title: Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study.
abstract: BACKGROUND
  Non-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash appearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive stress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major depression after a first-attack and non-infection caused urticaria.
  
  
  METHODS
  This study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized for a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with 17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or depression prior to the evaluation period were excluded. Each patient was followed for one year to identify the occurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression, adjusting for the subjects' sociodemographic characteristics. Depression-free survival curves were also analyzed.
  
  
  RESULTS
  Thirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects suffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis showed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI, 1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI 2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78).
  
  
  CONCLUSIONS
  Individuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing major depression.
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Kuo
authors.forename: Chi-Yen
authors.initials: CY
authors.lastname: Chen
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Huang
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Chen
authors.forename: Hua-Chin
authors.initials: HC
authors.lastname: Lee
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Chu-Chung
authors.initials: CC
authors.lastname: Chou
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan. syho@mail.nctu.edu.tw.
authors.forename: Shinn-Ying
authors.initials: SY
authors.lastname: Ho
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
authors.forename: Yan-Ren
authors.initials: YR
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D014581:Urticaria / Q000523:psychology*