Authors: Hui-Hui Chu, Ru Zhang, Ling-Ling Han, Ji-Feng Yu
Categories: Research, Beck anxiety inventory, Child development, Myopia, Parental anxiety, Psychological impact
Source: European Journal of Pediatrics
To assess how children’s myopia affects the psychological state of their parents, especially their anxiety levels, and its related factors.
Using a cross-sectional case series design, this study employed the Beck Anxiety Inventory (BAI) to assess the anxiety status of parents of myopic children who visited Beijing Children’s Hospital from May to August 2024. Data were statistically analyzed using Chi-square test, t-test, and analysis of variance, and Spearman correlation analysis was used to explore the relationship between myopia and anxiety.
Among the 242 parents surveyed, 64.46% (156) showed no anxiety symptoms, 17.36% (42) exhibited mild anxiety, 9.5% (23) had moderate anxiety, and 8.68% (21) had severe anxiety. There was a significant gender difference in anxiety levels, with mothers generally experiencing more anxiety. Specifically, the average anxiety score for mothers was 8.58 ± 12.01, while that for fathers was 7.19 ± 9.16. Univariate analysis revealed that mothers of girls aged under40 with the myopia degree ranging from -0.25D to -6.00D exhibited more pronounced myopic anxiety. In addition, difference analysis indicated that the higher the degree of myopia in the child, the higher the anxiety score of the parents (P < 0.05). Younger children were typically associated with a higher anxiety level of parents. Spearman correlation analysis showed a positive correlation between the degree of myopia in the child and the anxiety level in the parents, while there was a negative correlation between the age of the child and anxiety scores (P < 0.05).
Children’s myopia has a significant impact on the mental health of parents, especially mothers. The anxiety level is closely related to the gender of the child and the severity of myopia. Therefore, it is particularly important to provide positive psychological support for promoting children’s vision health and enhancing family psychological harmony.
Keywords: Myopia, Parental anxiety, Psychological impact, Beck anxiety inventory, Child development
In recent years, the myopia among children has been increasingly severe globally. A report from the World Health Organization pointed out that myopia has emerged as one of the primary causes threatening the visual health of adolescents. Especially in China, the myopia rate among adolescents aged 6 to 18 has exceeded 50% [1, 2]. Myopia not only seriously affects children’s learning efficiency and quality of life, but also arouses great concern and significant anxiety among parents. This anxiety not only imposes a heavy psychological burden, but also may cause various physiological issues, including sleep disorders, high blood pressure, and gastrointestinal issues [3].
The Beck Anxiety Inventory (BAI) is a widely used psychological assessment tool with high reliability and validity. This tool can assess a variety of anxiety symptoms from both cognitive and physiological levels, including physiological reactions such as tachycardia, sweating, and trembling, as well as psychological manifestations such as excessive worry and tension [4]. Currently, there are few research reports on the anxiety levels of parents and guardians before and after their children’s myopia. The BAI was selected for this study due to its comprehensive assessment of both cognitive and physiological aspects of anxiety. Unlike other instruments such as the State-Trait Anxiety Inventory (STAI), the BAI offers a more detailed evaluation of anxiety symptoms, including physiological reactions like tachycardia and sweating, as well as cognitive manifestations such as excessive worry. Additionally, the BAI is concise and user-friendly, making it suitable for parents without a psychological background to complete easily. These attributes make BAI an optimal choice for assessing parental anxiety in the context of their children’s myopia. This study opts to utilize BAI to assess the parents of myopic children, systematically analyzes the impact of children’s myopia on their parents’ psychological state, and proposes scientific intervention strategies for medical institutions, educators, and families to jointly promote children’s vision health and family psychological harmony.
This study was designed as a cross-sectional case series to analyze the basic information and anxiety status of parents of myopic children who visited Beijing Children’s Hospital from May to August 2024. The inclusion criteria were as (1) The parents had children aged 0 to 18 years; (2) The best corrected visual acuity of the pediatric patient reached the normal level for their age group; (3) The spherical equivalent power of refractive errors was ≤ −0.25D or the children had normal vision screening results. The exclusion criteria were as (1) patients with simple hyperopia or astigmatism; (2) patients with systemic diseases; (3) patients with ocular diseases such as strabismus, amblyopia, ptosis, or a history of ocular surgery and trauma. The study procedures strictly followed the ethical principles of the "Declaration of Helsinki" and were approved by the Ethics Committee of Beijing Children’s Hospital, Capital Medical University. All parents of the affected children agreed to participate in this survey and signed the informed consent form.
In response to the commonly concerned issues among myopic patients, this study employed the Beck Anxiety Inventory (BAI) to score and quantify the anxiety level. The BAI scoring criteria are as 0–7 points indicate no anxiety; 8–15 points indicate mild anxiety; 16–25 points indicate moderate anxiety; and over 26 points indicate severe anxiety [4, 5]. The questionnaire used in the study contains 27 questions, of which questions 1–6 collect basic information, and questions 7–27 conduct anxiety scoring based on the BAI. The questionnaire’s reliability and validity were assessed to ensure the accuracy and consistency of the data collected.
We conducted a priori sample size calculation using G*Power for a one-way ANOVA with five levels. To achieve an effect size of 0.25, a significance level of α = 0.05, and a statistical power of 0.80, a total of 200 participants were required. Considering a 10% dropout rate, a minimum of 223 participants was needed.
This study employed SPSS 26.0 software for statistical analysis. Count data were presented as percentages and were analyzed using the Chi-square test (χ^2^); Measurement data were presented as mean ± standard deviation (x ± s) and were processed using t-test or analysis of variance. Prior to performing t-tests and ANOVA, we assessed the normality of the BAI score distribution. Given the observed right-skewness, a natural log transformation was applied to the BAI scores to approximate a normal distribution. Additionally, this study utilized Spearman correlation analysis to assess the correlation between myopia and anxiety, with a statistical significance level set at P < 0.05.
The results of the descriptive analysis are shown in Table 1. A total of 242 questionnaires were collected, with the majority of respondents being mothers of children (180, accounting for 74.38%). In terms of the age distribution of parents, 65.29% of the population is under 40 years old, while 34.71% is over 40. The proportion of parents with normal vision was 17.36%, and the majority of the rest had varying degrees of myopia, with the diopters mainly ranging from −3.00D to −6.00D. From the perspective of the gender distribution of children, males accounted for 59.09%. In terms of children’s vision, 17.77% of children had normal vision, while the rest were myopic, with the negative diopters mainly ranging from −1.00D to −3.00D. The ages of the children mostly fell within the range of 7 to 10 years old. Regarding the anxiety levels, 64.46% of parents had no anxiety symptoms, 17.36% had mild anxiety, 9.5% had moderate anxiety, and 8.68% had severe anxiety. Initial comparison between parents of myopic versus non-myopic children revealed a significant difference in anxiety levels (p = 0.002), with parents of myopic children exhibiting higher BAI scores compared to parents of non-myopic children. This finding underscores the heightened anxiety associated with myopia in children. Combining moderate and severe anxiety levels indicates that approximately 18.18% (44 out of 242) of parents of myopic children exhibit clinically significant anxiety. The average anxiety score for mothers was 8.58 ± 12.01, while the score for fathers was 7.19 ± 9.16. The overall score ranged from 0 to 63 points, with a median of 4 points and an average score of 8.22 ± 11.34 points, indicating that most parents were either not anxious or had a relatively low anxiety level.
Among the 21 BAI items, parents reported the highest scores on items related to excessive worry, trembling, and feeling nervous. Specifically, items such as “I am scared for no good reason,” “I feel tense or nervous,” and “I have shaky hands” were frequently endorsed by parents with moderate to severe anxiety levels. These key items suggest that both cognitive and physiological symptoms are prominent in parental anxiety associated with their children’s myopia.
Research indicated that fathers typically experienced a lower anxiety level compared to mothers, which may be attributed to women’s higher emotional sensitivity, making mothers more prone to experiencing anxiety. Among parental age groups, those aged over 40 years old showed a higher anxiety level towards their children’s myopia. In terms of myopia severity, parents with the diopters ranging from −0.25D to −6.00D were more prone to experiencing anxiety. In terms of gender, parents had a higher anxiety level about their girls’ myopia. When the children’s negative diopters ranged from −0.25D to −3.00D, parents also felt a strong sense of anxiety. Especially for myopia in children aged 7 to 10, parents often exhibited moderate to severe anxiety. Overall, myopic mothers aged below40 (with the negative diopters ranging from −0.25D to −6.00D), whose daughters were aged 7 to 10 and had diopters ranging from −0.25D to −3.00D, were more likely to experience severe anxiety about myopia. For detailed data, please refer to Table 2.
A difference analysis of the factors influencing parental myopia anxiety was conducted, with the results presented in Table 3. The analysis revealed that mothers scored higher in anxiety compared to fathers, indicating that mothers were more prone to experiencing anxiety. However, there was no significant difference in anxiety levels between mothers and fathers due to their own myopia (P > 0.05).
Considering the age of the parents, there was no significant difference in anxiety scores among parents of different age groups (P > 0.05). From the severity of myopia, parents with higher level of myopia (−3.00D to −6.00D) showed an upward trend in the anxiety levels, although these differences were not significant (P > 0.05).
Upon analyzing the gender and myopia impact on children, it was found that parents exhibited higher anxiety levels towards girls, and worried about the potential impact of myopia on girls’ studies and life, although the difference in anxiety scores between genders was not significant (P > 0.05). Regarding the ages of the children, the data showed that the younger the children, the higher the anxiety level of their parents, although this trend did not show significant differences between different age groups (P > 0.05).
Finally, the degree of children’s myopia was also an influencing factor, with parents whose children’s negative diopters ranged from −3.00D to −6.00D and below −6.00D scoring significantly higher in anxiety compared to other groups (P < 0.05), clearly indicating that highly myopic children significantly increased parental anxiety levels.
While initial analyses suggested potential differences in BAI scores across various parental factors such as age, gender, and parental myopia status, these differences did not reach statistical significance. Thus, any observed variations in anxiety levels related to these factors may be attributable to random chance rather than a true underlying association.
The results of the correlation analysis (Table 4) indicated that there was a negative correlation between the age of the child and the anxiety score, meaning that younger children tend to increase the anxiety level of their parents. There was a positive correlation between gender and anxiety score, demonstrating that parents were more anxious about the myopia of female children. Additionally, there was a significant positive correlation between anxiety score and the degree of children’s myopia (P < 0.05), clearly showing that an increase in the degree of children’s myopia significantly enhanced the anxiety level of their parents. This finding highlights the need for more attention and support for the psychological state of parents whose children have a higher degree of myopia.
Normality assessments indicated that the BAI scores for parents did not conform to a normal distribution. Given that parental age, parental myopia severity, child age, and child myopia severity were treated as ordinal variables, Spearman’s rank-order correlation was employed to examine the relationships among these variables. The analysis revealed a significant positive correlation between parental BAI scores and child myopia severity (r = 0.186, p = 0.004).Among the factors examined, only the degree of children’s myopia was significantly associated with parental anxiety levels. This suggests that higher levels of myopia in children are linked to increased anxiety in their parents. Figure 1 illustrates the scatterplot depicting the relationship between the degree of myopia in children and parental BAI scores, demonstrating a positive trend where higher myopia levels are associated with higher anxiety scores.
Fig. 1 Scatterplot showing the correlation between the degree of children’s myopia (in diopters) and parental anxiety levels (BAI scores)
Previous studies have mainly focused on the impact of myopia and anxiety on the social emotions of individual patients, as well as the emotional changes of patients before and after surgery [6–10]. However, in-depth study on the emotional changes of parents caused by children’s myopia is still lacking. In clinical practice, it is common to see parents of children with myopia tend to exhibit significant anxiety and tension. These emotions may lead them to overestimate the risks of myopia, spend a lot of money on expensive equipment, or take too many unnecessary treatment measures, thus complicating simple issues. In order to further explore the impact of children’s myopia on parents’ emotions and provide effective psychological counseling, this study was conducted.
The questionnaire used in this study exhibited excellent reliability and validity, aligning with prior research that supports the robustness of the Beck Anxiety Inventory in assessing anxiety levels [4, 11]. Analysis of the BAI items indicated that excessive worry, trembling, and feelings of nervousness were particularly prominent among parents with moderate to severe anxiety. These key symptoms reflect the cognitive preoccupations and physical manifestations of anxiety that may stem from concerns about their children’s long-term visual health and academic performance. Targeted interventions addressing these specific symptoms could be more effective in reducing parental anxiety. For instance, cognitive-behavioral strategies that focus on managing excessive worry and physical relaxation techniques could be integrated into myopia management programs to provide comprehensive support for affected parents.
Compared with other mainstream anxiety assessment tools such as the Self-rating Anxiety Scale (SAS), the Hamilton Anxiety Scale (HAM-A), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Multidimensional Anxiety Scale for Children (MASC), the BAI performs better in terms of coverage of anxiety symptoms, ease of assessment, and ability to complete the assessment independently. The items of SAS and GAD-7 are relatively straightforward, HAM-A relies on clinical scoring, and MASC is mainly targeted at children, so the BAI is more suitable for assessing parents’ anxiety caused by their children’s myopia [11, 12]. While the BAI was chosen for its comprehensive and user-friendly nature, it is important to acknowledge its limitations. The BAI primarily focuses on physiological symptoms of anxiety, which may lead to an overestimation of anxiety levels in individuals who exhibit significant physiological responses but less cognitive anxiety. Additionally, self-reported measures like the BAI are subject to response biases, including social desirability and subjective interpretation of symptoms. Future studies might consider complementing BAI with other instruments or qualitative assessments to provide a more nuanced understanding of parental anxiety.
This study explored the impact of children’s myopia on parental anxiety by analyzing 242 questionnaires. The main survey respondents were mothers, accounting for 74.4%, indicating that mothers bear a greater responsibility in the management of their children’s health. Among the parents interviewed, most were aged under 40 (65.29%), followed by over 40 (34.71%). Regarding the anxiety level, 64.46% of parents had no anxiety symptoms, with a median anxiety score of 4 and an average score of 8.22 ± 11.34, indicating that the vast majority were in a state of no or low anxiety. 8.68% of parents showed severe anxiety, which may be related to the severity of their children’s myopia, the complexity of treatment, and the uncertainty of visual development. They may need further psychological counseling. Our findings reveal that approximately 18.18% of parents of myopic children experience clinically significant anxiety levels (moderate to severe). These results underscore the critical need for integrating mental health support into myopia management programs. Addressing parental anxiety is essential not only for the well-being of the parents but also for the effective management and prevention of further myopia progression in children. Healthcare providers should consider psychological counseling as a component of comprehensive myopia treatment plans to alleviate parental anxiety and promote a supportive environment for children’s vision health. These results also show that society’s awareness of the universality and controllability of myopia has increased, leading parents to respond more rationally. However, parents with a high anxiety level may be concerned about their children’s academic performance, health, and future career choices, especially in East Asia. In the future, psychological support and health education for parents should be strengthened to help them better understand and deal with their children’s myopia issues, thereby reducing their psychological burden.
Our study found that mothers, compared to fathers, primarily undertook the responsibility of childcare in the family, and were therefore more likely to experience anxiety towards their children’s myopia. In addition, parents aged under 40 had a higher anxiety level, which may be due to the heavier life pressure they have endured and the higher expectations they have had for their children. The degree of myopia of parents also affected their anxiety level. Those parents with the myopia defree between −0.25D and −6.00D were more concerned about their children’s myopia due to personal experience [13]. Anxiety towards girls may be related to cultural background and the emphasis on gender roles. When children’s myopia were in the early stage of −0.25D to −3.00D, parents’ anxiety began to increase. If not treated in time, the issue may further deteriorate. Especially for school-age children aged 7 to 10, parents were worried that myopia may affect their children’s academic performance. And this period is also a critical stage for myopia prevention and control, so more attention needs to be paid [14].
Further difference analysis revealed that the degree of children’s myopia was a significant factor affecting parental anxiety. The study pointed out that mothers were more likely to experience anxiety than fathers, possibly because they have bore more responsibilities in childcare. Although the myopia degree of parents, the gender and age of children had no significant impact on the anxiety of parents, when the myopia degree in children were higher (−3.00D to −6.00D), the parental anxiety level increased significantly (P < 0.05). This indicates that high myopia poses a greater threat to children’s health, thus requiring more support to alleviate parental anxiety and optimize children’s vision management. In addition, the earlier children develop myopia, the more parents tend to feel anxious. Although the statistical data did not show significant differences, the trend was still very clear.
Our study found that mothers, compared to fathers, were affected by their anxiety about their children’s myopia more significantly. Although the majority of parents had no significant anxiety, 8.68% of parents felt severe anxiety due to their children’s myopia. In fact, the severity of children’s myopia is the only significant factor affecting the anxiety of parents. In contrast, the positive correlation (r = 0.186) between the degree of children’s myopia and parental anxiety levels suggests a small to moderate association, other factors such as parental age, gender, and parental myopia status did not show significant associations with anxiety levels. These non-significant results suggest that, within our sample, these factors may not independently influence parental anxiety, or that the study may have been underpowered to detect such associations.
In addition, there are some limitations in this study, such as the limited number of samples, and some parents participated in the survey after their children had been myopic for some time, which may lead to a relatively lower anxiety level, thus affecting the accuracy of anxiety scores. The BAI scores exhibited a right-skewed distribution with substantial variability, which may have compromised the assumptions of the t-tests and chi-square tests used in our analysis. Although we applied a natural log transformation and collapsed anxiety categories to address these issues, the adjusted analyses did not yield significant results, potentially due to the limited sample size and high variability. Future research should consider larger and more homogeneous samples, as well as employing non-parametric statistical methods, to more accurately detect associations between parent and child factors and parental anxiety levels.
In summary, the impact of children’s myopia on parents’ emotions cannot be ignored. It is recommended to provide appropriate psychological support to help parents manage their emotions more effectively, thereby helping to control the further development of children’s myopia.
Hui-Hui Chu: Scale design and thesis writing; Data collection via scales and statistical analysis. Ru Zhang: Data collection via scales and statistical analysis. Ling-Ling Han: Data collection via scales and statistical analysis. Ji-Feng Yu: Overall planning and design, comprehensive analysis, and paper review.
The article was supported by Capital’s Funds for Health Improvement and Research (No. 2022-1G-4083).
No datasets were generated or analysed during the current study.
All parents of the affected children agreed to participate in this survey and signed the informed consent form.
The authors declare no competing interests.
No datasets were generated or analysed during the current study.