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Increased risks of psychiatric disorders in patients with primary Sjögren’s syndrome—a secondary cohort analysis of nationwide, population-based health claim data

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Abstract

Introduction/objectives

Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease. The aim of this study was to investigate the risk of five common psychiatrist-diagnosed disorders in patients with pSS.

Method

Using Taiwan’s National Health Insurance Research Database, 688 patients with newly diagnosed pSS between 2000 and 2012 were identified. Two comparison cohorts were assembled, namely, 3440 patients without pSS and 1302 newly diagnosed patients with rheumatoid arthritis. The incidences of depressive disorder, anxiety disorder, bipolar disorder, sleep disorder, and schizophrenia between the pSS cohort and the comparison cohorts were compared using Poisson regression models.

Results

Patients with pSS exhibited a significantly higher risk of developing depressive disorder (adjusted incidence rate ratio [aIRR] = 2.11, p < 0.001), anxiety disorder (aIRR = 2.20, p < 0.001), and sleep disorder (aIRR = 1.76, p = 0.012) when compared with the non-pSS cohort. The risks of developing depressive, anxiety, and sleep disorders were also significantly increased when compared to the rheumatoid arthritis comparison cohort. When the analyses were stratified by sex, depressive disorder (aIRR = 2.10, p < 0.001), anxiety disorder (aIRR = 2.02, p = 0.001), and sleep disorder (aIRR = 1.74, p = 0.022) were found to be significantly increased in female patients with pSS. However, only anxiety disorder (aIRR = 4.88, p = 0.044) was also significantly increased in male patients with pSS. The peak age group of developing depressive disorder was 65–80 years old (aIRR = 3.46, p < 0.001).

Conclusions

In this retrospective cohort study based on population-based claim data, significantly increased incidences of depressive disorder, anxiety disorder, and sleep disorder were observed in patients with pSS.

Key Points

• Patients, particularly women, with primary Sjögren’s syndrome exhibited a significantly higher risk of developing depressive disorder, anxiety disorder, and sleep disorder.

• The peak age group of developing depressive disorder was 65–80 years old.

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Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by the National Health Research Institutes, Taiwan. The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare or the National Health Research Institutes, Taiwan.

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Authors and Affiliations

  1. Division of Obstetrics and Gynecology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

    Min-Chih Hsieh

  2. School of Medicine, Tzu Chi University, Hualien, Taiwan

    Min-Chih Hsieh & Ming-Chi Lu

  3. Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

    Chia-Wen Hsu

  4. Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan

    Ming-Chi Lu

  5. Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan

    Malcolm Koo

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Malcolm Koo

Authors
  1. Min-Chih Hsieh
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  2. Chia-Wen Hsu
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  3. Ming-Chi Lu
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  4. Malcolm Koo
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Corresponding authors

Correspondence to Ming-Chi Lu or Malcolm Koo.

Ethics declarations

The study protocol was reviewed and approved by the Institutional Review Board of the Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan (Nos. B10104020 and B10004021).

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Hsieh, MC., Hsu, CW., Lu, MC. et al. Increased risks of psychiatric disorders in patients with primary Sjögren’s syndrome—a secondary cohort analysis of nationwide, population-based health claim data. Clin Rheumatol 38, 3195–3203 (2019). https://doi.org/10.1007/s10067-019-04705-z

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  • DOI: https://doi.org/10.1007/s10067-019-04705-z

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