Midlife vision impairment and depressive symptoms

Contemporary OB/GYN JournalVol 67 No 02
Volume 67
Issue 02

Midlife women with early-stage vision impairment are significantly more likely to develop depressive symptoms, according to a study in the journal Menopause, which used data from the Michigan site of the Study of Women’s Health Across the Nation (SWAN).

The Michigan site for SWAN has had a long history of studying sensory and physical function, due to the importance of these factors for healthy aging,” said principal investigator Carrie Karvonen-Gutierrez, PhD, MPH, an assistant professor of epidemiology at the University of Michigan, School of Public Health, in Ann Arbor.

Carrie Karvonen-Gutierrez, PhD, MPH

Carrie Karvonen-Gutierrez, PhD, MPH

The link between visual impairment and depression has been well documented among older adults, aged 65 and older, with a prevalence of roughly 14% for major depression and about 33% for depressive symptoms.1

“We were interested whether this relationship was present among midlife women, given that the midlife is a critical window for the development or worsening of many health measures, including vision and depression,” Karvonen-Gutierrez told Contemporary OB/GYN®.

The Michigan site of SWAN conducted evaluations of distance visual acuity at six consecutive, near-annual follow-up visits, starting in 2001.

Visual impairment was defined as either mild (20/30 to 20/60) or moderate-severe (20/70 or worse).

At each visit, depressive symptoms were also assessed, based on the Center for Epidemiological Studies-Depression Scale.

At baseline, the mean age of the 226 participants was 50.0 years. Overall, 53.5% of women had mild visual impairment and 8.0% had moderate-severe visual impairment.

After accounting for age, preexisting depressive symptoms, race, education, economic strain, body mass index (BMI), and smoking, participants with mild visual impairment were 68% more likely to report depressive symptoms at their subsequent study visit versus women without visual impairment.

For women with moderate-severe visual impairment, there was a 2.55-fold increased risk.

Further adjustment for diabetes, hypertension, and osteoarthritis did not significantly alter the results.

“Our finding of an association between mild vision impairment and depressive symptoms was surprising and important to us,” Karvonen-Gutierrez said. “It suggests that even small, early changes in vision function during the midlife are meaningful and should not be ignored. Many times these early, smaller changes in health are not deemed as meaningful and are brushed off as an expected consequence of aging. Yet, this finding suggests that these smaller changes are also predictive of depressive symptoms and, therefore, should be taken seriously.”

Women during midlife and their providers should pay close attention to vision health during this crucial life stage, according to Karvonen-Gutierrez. “Not only is vision health an important metric of overall health, but our research indicates it can exacerbate changes in mental health during the midlife,” she said.

Karvonen-Gutierrez noted that early changes in vision function are mostly treatable through visual correction. “Hence, even mild levels of vision impairment should be identified and treated in this population,” she said.

Data from SWAN suggest that women with worsening depressive symptoms across the midlife have lower physical activity, worsening sleep problems, less social support, and higher levels of anxiety. “Each of these correlates represents potential targets for intervention or modification through this life stage,” Karvonen-Gutierrez said.

Research is needed, though, to identify midlife women at greatest risk for poor or worsening vision function, according to Karvonen-Gutierrez. “However, vision healthcare is not routinely accessed by all individuals, and important differences remain by age, race/ethnicity, and socioeconomic status,” she said. “Recognizing those who are typically missed in vision healthcare settings, and thus who may be most in need, is required to address not only vision health but associated health outcomes as well.”


Karvonen-Gutierrez reports no relevant financial disclosures.


1. Karvonen-Gutierrez CA, Navasuja K, Hood MM, et al. Longitudinal association of midlife vision impairment and depressive symptoms: the study of Women's Health Across the Nation, Michigan site.Menopause. Published online October 25, 2021. doi:10.1097/GME.0000000000001880

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