title: People with tuberculosis are associated with a subsequent risk of depression.
abstract: BACKGROUND
  There is some evidence that the prevalence of depression in patients with tuberculosis (TB) is higher than those in the general population. However, the incidence of depression after Mycobacterium tuberculosis infection remains unknown. Our aim was to assess the association between TB and the subsequent risk of depression.
  
  
  METHODS
  We conducted a retrospective cohort study using data from the National Health Insurance (NHI) system of Taiwan. The TB cohort included 9020 patients who were newly diagnosed and recruited between 2000 and 2010. Each patient was randomly frequency-matched for age, sex and the year of index date with four people without TB from the general population. The newly diagnosed depression was followed up until the end of 2011. The relative risks of depression were estimated using Cox proportional hazard models after adjusting for age, sex, index year and comorbidities.
  
  
  RESULTS
  The overall incidence rate of depression was 1.54-fold higher in the TB cohort as compared with the controlled cohort (8.15 vs. 5.29 per 1000 person-years, 95% confidence interval [CI]=1.45-1.64). Stratified analyses by gender, age group, monthly income and comorbidities revealed that the adjusted hazard ratio (HR) of depression was higher in males as well as individuals older than 65 years with a low monthly income and comorbidities.
  
  
  CONCLUSIONS
  People who have been diagnosed with TB have a significantly higher risk of developing depression compared with those in the general population. We should pay more attention to this group of individuals and ensure that they are offered appropriate support.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou 557, Taiwan; Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung 404, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Shen
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou 557, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung 404, Taiwan.
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung 404, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan. Electronic address: chesttu@gmail.com.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
authors.affiliation: Department of Health Risk Management, College of Management, China Medical University, Taichung 404, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan. Electronic address: cjchung@mail.cmu.edu.tw.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000523:psychology*; D014507:Urbanization
keywords: Depression; Epidemiology; Mycobacterium tuberculosis; Tuberculosis (TB)