title: Increased depression risk among patients with chronic osteomyelitis.
abstract: OBJECTIVE
  Inflammatory processes, which provoke alternations of neurotransmitter metabolism, neuroendocrine function, and neuroplasticity in the brain, might promote depression. In depression patients who do not exhibit risk factors, including hypertension, diabetes, coronary heart disease, stroke, Parkinson's disease and dementia, particularly in young people, inflammation is a likely risk factor for depression. We explored whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases depression risk.
  
  
  METHODS
  A Taiwanese national insurance claims data set of more than 22 million enrollees was used to select 15,529 COM patients without depression history and 62,116 randomly selected age- and gender-matched controls without depression and COM history to trace depression development for an 12-year follow-up period from January 1, 1999 to December 31, 2010. The depression risk was analyzed using the Cox proportional hazards regression model.
  
  
  RESULTS
  The above-mentioned risk factors for depression were more frequent in the COM cohort, who exhibited significantly higher depression risk than the control group did. Comparing only those without comorbidities, the COM group exhibited higher depression risk than the control group did (hazard ratio [HR]=3.04, 95% confidence interval [CI]: 2.55-3.62). The younger population carried even greater risk (age<45: HR=6.08, 95% CI: 1.71-7.85; age>65: HR=1.75, 95% CI: 1.39-2.19).
  
  
  CONCLUSIONS
  This is the first study connecting COM to increased risk of developing depression. The outcomes suggest that COM is a substantial depression predictor and call for a closer focus on these patients for more rigorous depression prevention, particularly in young people.
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Wei-Shih
authors.initials: WS
authors.lastname: Huang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Yen-Jung
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007249:Inflammation / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000523:psychology*; D010300:Parkinson Disease / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
keywords: Chronic osteomyelitis; Depression; Inflammation