This retrospective cross-sectional study used the All of Us database to compare psychiatric comorbidity rates between 3,266 NIU patients and 9,798 matched controls (1:3), matched on race, age, sex, ethnicity, smoking status, and social determinants of health.
NIU patients had significantly higher odds of mood disorder (46.4%, OR 3.31), depressive disorder (44.0%, OR 3.34), anxiety (44.3%, OR 3.13), insomnia (25.3%, OR 2.93), substance abuse (16.1%, OR 2.34), personality disorder (5.2%, OR 3.74), bipolar disorder (7.8%, OR 2.16), schizophrenia (3.0%, OR 2.38), and opioid abuse (3.0%, OR 2.06) vs. controls (all P<0.05); associations were stronger in Black vs. White participants. PHQ-2 and PHQ-9 screening use was low (4.8% and 1.4%, respectively).
Cross-sectional design limits causal inference. Reliance on ICD/SNOMED coding may miss undiagnosed psychiatric conditions or misclassify NIU cases. PHQ screening rates may underrepresent true tool usage if not consistently documented in EHR.
Ophthalmologists caring for NIU patients should routinely screen for depression, anxiety, and substance use—especially in Black patients where these associations are strongest. PHQ-2 and PHQ-9 use is currently very low in this population and should be integrated into standard NIU care.
