Supplementary Material for: Association of Ptosis with Mental Health Conditions in Adults from a Large United States Research Database

Objective: To evaluate the association between blepharoptosis (ptosis) and the prevalence of mental health disorders in adults, including anxiety, depression, bipolar disorder, schizophrenia spectrum disorders, and substance use/addictive disorders. Design: Cross-sectional study using data from the National Institutes of Health's All of Us Research Program. Subjects: The study included 4411 adults diagnosed with ptosis and 4411 propensity score–matched controls, matched by age, sex, race, education, and income. Methods: A 1:1 propensity score-matched analysis was performed, comparing adults with ptosis to matched controls. Logistic regression was used to adjust for potential confounders, including body mass index, elevated blood pressure, and blood glucose levels. Main Outcome Measures: Prevalence rates of anxiety, depression, bipolar disorder, schizophrenia spectrum disorders, and substance use/addictive disorders. The primary outcome was the association between ptosis and any mental health disorder. Results: Adults with ptosis exhibited significantly higher rates of mental health disorders compared to controls, including anxiety (46.8% vs. 28.9%), depression (44.9% vs. 27.8%), bipolar disorder (5.8% vs. 3.6%), schizophrenia spectrum disorders (1.8% vs. 1.1%), and substance use/addictive disorders (23.4% vs. 17.0%). The prevalence of any mental health disorder was significantly higher in the ptosis group (63.4% vs. 44.8%, p < 0.001). After adjustment, ptosis was associated with increased odds of any mental health disorder (aOR: 1.92, 95% CI, 1.76 - 2.10) and each specific mental health disorder. Conclusions: Ptosis is associated with a significantly higher prevalence of mental health disorders, suggesting it may be an independent risk factor. Mental health screenings and psychosocial support should be considered for patients with ptosis. Further research is needed to explore causal mechanisms and stratify risk based on ptosis etiology and severity. This study may be subject to Berkson’s bias, wherein individuals with ptosis may have more frequent healthcare encounters, increasing the likelihood of being diagnosed with psychiatric conditions.