In a national analysis, patients with chronic rhinosinusitis were at a higher risk of developing depression and anxiety than individuals without chronic rhinosinusitis, according to a study published in JAMA Otorhinolaryngology – Head and Neck Surgery.
The researchers of this retrospective study sought to examine the association between chronic rhinosinusitis and the risk of developing depression and anxiety in a national cohort. Furthermore, the associated risk of mental health problems was assessed based on the phenotype: chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps.
The study cohort included 48,672 participants from the national health insurance dataset covering the entire South Korean population from 2002 to 2013. The cohort included 16,224 patients with chronic rhinosinusitis (10,763 without nasal polyps and 5461 with nasal polyps ) to which socio-demographic factors and the year of enrollment were associated with 32,448 participants without chronic rhinosinusitis. The primary results measured were the incidence of depression, anxiety and mortality from all causes; investigators compared the risk of depression and anxiety between the chronic rhinosinusitis group and the control group based on person-years at risk. By adapting the outcome variables, Cox proportional risk regression models were used to identify whether chronic rhinosinusitis was associated with an increased risk of developing depression and anxiety.
During the 11-year follow-up period, the overall incidence of depression was significantly higher in the chronic rhinosinusitis group (24.2 per 1000 person-years) than in the control group (16.0 per 1000 people -year) with an adjusted risk ratio (HR) of 1.54 (95% confidence interval [CI], 1.48-1.61). Similarly, the overall incidence of anxiety was significantly higher in the chronic rhinosinusitis group (42.2 per 1000 person-years) than in the control group (27.8 per 1000 person-years) with an adjusted HR of 1.57 (95% CI 1.52-1.62).
Analyzing the phenotype, patients with chronic rhinosinusitis without nasal polyps had a significantly higher incidence of depression and anxiety (respectively 25.2 and 43.7 per 1000 person-years) compared to patients with chronic rhinosinusitis with nasal polyps (22 , 1 and 39.2 per 1000 person-years, respectively). The corrected HR for depression for patients with chronic rhinosinusitis without nasal polyps vs patients with nasal polyps were 1.61 (95% CI, 1.54-1.69) vs 1.41 (95% CI, 1.32- 1.50). For anxiety, the HR was 1.63 (95% CI, 1.57-1.69) vs 1.45 (95% CI, 1.38-1.52). This indicates that patients with chronic rhinosinusitis without nasal polyps were at greater risk of developing depression and anxiety.
The limitations to the study included the inability to deduce causality; lack of data on health behaviors, which could confuse the results; and the use of KCD diagnostic codes, which may be less accurate than diagnoses based on medical history and examination. Furthermore, the lack of data regarding the severity of the disease and the use of simplistic terms that define depression and anxiety may have limited the results of the study.
Investigators suggest that chronic rhinosinusitis regardless of phenotype is associated with an increase in the incidence of depression and anxiety. However, patients with chronic phenotype rhinosinusitis without nasal polyps were considered at greater risk of developing depression and anxiety than those with chronic rhinosinusitis with nasal polyps.
This study was sponsored by the Korea Health Technology research and development project and the National Research Foundation's Bio & Medical technology development program.
Kim JY, Ko I, Kim MS, Yu MS, Cho BJ, Kim DK. Association of chronic rhinosinusitis with increased risk of depression and anxiety in a nationwide insurance population [published online February 7, 2019]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001 / jamaoto.2018.4103