Abstract / Summary
The aim of this study is to investigate the association between depressive symptoms and retinal layer thickness in a population-based adult Chinese cohort. This population-based, cross-sectional study included 2127 eyes of 2127 participants of Beijing Eye Study 2011, free of any retinal or optic nerve disease. All participants underwent comprehensive ocular examinations including spectral-domain optical coherence tomography (OCT). The retina was automatically segmented into 9 layers using a validated multiple-surface OCT segmentation algorithm and the thickness of each layer was calculated. A modified Chinese version of the Zung Self-rating Depression Scale was employed to evaluate depressive symptoms. Analyses were performed using both continuous depressive symptom scores and a categorical definition (cutoff ≥ 37), with multivariable adjustment for demographic, systemic, and ocular factors, including axial length. Among 2127 participants (43.2% men; mean age: 61.8 ± 8.4 years), the mean depressive symptom score was 30.9 ± 6.7. Higher depressive symptom scores were associated with thinner ganglion cell layer (GCL) ( P = 0.029; B = − 0.09; 95% CI: −0.17 to − 0.009, standardized β=−0.048), after multivariable adjustment for age, sex, prevalence of cardiovascular disease, household income, education level, axial length, alcohol intake frequency and scan quality. In a parallel manner, elevated depressive symptoms were additionally associated with thinner retinal nerve fiber layer ( P = 0.006; OR per 1 SD: 0.83; 95% CI: 0.73 to 0.95), thinner GCL ( P = 0.001; OR per 1 SD: 0.81; 95% CI: 0.71 to 0.92), and thicker ellipsoid zone ( P = 0.018; OR per 1 SD: 1.17; 95% CI: 1.03 to 1.33). After Bonferroni correction, the association between GCL thickness and elevated depressive symptoms remained statistically significant, whereas associations involving other retinal layers did not. Sensitivity analyses using stricter definitions showed similar directional patterns but reduced statistical significance. Depressive symptoms were modestly associated with thinner GCL in a population-based setting, while associations with other retinal layers were less consistent. These findings suggest that retinal structural variations in relation to depressive symptoms are subtle and layer-specific, providing population-based evidence for retinal correlates across the depressive symptom spectrum.