Psychological states in diabetic retinopathy: Social support correlates and risk factors

BACKGROUND Diabetic retinopathy (DR) is closely and bidirectionally linked to psychological distress, yet research examining anxiety, depression, and social support among such patients remains limited. AIM To evaluate associations between psychological status and social support in DR and identify contributing risk factors. METHODS We enrolled 125 patients with DR treated at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (January 2022-January 2025). Anxiety, depression, and social support were assessed using the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Social Support Rating Scale (SSRS). Spearman’s or Pearson’s correlation coefficients were used to analyze correlations between anxiety or depression and social support, and single- and multivariable regressions were used to identify key influencing factors. RESULTS Overall, 33.60% of participants experienced anxiety (HAMA: 11.1 ± 5.22) and 24.8% experienced depression (HAMD: 10.83 ± 5.75); the incidences of anxiety or depression and combined anxiety-depression were 49.60% and 8.8%, respectively. Mean SSRS scores were 34.37 ± 7.69, with sub-scores of 20.85 ± 6.59, 6.89 ± 5.92, and 6.63 ± 2.70. HAMA and HAMD scores were inversely correlated with SSRS (r = -0.396/-0.481, P < 0.001), a pattern that persisted in non-proliferative DR. Longer diabetes mellitus (DM) duration (≥ 8 years), visual disturbances, hypertension, and a family history of DM increased the likelihood of psychological distress, whereas social support (SSRS ≥ 35) had a protective effect. CONCLUSION Psychological distress affects nearly half of DR patients (49.60%). For those with non-proliferative DR, anxiety and depression show a strong negative association with social support. A prolonged DR course (≥ 8 years), visual impairment, hypertension, DM family history, and SSRS < 35 elevate distress risk.