title: Risk of Psychiatric Disorders Following Primary Sjögren Syndrome: A Nationwide Population-based Retrospective Cohort Study.
abstract: OBJECTIVE
  Primary Sjögren syndrome (pSS) is a chronic autoimmune disease. A clear temporal causal relationship between pSS and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between pSS and the subsequent development of psychiatric disorders.
  
  
  METHODS
  We identified subjects who were newly diagnosed with pSS between January 1, 2000, and December 31, 2008, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed for patients without pSS. There were 2686 patients with pSS and 10,744 matched controls observed until diagnosed with psychiatric disorders or until death, withdrawal from the NHI system, or December 31, 2009. The Institutional Review Board of Taipei Veterans General Hospital approved this study (2012-12-013BC).
  
  
  RESULTS
  The adjusted HR of depressive disorder, anxiety disorder, and sleep disorder in subjects with pSS were significantly higher at 1.829, 1.856, and 1.967 than those of the controls during the followup. We found that pSS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder that may impair life quality.
  
  
  CONCLUSIONS
  Our findings highlight the need for psychiatric evaluation and intervention for patients with pSS.
authors.affiliation: From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University.
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Shen
authors.affiliation: From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yang
authors.affiliation: From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University.
authors.forename: Benjamin Ing-Tiau
authors.initials: BI
authors.lastname: Kuo
authors.affiliation: From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University. tsai610913@gmail.com.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D016208:Databases, Factual; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012859:Sjogren's Syndrome / Q000150:complications* / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology; D013624:Taiwan
keywords: ANXIETY DISORDER; DEPRESSIVE DISORDER; PRIMARY SJÖGREN SYNDROME; SLEEP DISORDER