai's trace in the multivariate analysis of variance (MANOVA), there was a significant effect of OSDI severity classification on depression, anxiety, and stress subscales scores of the DASS-21, V=0.37, F-(3,F- 207)=9.67, P<0.001. Furthermore, separate univariate analyses of variances on the outcome variables revealed a significant effect of OSDI severity classification on depression F-(3,F- 207)=35.24, P<0.001, anxiety F-(3,F- 207)=25.27, P<0.001, and stress F-(3,F- 207)=13.08, P<0.001. The MANOVA was followed up with a discriminant analysis, which revealed three discriminant functions. When subjects were classified according to the OSDI grading of severity, there were a statistically significant difference between all levels of severity dry eye symptoms for the DEQSs (F-(3,F- 207)=63.9.3 P<0.001, eta(2)=0.48). Conclusion: The study showed that the severity of dry eye symptoms impacted on psychosomatic symptoms and quality of life. The study also revealed that the severity of dry eye symptoms impacted more on the depressive symptoms compared with other psychosomatic symptoms in this youthful clinical sample.