Determination of depression, anxiety, and hopelessness levels in adolescents with refractive errors after the COVID-19 pandemic
Authors: Tubaş Filiz , Sönmez Hatice Kübra , Gül Melike Kevser , Evereklioğlu Cem , Duyan Çamurdan Aysu 
Published: November 2023

Background/Aim: The prevalence of myopia is increasing worldwide especially among adolescents. Changes in living conditions such as reduced engagement in outdoor activities as well as increased activities near the workplace like reading, writing, and screen exposure are thought to be responsible for this increase. Adolescence is a sensitive period of rapid changes in psychological, physiological, and social aspects. Mental health issues such as anxiety and depression are common during this period. During the pandemic, mental health issues among children and adolescents increased due to stress caused by the disease, social isolation, disruption of routines, and the loss of loved ones. With the rapid increase in myopia among adolescents, there is a need to investigate the effects of myopia on mental health. The aim of this study is to evaluate anxiety, depression, and hopelessness levels in adolescents with myopia after the COVID-19 pandemic and to examine the relationship between myopia and anxiety, depression, and hopelessness.
Methods: This was a case-control study that included 40 myopic adolescents aged 16-19 with a spherical refractive degree of -2 diopters (D) and above and 40 emmetropic (no refractive error). Participants who had previously undergone refractive surgery, had binocular visual acuity less than 1.0, had strabismus and amblyopia, had a diagnosis of glaucoma, had undergone ocular surgery for any reason, had retinopathy, or had an astigmatic refractive degree greater than ±0.50 were excluded from the study. The study did not include patients with chronic physiological or psychiatric diseases. Both groups were administered the Automatic Thoughts Questionnaire (ATQ), Coronavirus Anxiety Scale (CAS), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI). The groups were compared according to the scales. Myopic degrees were compared with mixed-effect linear models according to scale categories, and the relationship between ATS scores and myopia degrees was evaluated using the Spearman correlation coefficient.
Results: The mean (SD) spherical refractive power of myopic adolescents was -3.156 (1.40) diopters; 62.5% of participants with myopia had been exposed to COVID-19, and the anxiety rate in myopic participants compared to controls was 15% (P=0.026). However, no significant difference was found between the myopia and control groups in terms of automatic thoughts, hopelessness, and depression inventory scores when comparing the groups. No correlation was found between the CAS (F=1.098), BHS (F=1.610), BDI (F=1.699), and ATQ (r=0.151) scales and the increase in myopia when we performed linear mixed model analysis and Spearman correlation analysis. There was no significant relationship between the degree of myopia and automatic thoughts, hopelessness anxiety, and depression.
Conclusion: The results indicate that adolescents with myopia had higher levels of anxiety after the COVID-19 pandemic. There was no significant correlation between the degree of myopia and anxiety, depression, hopelessness, and automatic thoughts. It is important to monitor adolescents with myopia carefully during pandemics and provide the necessary mental health support. This is because offering mental health support to myopic young people may protect them from potential lasting emotional problems in adulthood during potential future pandemics. It may be beneficial for adolescents to increase their engagement in outdoor activities to reduce myopia and anxiety.