Neuroticism predicts depression and disability in age-related macular degeneration

OBJECTIVES: Age-related macular degeneration (AMD) is a common, disabling disorder of older age that is associated with depression. We investigated the incidence rate of depression and its risk factors and consequences in this 6-month longitudinal study. DESIGN: A prospective cohort study in which subjects were interviewed 6 weeks after the onset of bilateral vision loss and 6 months later. SETTING: The sample was recruited from the retinovascular clinic of a specialty eye hospital. PARTICIPANTS: Subjects were 51 patients with new onset bilateral AMD. MEASUREMENTS: We assessed depressive symptoms personality traits, visual acuity, and vision and physical functioning. Additionally, we interviewed informants to obtain independent assessments of subjects' personality traits. RESULTS: The baseline prevalence rate of syndromal depression was 23.5% and high levels of depressive symptoms persisted over time. The 6-month incidence rate of depression was 27.8%. The strongest risk factors for incident depression were self-rated and informant-rated neuroticism. Patients who developed syndromal depression were 8.3 times (95% confidence interval = 1.1-63.4) more likely than nondepressed patients to become disabled in vision function, independent of change in visual acuity. CONCLUSION: AMD is associated with high rates of depression and visual disability independent of severity of vision loss. The personality trait of neuroticism is highly predictive of incident depression and identifies patients at high risk for excess disability. Psychotherapeutic treatments targeted to this group may prevent depression and reduce disability.