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Strabismus Associated With Mental Health Conditions in Adults


Poor mental health was worse in adults with strabismus compared with adults without strabismus.

Diagnoses of mental health conditions were more likely in adults with strabismus compared with adults without, according to a study published in JAMA Ophthalmology. Interventions could be designed to address this issue with further research into risk factors of mental health in these adults.

Strabismus, known as crossed eyes, affects approximately 2% to 3% of individuals in the United States. The condition "may negatively affect psychosocial well-being and predispose individuals to mental health conditions, such as anxiety and depression," researchers explained. However, there is limited research on the association of strabismus and mental health in diverse populations.

This study aimed to use data from a large cohort of adults from the United States to evaluate the association between both strabismus and mental health.

Man with strabismus smiling | Image credit: Fabián Montaño - stock.adobe.com

Man with strabismus smiling | Image credit: Fabián Montaño - stock.adobe.com

The All of Us Research Program (AoURP) from the National Institutes of Health was used to for all of the data in this study. All adults who were aged 18 years and older who had a health code for strabismus and a 1:1 propensity score-matched control group were included in this study. Self-reporting was used for race and ethnicity. All adults with strabismus were included, regardless of any previous treatment that they had received. Mental health diagnoses, including diagnoses of anxiety, depression, substance use, schizophrenia, and bipolar disorder, acted as the primary outcome.

There were 3646 participants from the AoURP cohort that were included in the study. All participants had strabismus, the median (IQR) age of the participants was 67 (53-76) years, and 55% of them were women. A higher prevalence of anxiety (32% vs 14%; 95% CI, 15%-19%), depression (33% vs 14%; 95% CI, 17%-20%), substance use (3% vs 1%; 95% CI, 1%-3%), bipolar disorder (7% vs 3%; 95% CI, 3%-5%), and schizophrenia (3% vs 1%; 95% CI, 1%-3%) were all higher in participants with strabismus compared with those without strabismus.

Younger age (OR, 1.11 per 10-year decrease; 95% CI, 1.06-1.16), being female (OR, 1.62; 95% CI, 1.41-1.85), being of Black or African American race and ethnicity (OR, 1.22; 95% CI, 1.01-1.48), and having low income (OR, 3.06; 95% CI, 2.56-3.67) were associated with higher odds of mental health conditions in adults with strabismus. Higher odds of anxiety (OR, 2.79; 95% CI, 2.48-3.13), depression (OR, 2.95; 95% CI, 2.63-3.31), substance use (OR, 2.32; 95% CI, 1.66-3.23), bipolar disorder (OR, 2.62; 95% CI, 2.07-3.31), and schizophrenia (OR, 2.92; 95% CI, 1.99-4.27) were found in adults with strabismus when compared with adults without after adjusting for sociodemographic factors.

There were some limitations to this study. Diagnostic codes were used to identify strabismus and diagnoses for mental health, which could have contained coding errors. Receiving a formal diagnosis of a mental health disorder can come with massive barriers that could underestimate the true prevalence. Small sample sizes of young adults and individuals of Black or African American race and ethnicity were present in this study. Unmeasured confounding factors, such as disability, could have affected the associations. Onset and type of strabismus could have affected the association between strabismus and mental health but was unmeasured for this study.

The researchers concluded that the association between mental health and adults with strabismus was present in a cohort of diverse adults. Mental well-being could be improved in this population through novel opportunities for interventions, which could be established through other studies looking into the risk factors for poor mental health in those who have strabismus.

"Clinicians caring for patients with strabismus should be aware of the prevalence of mental health conditions—especially among individuals from historically marginalized and socioeconomically disadvantaged backgrounds," the authors concluded.


Jin K, Aboobakar IF, Whitman MC, Oke I, et al. Mental health conditions associated with strabismus in a diverse cohort of US adults. JAMA Ophthalmol. Published online April 4, 2024. doi:10.1001/jamaophthalmol.2024.0540

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