Elsevier

Journal of Psychiatric Research

Volume 49, February 2014, Pages 25-30
Journal of Psychiatric Research

Higher risk of developing major depression and bipolar disorder in later life among adolescents with asthma: A nationwide prospective study

https://doi.org/10.1016/j.jpsychires.2013.10.015Get rights and content

Abstract

Objective

Previous studies have suggested an immunological dysfunction in mood disorders, but rarely have investigated the temporal association between allergic diseases and mood disorders. Using the Taiwan National Health Insurance Research Database, we attempted to investigate the association between asthma in early adolescence and the risk of unipolar depression and bipolar disorder in later life.

Methods

In all, 1453 adolescents with asthma aged between 10 and 15 years and 5812 age-/gender-matched controls were selected in 1998–2000. Subjects with unipolar depression and bipolar disorder that occurred up to the end of follow-up (December 31 2010) were identified.

Results

Adolescents with asthma had a higher incidence of major depression (2.8% vs. 1.1%, p < 0.001), any depressive disorder (6.1% vs. 2.6%, p < 0.001), and bipolar disorder (1.0% vs. 0.3%, p < 0.001) than the control group. Cox regression analysis showed that asthma in early adolescence was associated with an increased risk of developing major depression (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.14–2.89), any depressive disorder (HR: 1.74, 95% CI: 1.27–2.37), and bipolar disorder (HR: 2.27, 95% CI: 1.01–5.07), after adjusting for demographic data and comorbid allergic diseases.

Discussion

Adolescents with asthma had an elevated risk of developing mood disorders in later life. Further studies would be required to investigate the underlying mechanisms for this comorbid association and elucidate whether prompt intervention for asthma would decrease the risk of developing mood disorders.

Section snippets

Data source

The National Health Insurance (NHI) program was implemented in 1995, and covers up to 99% of all 23,000,000 residents of Taiwan (http://www.nhi.gov.tw/). The NHIRD was audited and released by the National Health Research Institute. Comprehensive information on insured subjects is included in the database, including demographic data, dates of clinical visits, and disease diagnoses. The diagnostic codes used were based on the International Classification of Diseases, 9th Revision, Clinical

Results

In our study, 1453 subjects with a mean age of 11.65 ± 1.62 years and male predominance (58.2%) were identified as having the diagnosis of asthma. Among them, 591 (40.7%) adolescents with asthma had ever used the inhaled corticosteroids during the follow-up period. Subjects with asthma exhibited a higher incidence of mood disorders and comorbid allergic diseases, including major depression (2.8% vs. 1.1%, p < 0.001), any depressive disorder (6.1% vs. 2.6%, p < 0.001), bipolar disorder (1.0% vs.

Discussion

Our results supported the study hypothesis that adolescents with asthma exhibited a higher risk of developing unipolar depressive disorder and bipolar disorder than the control group after adjusting for demographic data and comorbid allergic diseases. The use of inhaled corticosteroids was not related to the risk of developing mood disorders among those adolescents with asthma.

Many previous studies have proposed the existence of a comorbid relationship between asthma and mood disorders (Goodwin

Contribution

Dr MHC, Dr TPS, and Dr YMB designed the study and wrote the protocol and manuscripts; Dr YMB, Dr TPS, Dr YSC, Dr JWH, and Dr KLH assisted with the preparation and proof-reading of the manuscript; Dr YMB, Dr TJC, and Ms WHC provided the advices on statistical analysis.

Conflict of interest

We declared that there is no conflict of interest.

Role of funding source

The study was supported by grant from Taipei Veterans General Hospital (V102D-001-2). There is no further role in any step of the present study.

Acknowledgment

We thank Mr I-Fan Hu's friendship and support.

We thank Dr MHC, Dr TPS, and Dr YMB, who designed the study, wrote the protocol and manuscripts, Dr YMB, Dr TPS, Dr YSC, Dr JWH, and Dr KLH, who assisted with the preparation and proof-reading of the manuscript, and Dr YMB, Dr TJC, and Ms WHC, who provided the advices on statistical analysis.

References (58)

  • C.L. Raison et al.

    Cytokines sing the blues: inflammation and the pathogenesis of depression

    Trends Immunol

    (2006)
  • O.J. Schiepers et al.

    Cytokines and major depression

    Prog Neuropsychopharmacol Biol Psychiatry

    (2005)
  • M.J. Slattery et al.

    Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents

    J Psychiatr Res

    (2011)
  • M. Timonen et al.

    Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth cohort study

    Biol Psychiatry

    (2002)
  • S.Y. Tsai et al.

    Activation of indices of cell-mediated immunity in bipolar mania

    Biol Psychiatry

    (1999)
  • D.C. Yan et al.

    Prevalence and severity of symptoms of asthma, rhinitis, and eczema in 13- to 14-year-old children in Taipei, Taiwan

    Ann Allergy Asthma Immunol

    (2005)
  • Y.M. Bai et al.

    Risk of developing diabetes mellitus and hyperlipidemia among patients with bipolar disorder, major depressive disorder, and schizophrenia: a 10-year nationwide population-based prospective cohort study

    J Affect Disord

    (2013)
  • P. Bedouch et al.

    Trends in asthma-related direct medical costs from 2002 to 2007 in British Columbia, Canada: a population based-cohort study

    PLoS One

    (2012)
  • J. Beyer et al.

    Medical comorbidity in a bipolar outpatient clinical population

    Neuropsychopharmacology

    (2005)
  • E.S. Brown et al.

    Mood changes during prednisone bursts in outpatients with asthma

    J Clin Psychopharmacol

    (2002)
  • M.H. Chen et al.

    Attention deficit hyperactivity disorder, tic disorder, and allergy: is there a link? A nationwide population-based study

    J Child Psychol Psychiatry

    (2012)
  • M.H. Chen et al.

    Symptomatic menopausal transition increases the risk of new-onset depressive disorder in later life: a nationwide prospective cohort study in Taiwan

    PLoS One

    (2013)
  • H.J. Cho et al.

    Population-based and family-based studies on the serotonin transporter gene polymorphisms and bipolar disorder: a systematic review and meta-analysis

    Mol Psychiatry

    (2005)
  • C.G. Davey et al.

    Regionally specific alterations in functional connectivity of the anterior cingulate cortex in major depressive disorder

    Psychol Med

    (2012)
  • W. Eder et al.

    The asthma epidemic

    N Engl J Med

    (2006)
  • E.P. Espejo et al.

    Elevated appraisals of the negative impact of naturally occurring life events: a risk factor for depressive and anxiety disorders

    J Abnorm Child Psychol

    (2012)
  • S.J. Galli et al.

    The development of allergic inflammation

    Nature

    (2008)
  • R.D. Goodwin et al.

    Childhood respiratory disease and the risk of anxiety disorder and major depression in adulthood

    Arch Pediatr Adolesc Med

    (2008)
  • R.D. Goodwin et al.

    Asthma and depressive and anxiety disorders among young persons in the community

    Psychol Med

    (2004)
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