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Association of mental disorders and strabismus among South Korean children and adolescents: a nationwide population-based study



The aim of this study is to determine the association between mental disorders and strabismus in South Korean children and adolescents.


Using data from the Korean National Health Claims Database from 2011 to 2017, the prevalence rates of mental illnesses and odds ratio were calculated. Children and adolescents (1–19 years) with strabismus and their randomly selected nonstrabismic age- and sex-matched controls (1:1) were enrolled. The odds ratios were adjusted for preterm birth, cerebral palsy, and mental retardation. Subgroup analysis was performed according to sex and the type of strabismus.


A total of 327,076 subjects (male, 158,597; female, 168,479) identified as strabismus patients were enrolled. After adjusting for preterm birth, cerebral palsy, and mental retardation, the corrected odds ratio of overall mental illness was 1.10 (95% CI, 1.08–1.12) for the strabismus group compared to the controls: 1.7 (95% CI, 1.62–1.78) for developmental disorder, 1.36 (95% CI, 1.27–1.45) for pervasive developmental disorder (autism), 1.14 (95% CI, 1.10–1.17) for attention-deficit hyperactivity disorder (ADHD), 1.15 (95% CI, 1.05–1.27) for obsessive–compulsive disorder (OCD), 1.08 (95% CI, 1.05–1.11) for pediatric behavioral and emotional disorders, 0.93 (95% CI, 0.88–0.99) for post-traumatic stress disorder (PTSD), and 0.85 (95% CI, 0.82–0.89) for tic disorder.


South Korean children and adolescents with strabismus had a higher relative risk for various types of mental disorders such as a developmental disorder, autism, ADHD, and OCD than the controls, whereas they had a relatively lower risk of tic disorder.

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This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology(2018R1D1A1B07043958) to SYO.

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Corresponding author

Correspondence to Sei Yeul Oh.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Samsung Medical Center Institutional Review Board and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The requirement for informed consent from the individual patients was waived because the data used were public and anonymized under confidentiality guidelines.

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The authors declare no competing interests.


The funders had no role in study design, data collection, and analysis, decision to publish or preparation of the manuscript.

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Choi, D.D., Park, KA., Yang, M. et al. Association of mental disorders and strabismus among South Korean children and adolescents: a nationwide population-based study. Graefes Arch Clin Exp Ophthalmol (2021).

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  • Strabismus
  • Mental illness
  • Autism; ADHD
  • Developmental disorder
  • Obsessive compulsive disorder