13 September 2024

Chronic runny nose increased the risk of developing depression and anxiety

A cohort study by US scientists has shown a bidirectional association of chronic rhinosinusitis with depression and anxiety. As reported in JAMA Otolaryngology-Head & Neck Surgery, patients with chronic rhinosinusitis had a nearly 4.5-fold increased risk of developing anxiety, and patients with anxiety had a nearly 2.5-fold increased risk of developing chronic rhinosinusitis.

Chronic rhinosinusitis is characterized by inflammation of the nasal mucosa and sinuses, which significantly reduces the quality of life. Such a diagnosis is made in the presence of at least two of the following symptoms, present for at least 12 weeks: swelling of the nasal mucosa, pain in the projection of the sinuses, nasal congestion and decreased sense of smell. The main method of treatment of chronic rhinosinusitis remains drug therapy, surgical intervention is used only when the disease is resistant to treatment.

Although patients with chronic rhinosinusitis may show objective improvement on endoscopy and imaging, they continue to report decreased quality of life. This would explain the lack of correlation between diagnostic findings and subjective assessment of symptoms, up to and including the development of anxiety and depressive symptoms. Furthermore, it can be hypothesized how the significant financial burden faced by patients with chronic rhinosinusitis along with anxiety may synergistically affect patients' quality of life.

A research team led by Omar Ahmed of Houston Methodist Hospital conducted a population-based cohort study to assess the association between chronic rhinosinusitis and the development of anxiety and depression. This utilized the U.S. National Institutes of Health database for an 11-year follow-up period.

The study sample included 278637 patients, including 250527 patients without chronic rhinosinusitis and 5622 with chronic rhinosinusitis (prevalence of 2.2 percent). The control group included 28110 healthy individuals. Patients with chronic rhinosinusitis were more likely to have tobacco dependence, allergic rhinitis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, sleep disorders, hypertension, obstructive sleep apnea, and obesity.

The results of multivariate logistic regression analysis showed that compared with the control group, patients with chronic rhinosinusitis were more likely to be diagnosed with anxiety (hazard ratio 4.39) and depression (hazard ratio 2.04). Women were more at risk for developing anxiety and depression, and conversely, African Americans were less likely to develop anxiety and depression.

Meanwhile, log-rank analysis showed a significant difference in the development of anxiety and depression after a diagnosis of chronic rhinosinusitis and the development of chronic rhinosinusitis after a diagnosis of anxiety and depression. Cox proportional regression analysis revealed patients with chronic rhinosinusitis had a significantly higher risk of developing anxiety (relative risk 2.79) and depression (relative risk 1.40). But compared to the control group, patients with anxiety had an increased risk of developing chronic rhinosinusitis (relative risk 2.37). Similarly, patients with depression were at an increased risk of developing chronic rhinosinusitis (relative risk 1.59).

Although scientists cannot yet fully explain the mechanism of the bidirectional relationship between chronic rhinosinusitis and psychiatric disorders, they urge clinicians to pay attention to this relationship to prevent both chronic rhinosinusitis and anxiety and depression.

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