Risk of benign paroxysmal positional vertigo in patients with depressive disorders: a nationwide population-based cohort study

Chiao-Lin Hsu; Shih-Jen Tsai; Cheng-Che Shen; Ti Lu; Yao-Min Hung; Li-Yu Hu

doi:10.1136/bmjopen-2018-026936

Risk of benign paroxysmal positional vertigo in patients with depressive disorders: a nationwide population-based cohort study

BMJ Open. 2019 Mar 30;9(3):e026936. doi: 10.1136/bmjopen-2018-026936.

Authors

Chiao-Lin Hsu^{1

2

3

4}, Shih-Jen Tsai^{5

6}, Cheng-Che Shen^{6

7}, Ti Lu⁸, Yao-Min Hung^{9

10}, Li-Yu Hu^{4

5

6

11}

Affiliations

¹ Department of Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² Department of Nursing, Meiho University, Pingtung, Taiwan.
³ Department of Medical Education and Research and Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁴ Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁵ Top Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Department of Psychiatry, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan.
⁸ Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁹ Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹⁰ School of Medicine, National Yang-Ming University, Taipei, Taiwan.
¹¹ Department of Social Work, Soochow University, Taipei, Taiwan.

Abstract

Objective: The association between depression and benign paroxysmal positional vertigo (BPPV) remains debated. This study aimed to investigate the risk of BPPV in patients with depressive disorders.

Design: Longitudinal nationwide cohort study.

Setting: National health insurance research database in Taiwan.

Participants: We enrolled 10 297 patients diagnosed with depressive disorders between 2000 and 2009 and compared them to 41 188 selected control patients who had never been diagnosed with depressive disorders (at a 1:4 ratio matched by age, sex and index date) in relation to the risk of developing BPPV.

Methods: The follow-up period was defined as the time from the initial diagnosis of depressive disorders to the date of BPPV, censoring or 31 December 2009. Cox proportional hazard regression analysis was used to investigate the risk of BPPV by sex, age and comorbidities, with HRs and 95% CIs.

Results: During the 9-year follow-up period, 44 (0.59 per 1000 person-years) patients with depressive disorders and 99 (0.33 per 1000 person-years) control patients were diagnosed with BPPV. The incidence rate ratio of BPPV among both cohorts calculating from events of BPPV per 1000 person-years of observation time was 1.79 (95% CI 1.23 to 2.58, p=0.002). Following adjustments for age, sex and comorbidities, patients with depressive disorders were 1.55 times more likely to develop BPPV (95% CI 1.08 to 2.23, p=0.019) as compared with control patients. In addition, hyperthyroidism (HR=3.75, 95% CI 1.67-8.42, p=0.001) and systemic lupus erythematosus (SLE) (HR=3.47, 95% CI 1.07 to 11.22, p=0.038) were potential risk factors for developing BPPV in patients with depressive disorders.

Conclusions: Patients with depressive disorders may have an increased risk of developing BPPV, especially those who have hyperthyroidism and SLE.

Keywords: benign paroxysmal positional vertigo; cohort study; depressive disorders; hyperthyroidism; risk factor; systemic lupus erythematosus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Benign Paroxysmal Positional Vertigo / epidemiology*
Case-Control Studies
Comorbidity
Depressive Disorder / complications*
Female
Humans
Incidence
Male
Middle Aged
Regression Analysis
Risk Factors
Taiwan / epidemiology