Adults with Strabismus More Likely to Experience Mental Health Conditions

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Adults with strabismus in a diverse nationwide cohort were approximately 2 to 3 times more likely to experience mental health conditions.

Adults with strabismus were more likely to have mental health conditions compared to adults without strabismus in a diverse and nationwide cohort, according to new cross-sectional research.1

Strabismus is prevalent in approximately 2–3% of individuals in the US and can negatively affect a patient’s psychosocial well-being.2 Despite this prevalence, there are limited data on the association between strabismus and mental health in diverse populations.

Using data from the National Institutes of Health (NIH) All of Us Research Program, this new analysis showed individuals with strabismus in a diverse population were approximately 2 to 3 times more likely to exhibit mental health conditions, including anxiety and depression, than those without misalignment of the eyes.1

“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,” wrote the investigative team, led by Isdin Oke, MD, MPH, department of ophthalmology at Boston Children’s Hospital.

The NIH All of Us Research Program was launched in 2015 and remains ongoing. For this analysis, investigators included all adults with a Systemized Nomenclature of Medicine (SNOMED) code for strabismus and a propensity score-matched control group by age, gender, race and ethnicity, income, educational level, and health insurance.

Outcomes for the analysis included mental health diagnoses, consisting of anxiety, depression, substance use and addiction, bipolar disorder, and schizophrenia spectrum disorder. Overall, the study included all 3646 participants with strabismus and 3646 propensity score-matched controls, with a mean age of 67 years and 55% women.

Upon analysis, compared with those without strabismus, participants with strabismus had a higher prevalence of anxiety, depression, substance use and addiction, bipolar disorder, and schizophrenia spectrum disorders (all P <.001).

Among those with strabismus, a greater likelihood of mental health conditions was associated with younger age (odds ratio [OR], 1.11 per 10-year decrease; 95% CI, 1.06 - 1.16), female gender (OR, 1.62; 95% CI, 1.41 - 1.85), Black or African American race and ethnicity (OR, 1.22; 95% CI, 1.01 - 1.48), low income (OR, 3.06; 95% CI, 2.56 - 3.67), and high school education or lower (OR, 1.58; 95% CI, 1.34 - 1.85).

After adjustment for sociodemographic factors, using propensity scores, adults with strabismus demonstrated 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 and addiction (OR, 2.32; 95% CI, 1.66 - 3.23), bipolar disorder (OR, 2.62; 95% CI, 2.07 - 3.31), and schizophrenia spectrum disorder (OR, 2.92; 95% CI, 1.99 - 4.27), compared with adults without strabismus.

These data remain consistent with existing evidence indicating an increased prevalence of mental health conditions among individuals with strabismus, including decreases in quality of life and a greater likelihood of developing mental health conditions in the second and third decades of life.3

“Further investigation into the risk factors for poor mental health among adults with strabismus across sociodemographic backgrounds may offer novel opportunities for interventions to improve mental well-being in this population,” Oke and colleagues wrote.1


  1. Jin K, Aboobakar IF, Whitman MC, Oke I. Mental Health Conditions Associated With Strabismus in a Diverse Cohort of US Adults. JAMA Ophthalmol. Published online April 04, 2024. doi:10.1001/jamaophthalmol.2024.0540
  2. Hashemi H, Pakzad R, Heydarian S, et al. Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis. Strabismus. 2019;27(2):54-65. doi:10.1080/09273972.2019.1604773
  3. Hassan MB, Hodge DO, Mohney BG. Prevalence of Mental Health Illness among Patients with Adult-Onset Strabismus. Strabismus. 2015;23(3):105-110. doi:10.3109/09273972.2015.1070881