Summary: Researchers report that people with asthma or hay fever face a higher risk of developing psychiatric disorders. Over a 15-year follow-up, 10.8% of individuals with allergic conditions developed psychiatric disorders compared with 6.7% of those without allergies.
Source: Frontiers.
New research published in the open-access journal Frontiers in Psychiatry shows that common allergic diseases—such as asthma and hay fever—are associated with an increased overall risk of developing psychiatric disorders. In a nationwide, population-based study spanning 15 years, the authors found that nearly 11% of people with allergic conditions went on to develop a psychiatric disorder, compared with 6.7% of people without allergies. That translates to a 1.66-fold increase in risk. These findings highlight the importance of awareness and mental health monitoring for patients who suffer from allergic diseases.
Allergic conditions like bronchial asthma, allergic rhinitis (commonly called hay fever) and atopic dermatitis (eczema) rank among the most prevalent immune-related diseases and are sometimes referred to collectively as the three “A”s. Dr. Nian-Sheng Tzeng, lead author and clinician at Tri-Service General Hospital in Taiwan, observed a pattern in his clinical practice that motivated this large-scale investigation.
“As a clinician, I observed that some patients with the three ‘A’s appeared to struggle emotionally,” says Tzeng. “I wanted to clarify whether these allergic diseases are linked to psychiatric disorders.”
Previous research had suggested connections between certain allergic conditions and specific mental health problems, such as higher rates of emotional or behavioral issues in children with allergies. Other studies produced mixed results, with some reporting no association or even lower rates of particular psychiatric conditions among people with certain allergies. Given these inconsistencies, Tzeng and colleagues sought to examine the relationship between the three major allergic diseases taken together and the overall risk of developing psychiatric disorders in a large, representative population.
To achieve this, the researchers analyzed Taiwan’s National Health Insurance database, using a long-term dataset that covered 15 years of medical records. From this database they identified 46,647 people diagnosed with allergic diseases and 139,941 age- and sex-matched controls without allergic diagnoses. Unlike some earlier studies, this analysis included patients of all ages and used a competing-risk statistical model to assess the chance of developing psychiatric disorders over time.
Across the 15-year follow-up period, 10.8% of people with allergic diseases developed a psychiatric disorder, compared to 6.7% of those without allergic conditions. After adjusting for potential confounders, the researchers calculated an adjusted hazard ratio of about 1.66, indicating a 66% higher risk of psychiatric disorders among people with allergic disease.
Not all allergic conditions showed the same pattern. The analysis found that atopic dermatitis alone and the combination of allergic rhinitis with atopic dermatitis were associated with a lower risk of psychiatric disorders, while bronchial asthma, allergic rhinitis alone, and several combinations that included asthma were associated with an elevated risk. The study also observed that the use of certain asthma medications correlated with a reduced risk of psychiatric disorders among asthma patients, an intriguing finding that the authors note requires further investigation.
Why might allergic disease increase the risk of psychiatric disorders? One leading hypothesis involves inflammation. Allergic conditions are characterized by immune activation and inflammatory processes, and an expanding body of research links systemic inflammation to mood disorders, anxiety and other psychiatric conditions. Persistent physical symptoms, disrupted sleep, social limitations and the emotional burden of chronic illness may also contribute to psychological distress, which in turn can worsen physical symptoms—a bidirectional relationship that complicates both diagnosis and treatment.
The study did not establish a direct cause-and-effect mechanism; it demonstrates an association that warrants further biological and clinical research. Understanding the pathways that connect allergic inflammation and mental health could influence both preventive care and therapeutic strategies for patients with allergies.
“We want clinicians who treat patients with allergic diseases to be aware that their patients may face an elevated risk for psychiatric conditions,” says Tzeng. “Routine assessment of emotional well-being and ongoing mental health monitoring could help identify problems earlier and reduce the chance of more serious psychiatric outcomes later.”
Source: Frontiers
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Original Research: Abstract for “Increased Risk of Psychiatric Disorders in Allergic Diseases: A Nationwide, Population-Based, Cohort Study” by Nian-Sheng Tzeng et al., published in Frontiers in Psychiatry, April 2018.
doi: 10.3389/fpsyt.2018.00133
Suggested citation formats: MLA, APA, Chicago style references to the original Frontiers/NeuroscienceNews summary published April 23, 2018.
Abstract
Increased Risk of Psychiatric Disorders in Allergic Diseases: A Nationwide, Population-Based, Cohort Study
Background and objective:
Allergic diseases such as bronchial asthma, allergic rhinitis and atopic dermatitis, and psychiatric disorders are major public health concerns. Prior studies suggested associations between some allergic diseases and specific psychiatric conditions like depression and anxiety. This study examined whether common allergic diseases increase the overall risk of developing psychiatric disorders in a Taiwanese population.
Methods:
This cohort study used Taiwan’s National Health Insurance database. A total of 186,588 patients were included: 46,647 with allergic diseases and 139,941 age- and sex-matched controls without allergic diagnoses, drawn from the longitudinal dataset covering 2000–2015. The researchers applied Fine & Gray’s competing-risk model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between allergic diseases and subsequent psychiatric disorders during the 15-year follow-up.
Results:
Among the subjects, 5,038 (10.8%) in the allergic-disease group developed psychiatric disorders compared with 9,376 (6.7%) in the control group, a statistically significant difference. The adjusted hazard ratio was 1.659 (95% CI = 1.602–1.717), indicating an elevated risk. Specific subgroup analyses showed that atopic dermatitis alone and the combination of allergic rhinitis plus atopic dermatitis were linked to a lower risk, while bronchial asthma alone, allergic rhinitis alone, and various combinations that included asthma were associated with higher risk.
Conclusions:
In this Taiwanese population, allergic diseases were associated with a 1.66-fold increased hazard of developing psychiatric disorders over 15 years, highlighting the need for integrated physical and mental health care for patients with allergic conditions.