In a nationwide analysis, patients with chronic rhinosinusitis were at higher risk for developing depression and anxiety compared with individuals without chronic rhinosinusitis, according to a study published in JAMA Otolaryngology – Head & Neck Surgery.
The investigators of this retrospective study sought to examine the association between chronic rhinosinusitis and the risk for developing depression and anxiety in a nationwide cohort. Furthermore, the associated risk for mental health problems was assessed according to phenotype: chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps.
The study cohort included 48,672 participants from the national health insurance data set that covered 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) who were matched by sociodemographic factors and enrollment year to 32,448 participants without chronic rhinosinusitis. The primary outcomes measured were the incidence of depression and anxiety and all-cause mortality; the investigators compared the risk for depression and anxiety between the chronic rhinosinusitis group and control group based on person-years at risk. Adjusting for outcome variables, Cox proportional hazards regression models were used to identify whether chronic rhinosinusitis was associated with an increased risk for developing depression and anxiety.
Over 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) vs the control group (16.0 per 1000 person-years) with an adjusted hazard 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) vs the control group (27.8 per 1000 person-years) with an adjusted HR of 1.57 (95% CI, 1.52-1.62).
Analyzing for phenotype, patients with chronic rhinosinusitis without nasal polyps had a significantly higher incidence of depression and anxiety (25.2 and 43.7 per 1000 person-years, respectively) vs patients with chronic rhinosinusitis with nasal polyps (22.1 and 39.2 per 1000 person-years, respectively). Adjusted HRs 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 for developing depression and anxiety.
Limitations to the study included the inability to infer causation; lack of data regarding health behaviors, which may confound the results; and the use of KCD diagnostic codes, which may be less accurate than diagnoses based on medical history and examination. In addition, lack of data regarding disease severity along with the use of simplistic terms defining depression and anxiety may have limited the study results.
The investigators suggest that chronic rhinosinusitis regardless of phenotype is associated with an increased incidence of depression and anxiety. However, patients with phenotype chronic rhinosinusitis without nasal polyps were considered at higher risk for developing depression and anxiety than those with chronic rhinosinusitis with nasal polyps.
This study was sponsored by the Korea Health Technology R&D Project and the Bio & Medical Technology Development Program of the National Research Foundation.
Kim JY, Ko I, Kim MS, Yu MS, Cho BJ, Kim DK. Association of chronic rhinosinusitis with increased risk for depression and anxiety in a nationwide insurance population [published online February 7, 2019]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2018.4103