The association between myopia and mental health among Chinese children in primary and secondary school: a crosssectional study

Shijie Yu¹Hongpo Yin²Wei Sun²Ruosong Yang¹Ronghua Lai¹Yushan Yu³Hongsheng Bi^2,4*Jianfeng WU^1,2,4*

• ¹Medical School of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
• ²Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
• ³Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
• ⁴Key Laboratory of Integrated Traditional Chinese and Western Medicine for Eye Disease Control, Shandong Shierming Eye Hospital, Jinan, Shandong Province, China

Objective: This study aimed to investigate the association between myopia and mental health among Chinese children in primary and secondary school.This study employed a cross-sectional study design, including 1,640 children and their parents, via an online survey. The children underwent routine eye examinations including cycloplegic autorefraction. Multivariable linear and logistic regression models were used to examine the association between myopia and mental health. Multivariable linear regression analyses were performed in distinct subgroups.Results: Among all children, 836 children (50.98%) were boys; the mean age was 9.39 ± 2.22 years old. A decline in visual acuity last year was associated with a higher strengths and difficulties questionnaire (SDQ) total difficulties score (β=0.564, 95%CI: 0.064, 1.064) and an increased risk of borderline mental health problems (OR=1.863, 95%CI: 1.135, 3.057). Abnormal mental health problems were more likely to occur in myopic children than emmetropic children (OR=3.601, 95%CI:1.070, 12.456). The risk of abnormal mental health problems decreased with an increase in number of correctly identified the early treatment diabetic retinopathy study (ETDRS) markers (OR=0.964, 95%CI: 0.933, 0.997). In grades 3-4, myopic children had a higher SDQ total difficulties score compared with emmetropic children (β=1.065, 95%CI: 0.200, 1.929), and children with a decline in visual acuity last year had a higher SDQ total difficulties score than those without decline (β=0.981, 95%CI: 0.011, 1.951).Myopic children, especially in grades 3-4, were more susceptible to mental health problems than emmetropic peers. This shows the importance of early targeted counseling for mental health in myopic children.