Determination of depression, anxiety, and hopelessness levels in adolescents with refractive errors after the COVID-19 pandemic

Anxiety levels in adolescents with myopia



COVID-19, myopia, adolescents, Beck Anxiety Inventory, depression, hopelessness


Background/Aim: The prevalence of myopia is increasing worldwide especially among adolescents. Changes in living conditions such as reduced engagement in outdoor activities as well as increased activities near the workplace like reading, writing, and screen exposure are thought to be responsible for this increase. Adolescence is a sensitive period of rapid changes in psychological, physiological, and social aspects. Mental health issues such as anxiety and depression are common during this period. During the pandemic, mental health issues among children and adolescents increased due to stress caused by the disease, social isolation, disruption of routines, and the loss of loved ones. With the rapid increase in myopia among adolescents, there is a need to investigate the effects of myopia on mental health. The aim of this study is to evaluate anxiety, depression, and hopelessness levels in adolescents with myopia after the COVID-19 pandemic and to examine the relationship between myopia and anxiety, depression, and hopelessness.

Methods: This was a case-control study that included 40 myopic adolescents aged 16-19 with a spherical refractive degree of -2 diopters (D) and above and 40 emmetropic (no refractive error). Participants who had previously undergone refractive surgery, had binocular visual acuity less than 1.0, had strabismus and amblyopia, had a diagnosis of glaucoma, had undergone ocular surgery for any reason, had retinopathy, or had an astigmatic refractive degree greater than ±0.50 were excluded from the study. The study did not include patients with chronic physiological or psychiatric diseases. Both groups were administered the Automatic Thoughts Questionnaire (ATQ), Coronavirus Anxiety Scale (CAS), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI). The groups were compared according to the scales. Myopic degrees were compared with mixed-effect linear models according to scale categories, and the relationship between ATS scores and myopia degrees was evaluated using the Spearman correlation coefficient.

Results: The mean (SD) spherical refractive power of myopic adolescents was -3.156 (1.40) diopters; 62.5% of participants with myopia had been exposed to COVID-19, and the anxiety rate in myopic participants compared to controls was 15% (P=0.026). However, no significant difference was found between the myopia and control groups in terms of automatic thoughts, hopelessness, and depression inventory scores when comparing the groups. No correlation was found between the CAS (F=1.098), BHS (F=1.610), BDI (F=1.699), and ATQ (r=0.151) scales and the increase in myopia when we performed linear mixed model analysis and Spearman correlation analysis. There was no significant relationship between the degree of myopia and automatic thoughts, hopelessness anxiety, and depression.

Conclusion: The results indicate that adolescents with myopia had higher levels of anxiety after the COVID-19 pandemic. There was no significant correlation between the degree of myopia and anxiety, depression, hopelessness, and automatic thoughts. It is important to monitor adolescents with myopia carefully during pandemics and provide the necessary mental health support. This is because offering mental health support to myopic young people may protect them from potential lasting emotional problems in adulthood during potential future pandemics. It may be beneficial for adolescents to increase their engagement in outdoor activities to reduce myopia and anxiety.


Download data is not yet available.

Author Biographies

Hatice Kübra Sönmez, Department of Ophthalmology, Erciyes University Faculty of Medicine, Kayseri, Turkey

Department of Ophthalmology, 

Melike Kevser Gül, Department of Child and Adolescent Psychiatry, Erciyes University Faculty of Medicine, Kayseri, Turkey

Department of Child and Adolescent Psychiatry

Cem Evereklioğlu, Department of Ophthalmology, Erciyes University Faculty of Medicine, Kayseri, Turkey

Department of Ophthalmology

Aysu Duyan Çamurdan, Department of Social Pediatrics, Gazi University School of Medicine, Ankara, Turkey

Department of Social Pediatrics


Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, et al. IMI Impact of Myopia. Invest Ophthalmol Vis Sci. 2021;62:2–2. DOI:

Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123:1036–42. DOI:

Lv L, Zhang Z. Pattern of myopia progression in Chinese medical students: a two-year follow-up study. Graefes Arch Clin Exp Ophthalmol. 2013;251:163–8. DOI:

Łazarczyk JB, Urban B, Konarzewska B, Szulc A, Bakunowicz-Łazarczyk A, Żmudzka E, et al. The differences in level of trait anxiety among girls and boys aged 13-17 years with myopia and emmetropia. BMC Ophthalmol. 2016;16:1–7. DOI:

Lanyon RI, Giddings JW. Psychological approaches to myopia: a review. Am J Optom Physiol Opt. 1974;51:271–81. DOI:

Stapinski LA, Bowes L, Wolke D, Pearson RM, Mahedy L, Button KS, et al. Peer victimization during adolescence and risk for anxiety disorders in adulthood: a prospective cohort study. Depress Anxiety. 2014;31:574–82. DOI:

Angi M, Rupolo G, De Bertolini C, Bisantis C. Personality, psychophysical stress and myopia progression. A prospective study on 57 university students. Graefes Arch Clin Exp Ophthalmol. 1993;231:136–40. DOI:

Branje S, Morris AS. The Impact of the COVID-19 Pandemic on Adolescent Emotional, Social, and Academic Adjustment. J Res Adolesc. 2021;31:486–99. DOI:

Ravens-Sieberer U, Kaman A, Otto C, Adedeji A, Napp AK, Becker M, et al. [Mental health and psychological burden of children and adolescents during the first wave of the COVID-19 pandemic-results of the COPSY study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021;64:1512–21. DOI:

Pasha H, Omidvar S, Faramarzi M, Bakhtiari A. Depression, anxiety, stress, and PTSD symptoms during the first and second COVID-19 waves: a comparison of elderly, middle-aged, and young people in Iran. BMC Psychiatry. 2023;23. DOI:

Hollon SD, Kendall PC. Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognit Ther Res. 1980;4:383–95. DOI:

Lee SA, Mathis AA, Jobe MC, Pappalardo EA. Clinically significant fear and anxiety of COVID-19: A psychometric examination of the Coronavirus Anxiety Scale. Psychiatry Res. 2020;290. DOI:

Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42:861–5. DOI:

Seber G, Dilbaz N, Kaptanoğlu C, Tekin D. The scale of desperation: Validity and reliability. Crisis Journal. 1993;1:139–42.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71. DOI:

Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol. 1989;7:3–13.

Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L, et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res. 2020;291:113264. DOI:

Chang P, Zhang B, Lin L, Chen R, Chen S, Zhao Y, et al. Comparison of Myopic Progression before, during, and after COVID-19 Lockdown. Ophthalmology. 2021;128:1655–7. DOI:

Liu J, Li B, Chen Q, Dang J. Student Health Implications of School Closures during the COVID-19 Pandemic: New Evidence on the Association of e-Learning, Outdoor Exercise, and Myopia. Healthcare (Basel). 2021;9(5):500. DOI:

Seitler BN. Separation-individuation issues and castration anxiety: their curious influence on the epigenesis of myopia. Am J Psychoanal. 2009;69:221–37. DOI:

Zhang H, Gao H, Zhu Y, Zhu Y, Dang W, Wei R, et al. Relationship Between Myopia and Other Risk Factors With Anxiety and Depression Among Chinese University Freshmen During the COVID-19 Pandemic. Front Public Health. 2021;9:774237. DOI:

Juvonen J, Graham S, Schuster MA. Bullying among young adolescents: the strong, the weak, and the troubled. Pediatrics. 2003;112:1231–7. DOI:

Horwood J, Waylen A, Herrick D, Williams C, Wolke D. Common visual defects and peer victimization in children. Invest Ophthalmol Vis Sci. 2005;46:1177–81. DOI:

Rosanes MB. Psychological correlates to myopia compared to hyperopia and emmetropia. J Proj Tech Pers Assess. 1967;31:31–5. DOI:

Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, et al. Quality of life in myopia. Br J Ophthalmol. 2000;84:1031–4. DOI:






Research Article

How to Cite

Tubaş F, Sönmez HK, Gül MK, Evereklioğlu C, Duyan Çamurdan A. Determination of depression, anxiety, and hopelessness levels in adolescents with refractive errors after the COVID-19 pandemic: Anxiety levels in adolescents with myopia. J Surg Med [Internet]. 2023 Nov. 23 [cited 2024 Apr. 23];7(11):736-9. Available from: