Highlights Is there an association between strabismus and mental illness in the pediatric population? Findings In this cross-sectional study using data from a commercial insurance claims database of 1,200,5189 children under 19 years of age, those with strabismus were more likely to have anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder compared to children without eye diseases. Meaning Understanding the association of mental illness with strabismus among children may improve the diagnosis and treatment of psychiatric conditions in children with strabismus.
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Importance
Children with strabismus have poorer functional vision and a lower quality of life than those without strabismus.
Aim
To evaluate the association between strabismus and mental illness in children.
Design, scope and participants
This cross-sectional study analyzed claims data from OptumLabs Data Warehouse, a longitudinal database of de-identified commercial insurance claims, from 1,200,5189 patients enrolled in the health plan between January 1, 2007 and December 31, 2017.
Eligibility criteria included age under 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 claim of strabismus based on the International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problem Codes, Tenth Revision, Clinical Modification.
Controls were children in the same database with no ocular disease codes other than reported refractive error. Demographic characteristics and mental illness claims were compared. The statistical analysis was carried out from December 1, 2018 to July 31, 2021.
Main results and measures
Presence of claims for mental illness.
Results
Among the 1,200,5189 patients (6,095,523 children [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, the adjusted odds ratios for the association of mental illness with strabismus were 2. 01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59 -1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for use disorder of substances.
There was a moderate association between each type of strabismus (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; Odds ratios ranged from 1.23 (95% CI, 1.17 to 1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66 to 2.74) for The association between exotropia and anxiety disorder.
Conclusions and relevance
This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder, but not substance use disorder.
Recognizing that these associations exist should encourage screening and treatment of mental illness for patients with strabismus.
