Jongkhajornpong P.Lekhanont K.Anothaisintawee T.Rattanasiri S.McKay G.Attia J.Thakkinstian A.Mahidol University2025-07-012025-07-012025-06-18BMJ Open Vol.15 No.6 (2025)https://repository.li.mahidol.ac.th/handle/20.500.14594/111003Objectives To estimate the prevalence of dry eye disease (DED) and explore its association with depression and poor sleep quality. Design A cross-sectional study. Setting The study was conducted at the ophthalmology outpatient clinic of a tertiary university hospital in Thailand, from September 2022 to April 2023. Participants A total of 1321 patients aged 18 years or older, without any history of orbital disease, active superficial or intraocular infection/inflammation, eyelid pathology, or prior intraocular or eyelid surgery within the past 6 months, were enrolled in the study. Interventions All patients underwent dry eye examination, including the Ocular Surface Disease Index questionnaire, tear break-up time and ocular surface staining. Physical activity was measured using the Global Physical Activity Questionnaire, which was expressed as total Metabolic Equivalent of Task-minutes per week. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), Composite Scale of Morningness (CSM) and STOP-Bang. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Primary and secondary outcome measures Prevalence of DED and association pathways involving depression, sleep quality and DED. Results The mean age of the participants was 58.3±14.0 years, with a female predominance of 73.7%. Of the 1321 patients, 668 were diagnosed with DED, resulting in a hospital-based prevalence of 50.6% (95% CI: 47.8%, 53.3%). After adjusting for age, sex and underlying disease, PSQI, PHQ-9, STOP-Bang and CSM scores remained significantly associated with DED with adjusted ORs of 2.48 (95% CI: 1.96, 3.14; p<0.001), 1.65 (95% CI: 1.05, 2.61; p=0.031), 1.81 (95% CI: 1.05, 3.14; p=0.033) and 1.32 (95% CI: 1.04, 1.68; p=0.023), respectively. The effects of depression on DED were mediated indirectly via poor sleep quality (OR=1.32; 95% CI: 1.18, 1.49; p<0.001) and directly via other mechanisms (OR=1.66; 95% CI: 1.06, 2.58; p=0.021). Conclusions DED is notably common among Thai patients. Depression and poor sleep quality are significantly associated with DED. Poor sleep quality may mediate the relationship between depression and DED.MedicineArticleSCOPUS10.1136/bmjopen-2024-0940462-s2.0-10500853884720446055