Increased Risk of Depression in Patients with Cholesteatoma: A Nationwide Study

Abstract

Learning Objectives: Cholesteatoma is a locally invasive condition; however, a comorbidity of depressive disorder could be a risk factor of systemic morbidity and mortality. A relationship between cholesteatoma and depressive disorder has been observed in clinical practice; however this link has not been firmly established in the literature. To the best of our knowledge, this is the first study to demonstrate a prospective link between cholesteatoma and subsequent depressive disorder within a three-year followup. Clinicians should keep this critical but neglected issue in mind and carefully investigate the possibility of subsequent psychological problems among cholesteatoma patients. Objective(s): Cholesteatoma is a locally invasive condition; however, a comorbidity of depression could be a risk factor of systemic morbidity and mortality. A relationship between cholesteatoma and depression has been observed in clinical practice; however this link has not been firmly established in the literature. This study sought to estimate the risk of developing depressive disorder (DD) following diagnosis with cholesteatoma. Method(s): In the study, we analyzed data from the Longitudinal Health Insurance Database of Taiwan. A total of 599 patients newly diagnosed with cholesteatoma between 1997 and 2007 were included with a comparison cohort of 2,995 matched non-cholesteatoma enrollees. Each patient was followed for 3 years to identify the subsequent development of DD. Cox proportional hazard regression analysis was performed to compute adjusted 3-year hazard ratios. Result(s): Of the 3,594 patients in the sample, 20 individuals (3.3%) from the cholesteatoma cohort, and 52 (1.7%) from the comparison cohort were subsequently diagnosed with DD during the 3-year follow-up. The incidence of DD per thousand person-years was approximately twice as high among patients with cholesteatoma (11.32) as among those without cholesteatoma (5.85). After adjusting for potential confounders, patients with cholesteatoma were 1.99 times (95% CI = 1.18-3.34, P = 0.010) more likely to suffer from DD within 3 years compared to those without cholesteatoma. Conclusion(s): This is the first study to demonstrate a link between cholesteatoma and subsequent DD within a threeyear followup. We suggest that clinicians keep this critical but neglected issue in mind and carefully investigate the possibility of subsequent psychological problems among cholesteatoma patients.