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Original Investigation
February 7, 2019

Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
  • 2Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
  • 3Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Republic of Korea
  • 4Department of Otorhinolaryngology–Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  • 5Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
  • 6Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
  • 7Department of Otorhinolaryngology–Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
JAMA Otolaryngol Head Neck Surg. 2019;145(4):313-319. doi:10.1001/jamaoto.2018.4103
Key Points

Question  Is chronic rhinosinusitis associated with the risk of depression and anxiety?

Findings  In this cohort study of 48 672 participants in a nationwide insurance data set, the overall incidence of depression and anxiety during the 11-year follow-up was higher in the group with chronic rhinosinusitis than in the comparison group. The adjusted hazard ratio for development of depression and anxiety was higher in the chronic rhinosinusitis group without nasal polyps vs those with nasal polyps.

Meaning  An increased incidence of depression and anxiety appears to be associated with chronic rhinosinusitis, and patients without nasal polyps seem to be at a higher risk of developing depression and anxiety than those with nasal polyps.

Abstract

Importance  Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety.

Objective  To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]).

Design, Setting, and Participants  This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018.

Main Outcomes and Measures  Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group.

Results  Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP.

Conclusions and Relevance  This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

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